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Rachmadi MF, Byra M, Skibbe H. A new family of instance-level loss functions for improving instance-level segmentation and detection of white matter hyperintensities in routine clinical brain MRI. Comput Biol Med 2024; 174:108414. [PMID: 38599072 DOI: 10.1016/j.compbiomed.2024.108414] [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: 10/17/2023] [Revised: 03/16/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
In this study, we introduce "instance loss functions", a new family of loss functions designed to enhance the training of neural networks in the instance-level segmentation and detection of objects in biomedical image data, particularly those of varied numbers and sizes. Intended to be utilized conjointly with traditional loss functions, these proposed functions, prioritize object instances over pixel-by-pixel comparisons. The specific functions, the instance segmentation loss (Linstance), the instance center loss (Lcenter), the false instance rate loss (Lfalse), and the instance proximity loss (Lproximity), serve distinct purposes. Specifically, Linstance improves instance-wise segmentation quality, Lcenter enhances segmentation quality of small instances, Lfalse minimizes the rate of false and missed detections across varied instance sizes, and Lproximity improves detection quality by pulling predicted instances towards the ground truth instances. Through the task of segmenting white matter hyperintensities (WMH) in brain MRI, we benchmarked our proposed instance loss functions, both individually and in combination via an ensemble inference models approach, against traditional pixel-level loss functions. Data were sourced from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and the WMH Segmentation Challenge datasets, which exhibit significant variation in WMH instance sizes. Empirical evaluations demonstrate that combining two instance-level loss functions through ensemble inference models outperforms models using other loss function on both the ADNI and WMH Segmentation Challenge datasets for the segmentation and detection of WMH instances. Further, applying these functions to the segmentation of nuclei in histopathology images demonstrated their effectiveness and generalizability beyond WMH, improving performance even in contexts with less severe instance imbalance.
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Affiliation(s)
- Muhammad Febrian Rachmadi
- Brain Image Analysis Unit, RIKEN Center for Brain Science, Wako-shi, Japan; Faculty of Computer Science, Universitas Indonesia, Depok, Indonesia.
| | - Michal Byra
- Brain Image Analysis Unit, RIKEN Center for Brain Science, Wako-shi, Japan; Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland
| | - Henrik Skibbe
- Brain Image Analysis Unit, RIKEN Center for Brain Science, Wako-shi, Japan
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2
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Ekino S, Sato K, Kurashige M, Morii E, Uozumi H, Susa M. Pathology of human organic mercury poisoning: Lessons from an autopsy case. J Neurol Sci 2023; 455:122802. [PMID: 38000298 DOI: 10.1016/j.jns.2023.122802] [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: 07/17/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
We had an opportunity to perform a general autopsy of a case with chronic organic mercury toxicosis in 2017. He had been engaged in synthesizing a variety of organic mercury compounds throughout the four years from 1966 and developed chronic organic mercury poisoning in 1969. Almost forty years on, he still remained to complain of persistent paresthesia at finger tips and tongue, and of narrowed visual field. Neurological examinations clarified a rise of two-point discrimination thresholds, a systemic increase of touch thresholds, constriction of the visual field caused by general visual depression, and sensorineural hearing loss while primary modalities of his somatic, visual, and auditory sensations were preserved. These symptoms and signs are characteristic of human organic mercury poisoning. Furthermore, he had difficulty in processing a lot of visual and auditory information at a time. His two-point discrimination thresholds and systemic elevation of touch thresholds were comparable to those of mild organic mercury poisoning cases. He had slight sensory ataxia, but not cerebellar ataxia. Brain [18F]-2-fluorodeoxyglucose positron emission tomography analysis exhibited marked hypometabolism at bilateral postcentral gyrus, striate cortex, and superior temporal gyrus, but not the cerebellum. Histopathological studies revealed considerable decrease of granular neurons and neuronal networks in bilateral primary somatosensory, visual, and auditory cortices. Those characteristic brain lesions fairly explain increase of thresholds of somatic, visual, and auditory sensations, and degradation of integrating sensory information. It is noted that damages to the peripheral nervous system and the cerebellum were not detected and that his intellectual faculties were preserved.
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Affiliation(s)
- Shigeo Ekino
- Department of Histology, Graduate School of Medical Sciences, Kumamoto University, Honjo 860-8556, Kumamoto, Japan.
| | - Kazuaki Sato
- Department of Pathology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Masako Kurashige
- Department of Pathology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Eiichi Morii
- Department of Pathology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | | | - Mari Susa
- Faculty of Law, Kumamoto University, Kurokami, 860-8555 Kumamoto, Japan.
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Soh WK, Yuen HY, Rajapakse JC. HUT: Hybrid UNet transformer for brain lesion and tumour segmentation. Heliyon 2023; 9:e22412. [PMID: 38046150 PMCID: PMC10686892 DOI: 10.1016/j.heliyon.2023.e22412] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/23/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023] Open
Abstract
A supervised deep learning network like the UNet has performed well in segmenting brain anomalies such as lesions and tumours. However, such methods were proposed to perform on single-modality or multi-modality images. We use the Hybrid UNet Transformer (HUT) to improve performance in single-modality lesion segmentation and multi-modality brain tumour segmentation. The HUT consists of two pipelines running in parallel, one of which is UNet-based and the other is Transformer-based. The Transformer-based pipeline relies on feature maps in the intermediate layers of the UNet decoder during training. The HUT network takes in the available modalities of 3D brain volumes and embeds the brain volumes into voxel patches. The transformers in the system improve global attention and long-range correlation between the voxel patches. In addition, we introduce a self-supervised training approach in the HUT framework to enhance the overall segmentation performance. We demonstrate that HUT performs better than the state-of-the-art network SPiN in the single-modality segmentation on Anatomical Tracings of Lesions After Stroke (ATLAS) dataset by 4.84% of Dice score and a significant 41% in the Hausdorff Distance score. HUT also performed well on brain scans in the Brain Tumour Segmentation (BraTS20) dataset and demonstrated an improvement over the state-of-the-art network nnUnet by 0.96% in the Dice score and 4.1% in the Hausdorff Distance score.
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Affiliation(s)
- Wei Kwek Soh
- Nanyang Technological University Biomedical Informatics Lab, Block NS4-04-33 50 Nanyang Avenue, Singapore, 639798, Singapore, Singapore
| | - Hing Yee Yuen
- Nanyang Technological University Biomedical Informatics Lab, Block NS4-04-33 50 Nanyang Avenue, Singapore, 639798, Singapore, Singapore
| | - Jagath C. Rajapakse
- Nanyang Technological University Biomedical Informatics Lab, Block NS4-04-33 50 Nanyang Avenue, Singapore, 639798, Singapore, Singapore
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4
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Acharya I, DeBoer SR, Bhansali D. Acute Presentation of Primary CNS Lymphoma Mimicking Toxoplasma in HIV Infection. J Community Hosp Intern Med Perspect 2023; 13:17-23. [PMID: 38596565 PMCID: PMC11000848 DOI: 10.55729/2000-9666.1251] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 04/11/2024] Open
Abstract
Primary CNS lymphoma (PCNSL) accounts for up to 15% of non-Hodgkin lymphomas in HIV patients and is the second most common cause of space-occupying brain lesions in HIV patients after CNS toxoplasmosis. Differentiation of PCNL and CNS toxoplasmosis is crucial as PCNL carries a poor prognosis with survival time of 2-4 months without treatment but can be improved with prompt initiation of chemotherapy. These two entities often present clinically in a similar manner, and conventional imaging can also be a diagnostic challenge due to overlapping imaging characteristics. Thus, definitive diagnosis of PCNSL relies on histopathologic confirmation. Here, we present a case of intracranial lesion that presented acutely in the context of headache and left sided body weakness and was found to have PCNSL.
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Affiliation(s)
- Indira Acharya
- Department of Internal Medicine, MedStar Union Memorial Hospital, Baltimore, MD,
USA
| | - Scott R. DeBoer
- MedStar Health, MedStar Franklin Square Medical Center, Baltimore, MD,
USA
- Georgetown University School of Medicine, Washington, DC,
USA
| | - Deepty Bhansali
- MedStar Health, MedStar Franklin Square Medical Center, Baltimore, MD,
USA
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Kamaleshwaran KK, Ramkumar E. Beware of the Coated Aorta in Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography: A Specific Clue to the Diagnosis of Erdheim-Chester Disease in a Case of Brain and Orbital Lesions with Unknown Primary. Indian J Nucl Med 2023; 38:381-383. [PMID: 38390541 PMCID: PMC10880849 DOI: 10.4103/ijnm.ijnm_63_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/09/2023] [Indexed: 02/24/2024] Open
Abstract
Erdheim-Chester disease (ECD) is a systemic histiocytosis that can involve several organs, with severity ranging from occult to life-threatening. The disease was first described by William Chester in 1930 after working with the Austrian pathologist Jakob Erdheim. Even today, a correct diagnosis of ECD often takes years, given the rarity and variable manifestations of ECD. We present a case of a 63-year-old female presenting with multiple brain lesions, sent for fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography to find primary, and it showed hypermetabolic right occipital brain lesion, right orbital lesion, and soft tissue around the arch of the aorta (coated aorta), and final histopathology of the brain lesion confirmed histiocytosis ECD.
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Affiliation(s)
| | - Elumalai Ramkumar
- Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
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Abstract
Antisocial behavior may develop in otherwise normal persons as a result of neurological diseases, including patients with focal brain lesions, frontotemporal dementia, and Parkinson Disease patients taking dopamine agonist medications. Evidence from these neurological patients demonstrates that antisocial behaviors relate to dysfunction in several different brain regions that form a specific brain network, rather than any single location alone. This network associated with acquired antisocial behavior is involved in social decision-making (measured using moral decision-making tasks) and value-based decision-making (measured using neuroeconomic and reward-based tasks). Collectively, this work supports the hypothesis that antisocial behavior across different neurological diseases results from dysfunction within a common network of brain regions associated with social valuation and decision-making, providing insight into the neural mechanisms leading to acquired antisocial behavior. These findings have important implications, but also important limitations, for understanding criminal behavior in patients with psychopathy, for rehabilitation in criminals, for ethical discussions regarding moral and legal responsibility, and for forensic neurological evaluations in persons accused of crimes.
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Affiliation(s)
- R Ryan Darby
- Department of Neurology, Division of Behavioral Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
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de Laurentis C, Bteich F, Beuriat PA, Almeida LCA, Combet S, Mottolese C, Vinchon M, Szathmari A, Di Rocco F. Sodium fluorescein in pediatric oncological neurosurgery: a pilot study on 50 children. Childs Nerv Syst 2022. [PMID: 36454309 DOI: 10.1007/s00381-022-05765-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/15/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Sodium fluorescein (SF) is currently considered a valid intraoperative adjunct in the resection of high-grade brain lesions in adults. Experiences in pediatric groups and in low-grade gliomas and other low-grade lesions are still limited in literature, and subjective evaluation of fluorescence is still a limitation. MATERIAL AND METHODS This study retrospectively reviewed all patients with brain or spine lesions operated on from September 2021 to July 2022 in the Pediatric Neurosurgery Unit of Hôpital Femme Mère Enfant, Lyon, who had received 5 mg/kg of 10%. Surgery was performed using a YELLOW560 filter at crucial times. At the end of surgery, the first operator completed a questionnaire, including his opinion on whether SF had been useful in tumor resection, recorded as a binary variable. Post hoc, surgical images were reviewed using ImageJ, an open-source Java image processing platform. In order to compare independent discrete variables, we applied the Student's t test, and we applied the Chi-square or Fisher exact test for binary variables. A threshold of p < 0.05 was set for statistical significance. RESULTS We included 50 pediatric patients (0.2-17.6 years old). Forty/50 lesions showed SF uptake (80%). The differentiation between healthy and affected tissue, thanks to SF, subjectively evaluated by the surgeon, had as objective counterpart the statistically significant higher brightness of green in lesions, registered by the software (p < 0.001). SF overall allowed a good differentiation in 33/50 lesions, and overall utility of SF has been noted in 67% of them. When specifically considering gliomas, overall utility reached 75%. CONCLUSION SF is a feasible, safe, and useful intraoperative adjunct in pediatric neurosurgery. In particular, it seems to have a promising role in some low-grade infiltrating glial tumors. The subjective evaluation of fluorescence seems to be reliable with respect to image analyses software.
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Yeager BE, Bruss J, Duffau H, Herbet G, Hwang K, Tranel D, Boes AD. Central precuneus lesions are associated with impaired executive function. Brain Struct Funct 2022; 227:3099-108. [PMID: 36087124 DOI: 10.1007/s00429-022-02556-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/17/2022] [Indexed: 12/14/2022]
Abstract
The functional roles of the precuneus are unclear. Focal precuneus lesions are rare, making it difficult to identify robust brain-behavior relationships. Distinct functional subdivisions of the precuneus have been proposed based on unique connectivity profiles. This includes an association of the anterior division with bodily awareness, the central region with complex cognition, and the posterior division with visual processing. Our goal was to test the hypothesis that the central precuneus is preferentially involved (compared to the other sectors of the precuneus) in executive function, as estimated from performance on the trail-making test (TMT). 35 patients with focal brain lesions involving the precuneus were included from the University of Iowa and Montpellier University. Multivariate lesion symptom mapping of TMT performance was performed to evaluate whether lesion location was associated with impaired task performance. Lesion symptom mapping revealed a statistically significant association of central precuneus lesions with impaired TMT performance (r = 0.43, p < 0.01). Further, a functional network derived from this precuneus region showed connectivity to other cortical areas implicated in executive function, including the dorsolateral prefrontal cortex and inferior parietal lobe. This analysis provides support for the role of the central precuneus in executive function, consistent with the unique connectivity pattern of the central precuneus with a broader network implicated in cognitive control and executive function.
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9
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Covey TJ, Golan D, Zarif M, Bumstead B, Buhse M, Kaczmarek O, Sergott R, Wilken J, Sima DM, Van Hecke W, Gudesblatt M. Individual differences in visual evoked potential latency are associated with variance in brain tissue volume in people with multiple sclerosis: An analysis of brain function-structure correlates. Mult Scler Relat Disord 2022; 68:104116. [PMID: 36041331 DOI: 10.1016/j.msard.2022.104116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/16/2022] [Accepted: 08/13/2022] [Indexed: 12/15/2022]
Abstract
Visual evoked potentials (VEP) index visual pathway functioning, and are often used for clinical assessment and as outcome measures in people with multiple sclerosis (PwMS). VEPs may also reflect broader neural disturbances that extend beyond the visual system, but this possibility requires further investigation. In the present study, we examined the hypothesis that delayed latency of the P100 component of the VEP would be associated with broader structural changes in the brain in PwMS. We obtained VEP latency for a standard pattern-reversal checkerboard stimulus paradigm, in addition to Magnetic Resonance Imaging (MRI) measures of whole brain volume (WBV), gray matter volume (GMV), white matter volume (WMV), and T2-weighted fluid attenuated inversion recovery (FLAIR) white matter lesion volume (FLV). Correlation analyses indicated that prolonged VEP latency was significantly associated with lower WBV, GMV, and WMV, and greater FLV. VEP latency remained significantly associated with WBV, GMV, and WMV even after controlling for the variance associated with inter-ocular latency, age, time between VEP and MRI assessments, and other MRI variables. VEP latency delays were most pronounced in PwMS that exhibited low volume in both white and gray matter simultaneously. Furthermore, PwMS that had delayed VEP latency based on a clinically relevant cutoff (VEP latency ≥ 113 ms) in both eyes had lower WBV, GMV, and WMV and greater FLV in comparison to PwMS that had normal VEP latency in one or both eyes. The findings suggest that PwMS that have delayed latency in both eyes may be particularly at risk for exhibiting greater brain atrophy and lesion volume. These analyses also indicate that VEP latency may index combined gray matter and white matter disturbances, and therefore broader network connectivity and efficiency. VEP latency may therefore provide a surrogate marker of broader structural disturbances in the brain in MS.
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Grande G, Vetrano DL, Kalpouzos G, Welmer AK, Laukka EJ, Marseglia A, Fratiglioni L, Rizzuto D. Brain Changes and Fast Cognitive and Motor Decline in Older Adults. J Gerontol A Biol Sci Med Sci 2022; 78:326-332. [PMID: 36037020 PMCID: PMC9951062 DOI: 10.1093/gerona/glac177] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To identify brain magnetic resonance imaging (MRI) signatures characterizing people with different patterns of decline in cognition and motor function. METHODS In the Swedish National Study on Aging and Care in Kungsholmen, Stockholm, 385 participants had available repeated brain MRI examinations, where markers of brain volumes and white matter integrity were assessed. The speed of cognitive and motor decline was estimated as the rate of a Mini-Mental State Examination and gait speed decline over 12 years (linear mixed models), and further dichotomized into the upper (25% fastest rate of decline) versus the lower quartiles. Participants were grouped in slow/no decliners (reference), isolated motor decliners, isolated cognitive decliners, and cognitive and motor decliners. We estimated the associations between changes in brain markers (linear mixed models) and baseline diffusion tensor imaging measures (linear regression model) and the 4 decline patterns. RESULTS Individuals with concurrent cognitive and motor decline (n = 51) experienced the greatest loss in the total brain (β: -12.3; 95% confidence interval [CI]: -18.2; -6.38) and hippocampal (β: -0.25; 95% CI: -0.34; -0.16) volumes, the steepest accumulation of white matter hyperintensities (β: 1.61; 95% CI: 0.54; 2.68), and the greatest ventricular enlargement (β: 2.07; 95% CI: 0.67; 3.47). Compared to the reference, those only experiencing cognitive decline presented with steeper hippocampal volume loss, whereas those exhibiting only motor decline displayed a greater white matter hyperintensities burden. Lower microstructural white matter integrity was associated with concurrent cognitive and motor decline. CONCLUSION Concurrent cognitive and motor decline is accompanied by rapidly evolving and complex brain pathology involving both gray and white matter. Isolated cognitive and motor declines seem to exhibit brain damage with different qualitative features.
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Affiliation(s)
- Giulia Grande
- Address correspondence to: Giulia Grande, MD, PhD, Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Tomtebodavägen 18A, 171 65 Solna, Stockholm, Sweden. E-mail:
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Grégoria Kalpouzos
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Anna Marseglia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden,Stockholm Gerontology Research Center, Stockholm, Sweden
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Moosa S, Craver A, Asuzu D, Eames M, Wang TR, Elias WJ. Patient-Reported Outcomes and Predictive Factors following Focused Ultrasound Thalamotomy for Essential Tremor. Stereotact Funct Neurosurg 2022; 100:291-299. [PMID: 36030772 DOI: 10.1159/000525763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/26/2021] [Accepted: 06/22/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The objectives of this study were to determine long-term patient-reported outcomes with magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for medication-refractory essential tremor (ET) and to identify risk factors for a poor clinical outcome. METHODS We administered a telephone or mail-in survey to patients who consecutively underwent unilateral MRgFUS thalamotomy for ET at our institution over an 8-year period. Patients were asked to self-report measures of hand tremor improvement, degree of overall postprocedure improvement, activities of daily life, side effects, and willingness to undergo the procedure again. Specific patient characteristics, ultrasound treatment parameters, and postoperative radiological findings from magnetic resonance imaging performed 1 day after the procedure were analyzed, and multivariable linear regression was used to determine if these factors could serve as predictors of clinical outcome. RESULTS A total of 85 patients were included in this study with a mean follow-up time of 3.0 years (range 2 months to 1 8.4 years). The mean patient-reported improvement in hand tremor at last follow-up was 66%, and 73% of patients reported meaningful change in their overall condition after the procedure. The percentages of patients reporting normal or only minimal limitations with feeding, drinking, and writing ability at last follow-up were 60%, 71%, and 48%, respectively. In the position of their former selves, 89% of patients would again choose to undergo the procedure. Larger lesions were correlated with a higher risk of adverse events. DISCUSSION/CONCLUSION While subjective hand tremor improvement declines with time, willingness to undergo the procedure again following MRgFUS thalamotomy for ET remains very high even several years after the procedure.
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Affiliation(s)
- Shayan Moosa
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Andrew Craver
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - David Asuzu
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Matthew Eames
- Focused Ultrasound Foundation, Charlottesville, Virginia, USA.,Department of Radiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Tony R Wang
- Department of Neurological Surgery, Swedish Neuroscience Institute, Seattle, Washington, USA
| | - William Jeffrey Elias
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Pyasik M, Scandola M, Moro V. Electrophysiological correlates of action monitoring in brain-damaged patients: A systematic review. Neuropsychologia 2022; 174:108333. [PMID: 35842019 DOI: 10.1016/j.neuropsychologia.2022.108333] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 03/21/2022] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 11/19/2022]
Abstract
Action monitoring is crucial to the successful execution of an action and understanding the actions of others. It is often impaired due to brain lesions, in particular after stroke. This systematic review aims to map the literature on the neurophysiological correlates of action monitoring in patients with brain lesions. Eighteen studies were identified and divided into two groups: studies on monitoring of one's own actions and studies on monitoring of the actions of others. The first group included EEG studies on monitoring of self-performed erroneous and correct actions. Impaired error detection (decreased error-related negativity) was observed in patients with lesions in the performance-monitoring network, as compared to healthy controls. Less consistent results were shown for error positivity and behavioral error monitoring performance. The second group of studies on monitoring of others' actions reported decreased mu frequency suppression, impaired readiness potential in the affected hemisphere and decreased EEG indices of error observation (observed error positivity and theta power) in stroke patients. As a whole, these results indicate distinct patterns of impaired neurophysiological activity related to monitoring one's own versus others' actions in patients with brain lesions. EEG recordings of this dissociation in the same patients might be a useful index of motor recovery, and therefore, potentially also beneficial in rehabilitation protocols.
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Affiliation(s)
- Maria Pyasik
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Verona, Italy.
| | - Michele Scandola
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Verona, Italy
| | - Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Verona, Italy
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13
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Alshammari QT, Salih M, Gameraddin M, Yousef M, Abdelmalik B, Loaz O. Accuracy of Magnetic Resonance Spectroscopy in Discrimination of Neoplastic and Non-Neoplastic Brain Lesions. Curr Med Imaging 2021; 17:904-910. [PMID: 33655843 PMCID: PMC8811616 DOI: 10.2174/1573405617666210224112808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/19/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/22/2022]
Abstract
Background Differentiation of brain lesions by conventional MRI alone is not enough. The introduction of sophisticated imaging methods, such as MR Spectroscopy (MRS), will contribute to accurate differentiation. Objective To determine the diagnostic accuracy of MRS in differentiating neoplasm and non-neoplastic brain lesion. Methodology This is a cross-sectional descriptive study conducted at Khartoum State from the period of 2015 to 2017. Thirty cases with brain lesions were included in the study investigated with MRS (Single-voxel spectroscopy) and conventional MRI. A comparison of MRS findings and histopathologic analysis was performed. The ratios of Cho/Cr and Cho/NAA were analyzed and compared between neoplastic and non-neoplastic brain masses. Data were analyzed using SPSS version 23. Results Out of the 30 patients affected with brain lesions, there were 16 females and 14 males with a mean age of 44 +- 18 years. The ratios of Cho/Cr and Cho/NAA were higher in gliomas, astrocytoma, and meningioma than non-neoplastic lesions. Kappa statistical value (K) showed a good agreement between MRS and histopathological analysis (K= 0.60). The diagnostic accuracy of MRS was 100%, with 82.60% sensitivity, 85.71% specificity, 95% PPV, and 60% NPV. Conclusion MRS has high diagnostic accuracy in differentiating neoplasm from non-neoplastic brain tumors. The elevation ratios of Choline-to- N-acetyl aspartate and choline-to- creatine can help neurosurgeons and clinicians differentiate benign from malignant masses.
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Affiliation(s)
- Qurain T Alshammari
- Diagnostic Radiology Department, College of Applied Medical Sciences, University of Hail, Hai', Saudi Arabia
| | - Mohammed Salih
- Diagnostic Radiology Department, College of Applied Medical Sciences, University of Hail, Hai', Saudi Arabia
| | - Moawia Gameraddin
- Diagnostic Radiology Department, College of Applied Medical Sciences, Taibah University, Al-Madinah, Saudi Arabia
| | - Mohamed Yousef
- Radiological Sciences Department, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Bushra Abdelmalik
- Diagnostic Radiology Department, College of Applied Medical Sciences, University of Hail, Hai', Saudi Arabia
| | - Omer Loaz
- Diagnostic Radiology Department, College of Medical Applied Sciences, King Khalid University, Abha, Saudi Arabia
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14
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Shrestha S, Munakomi S. Do Multiple Brain Lesions Always Connote Worse Outcomes? Appraisal Evidence from a Tertiary Care Center in Koshi/Purbanchal Province of Nepal. Adv Exp Med Biol 2021; 1374:91-103. [PMID: 34061333 DOI: 10.1007/5584_2021_642] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Advances in medicine comprising diverse diagnostic and management modalities call for a bundle approach to improve patient care. This study aimed to present diagnostic patterns in patients with multiple intracranial lesions together with connoted survival implications. We retrospectively reviewed medical files of 85 patients with tumor and non-tumor intracranial lesions. Metastatic brain lesions were identified in 23.5% of patients. Neurological pathogenesis underlay 29.4%, infectious 21.2%, and vascular 14.1% of lesions, with the remaining portion comprising less frequent disorders. A favorable prognosis was predicted in 52/85 (61.2%) of the study population despite a variety of pathologies, which speaks for substantial improvements in outcomes of once hardly manageable or mortal brain disorders, comprising both common and rare conditions. The improvements are to the credit of advances in medical radio-imaging enhancing the diagnostic power which enables a precise stratification of brain pathologies. We emphasize the use of an algorithmic evaluation of patients presenting with multiple brain lesions for differential diagnosis and survival prognostication. There seems to be an ongoing transition from imperfect probabilistic prediction models to precision medicine, which determines advantages in disease management and outcome.
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Affiliation(s)
- Sangam Shrestha
- Department of Psychiatry, National Academy of Medical Sciences, Bir Hospital Nursing Campus, Gaushala, Kathmandu, Nepal
| | - Sunil Munakomi
- Department of Neurosurgery, College of Medical Sciences, Bharatpur, Chitwan, Nepal.
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15
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Pehlivan KC, Khanna PC, Elster JD, Paul MR, Levy ML, Crawford JR, Gonda DD. Clinical and Neuroimaging Features of Magnetic Resonance-Guided Stereotactic Laser Ablation for Newly Diagnosed and Recurrent Pediatric Brain Tumors: A Single Institutional Series. World Neurosurg 2021; 150:e378-e387. [PMID: 33722713 DOI: 10.1016/j.wneu.2021.03.027] [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: 11/11/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We describe our single-institutional experience with magnetic resonance-guided stereotactic laser ablation (SLA) for the treatment of newly diagnosed and recurrent pediatric brain tumors. METHODS Eighteen consecutive ablation procedures were performed in 17 patients from March 2016-April 2020. Patient demographics, indications, procedures, neuroimaging features, and outcomes were reviewed retrospectively. RESULTS Seventeen patients (mean age of 11.4 years, 11 boys, 6 girls) underwent SLA with a mean follow-up of 24 months (range: 3-45 months). Tumor histologies included pilocytic astrocytoma (n = 5), ganglioglioma (n = 3), low-grade glioma not otherwise specified (n = 4), glioblastoma (n = 2), meningioma (n = 1), medulloblastoma (n = 1), and metastatic malignant peripheral nerve sheath tumor (n = 1). SLA was first-line therapy in 10 patients. Mean procedure duration including anesthesia time was 328 minutes (range: 244-529 minutes), and mean postoperative length of stay was 1.5 days (range 1-5 days). The complication rate was 29%, which included 3 patients who experienced postoperative motor changes, which resolved within several weeks of surgery, 1 patient with self-limited intraoperative bradycardia and hypotension, and 1 patient who died postoperatively due to intracranial hemorrhage from a distant lesion. Twelve of 17 patients had a neuroimaging response after SLA (4 complete responses, 8 partial responses, 1 stable disease). Percentage of tumor shrinkage from baseline ranged from 33%-100% (mean 75%). Patients with low-grade glioma exhibited the best responses to SLA (range 3%-100% decrease; mean 90%; 36% complete response rate). CONCLUSIONS SLA is a minimally invasive modality for the treatment of newly diagnosed and recurrent low-grade pediatric brain tumors. Low-grade glioma exhibited the best responses. Identification of ideal candidates for SLA, mitigation of perioperative complications, and demonstration of long-term outcomes need to be better defined in a clinical trial setting.
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Affiliation(s)
- Katherine C Pehlivan
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA; Rady Children's Hospital, San Diego, California, USA
| | - Paritosh C Khanna
- Department of Radiology, University of California San Diego, La Jolla, California, USA; Rady Children's Hospital, San Diego, California, USA
| | - Jennifer D Elster
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA; Rady Children's Hospital, San Diego, California, USA
| | - Megan Rose Paul
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA; Rady Children's Hospital, San Diego, California, USA
| | - Michael L Levy
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA; Rady Children's Hospital, San Diego, California, USA
| | - John R Crawford
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA; Department of Pediatrics, University of California San Diego, La Jolla, California, USA; Rady Children's Hospital, San Diego, California, USA.
| | - David D Gonda
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA; Rady Children's Hospital, San Diego, California, USA
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Boswinkel V, Krüse-Ruijter MF, Nijboer-Oosterveld J, Nijholt IM, Edens MA, Mulder-de Tollenaer SM, Smit-Wu MN, Boomsma MF, de Vries LS, van Wezel-Meijler G. Incidence of brain lesions in moderate-late preterm infants assessed by cranial ultrasound and MRI: The BIMP-study. Eur J Radiol 2020; 136:109500. [PMID: 33429207 DOI: 10.1016/j.ejrad.2020.109500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/29/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the incidence and characteristics of brain lesions in moderate-late preterm (MLPT) infants, born at 32-36 weeks' gestation using cranial ultrasound (cUS) and magnetic resonance imaging (MRI). METHODS Prospective cohort study carried out at Isala Women and Children's Hospital between August 2017 and November 2019. cUS was performed at postnatal day 3-4 (early-cUS), before discharge and repeated at term equivalent age (TEA) in MLPT infants born between 32+0 and 35+6 weeks' gestation. At TEA, MRI was also performed. Several brain lesions were assessed e.g. hemorrhages, white matter and deep gray matter injury. Brain maturation was visually evaluated. Lesions were classified as mild or moderate-severe. Incidences and confidence intervals were calculated. RESULTS 166 MLPT infants were included of whom 127 underwent MRI. One or more mild lesions were present in 119/166 (71.7 %) and moderate-severe lesions in 6/166 (3.6 %) infants on cUS and/or MRI. The most frequent lesions were signs suggestive of white matter injury: inhomogeneous echogenicity in 50/164 infants (30.5 %) at early-cUS, in 12/148 infants (8.1 %) at TEA-cUS and diffuse white matter signal changes (MRI) in 27/127 (23.5 %) infants. Cerebellar hemorrhage (MRI) was observed in 16/127 infants (12.6 %). Delayed maturation (MRI) was seen in 17/117 (13.4 %) infants. Small hemorrhages and punctate white matter lesions were more frequently detected on MRI than on cUS. CONCLUSIONS In MLPT infants mild brain lesions were frequently encountered, especially signs suggestive of white matter injury and small hemorrhages. Moderate-severe lesions were less frequently seen.
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Affiliation(s)
- Vivian Boswinkel
- Department of Neonatology, Isala Women and Children's Hospital, Zwolle, the Netherlands; University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | | | | | - Ingrid M Nijholt
- Department of Radiology, Isala Hospital, Zwolle, the Netherlands
| | - Mireille A Edens
- Department of Innovation and Science, Isala Hospital, Zwolle, the Netherlands
| | | | - Mei-Nga Smit-Wu
- Department of Pediatrics, Isala Women and Children's Hospital, Zwolle, the Netherlands
| | | | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands
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Bertuccio A, Elia A, Robba C, Scaglione G, Longo GP, Sgubin D, Vitali M, Barbanera A. Frameless Stereotactic Biopsy with DTI-Based Tractography Integration: How to Adjust the Trajectory-A Case Series. World Neurosurg 2020; 143:346-352. [PMID: 32791224 DOI: 10.1016/j.wneu.2020.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/05/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Frameless stereotactic biopsy represents a minimally invasive procedure used for the histopathological diagnosis of brain tumors or to safely approach deep-seated lesions near eloquent areas not amenable for classical neurosurgical procedures. Traditionally, biopsy is performed relying on anatomical landmarks, but it can lead itself to intra- and postoperative complications, such as hemorrhage and fiber disruption. Diffusion tensor imaging (DTI) tractography represents a useful tool that can analyze the individual fiber tract conformation in cases of brain tumor and consequently identify the best biopsy trajectory, preserving white matter pathways. In our study, we present a novel technique that is based on the use of preoperative DTI for biopsy. METHODS Between January 2018 and January 2020, data about patients who underwent frameless biopsy using DTI tractography were retrospectively reviewed. The inclusion criterion was adult patients eligible for elective surgery for a single or multiple deep-seated lesions with contraindications to complete surgical resection. RESULTS We included 12 patients (mean age of 67.9 [±9.6] years). A single cranial lesion was detected in 7 cases, and multiple lesions in 5 cases. The use of DTI enabled the identification of white matter pathways in all cases and adjustment of the biopsy trajectory based on anatomical landmarks in 7 cases. Postoperative hematoma was reported in 1 case, and histological diagnosis was obtained in 11 cases. CONCLUSION According to our results, tractography is a useful tool that can enhance the safety of cerebral lesions biopsy sparing any fiber tract damages.
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Affiliation(s)
- Alessandro Bertuccio
- Department of Neurosurgery, SS Antonio e Biagio e Cesare Arrigo Alessandria Hospital, Alessandria, Italy.
| | - Angela Elia
- Department of Neurosurgery, SS Antonio e Biagio e Cesare Arrigo Alessandria Hospital, Alessandria, Italy; Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia
| | - Chiara Robba
- Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Giorgio Scaglione
- Department of Neurosurgery, SS Antonio e Biagio e Cesare Arrigo Alessandria Hospital, Alessandria, Italy; Department of Neurosurgery, Azienda Ospedaliera Univeristaria Pisana, Pisa, Italy
| | - Gian Paolo Longo
- Department of Neurosurgery, SS Antonio e Biagio e Cesare Arrigo Alessandria Hospital, Alessandria, Italy
| | - Donatella Sgubin
- Department of Neurosurgery, SS Antonio e Biagio e Cesare Arrigo Alessandria Hospital, Alessandria, Italy
| | - Matteo Vitali
- Department of Neurosurgery, SS Antonio e Biagio e Cesare Arrigo Alessandria Hospital, Alessandria, Italy
| | - Andrea Barbanera
- Department of Neurosurgery, SS Antonio e Biagio e Cesare Arrigo Alessandria Hospital, Alessandria, Italy
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Markousis-Mavrogenis G, Koutsogeorgopoulou L, Dimitroulas T, Katsifis G, Vartela V, Mitsikostas D, Kolovou G, Voulgari P, Sfikakis PP, Kitas GD, Mavrogeni SI. Is There a Brain/Heart Interaction in Rheumatoid Arthritis and Seronegative Spondyloartropathies? A Combined Brain/Heart Magnetic Resonance Imaging Reveals the Answer. Curr Rheumatol Rep 2020; 22:39. [PMID: 32562092 DOI: 10.1007/s11926-020-00922-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW To present the interaction between brain/heart and emphasize the role of combined brain/heart magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA) and other seronegative spondyloarthropathies (SNA). RECENT FINDINGS Both traditional cardiovascular disease (CVD) risk factors and intrinsic RA/SNA features contribute to the increased CVD-related morbidity/mortality. CVD in RA usually occurs a decade earlier than age- and sex-matched controls, and RA patients are twice more likely to develop myocardial infarction irrespective of age, history of prior CVD, and traditional CVD risk factors. RA also increases risk of non-ischemic heart failure (HF), valvular disease, and myo-pericarditis. CVD in SNA affects more commonly patients with long-standing disease. Ascending aortitis, aortic/mitral insufficiency, conduction defects, and diastolic dysfunction are the commonest findings in ankylosing spondylitis (AS). CVD is also the leading cause of death in psoriatic arthritis (PsA), due to myopericarditis, diastolic dysfunction, and valvular disease. Brain damage, due to either ischemic or hemorrhagic stroke and silent vascular damage, such as white matter hyperenhancement (WMH), is increased in both RA/SNA and may lead to cognitive dysfunction, depression, and brain atrophy. Magnetic resonance imaging (MRI) is ideal for serial brain/heart evaluation of patients with systemic diseases. RA/SNA patients are at high risk for brain/heart damage at early age, irrespectively of classic risk factors. Until more data will be obtained, a combined brain/heart MRI evaluation can be proposed in RA/SNA with new onset of arrhythmia and/or HF, cognitive dysfunction and/or depression.
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Affiliation(s)
| | | | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, School of Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Vasiliki Vartela
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61 P.Faliro, Athens, Greece
| | - Dimos Mitsikostas
- Aretaiion Hospital, Athens, Greece.,Kapodistrian University of Athens, Athens, Greece
| | - Genovefa Kolovou
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61 P.Faliro, Athens, Greece
| | | | - Petros P Sfikakis
- Kapodistrian University of Athens, Athens, Greece.,Joint Rheumatology, Laikon Hospital, Athens, Greece
| | - George D Kitas
- Arthritis Research UK Epidemiology Unit, Manchester University, Manchester, UK
| | - Sophie I Mavrogeni
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61 P.Faliro, Athens, Greece. .,Kapodistrian University of Athens, Athens, Greece.
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Alaverdyan Z, Jung J, Bouet R, Lartizien C. Regularized siamese neural network for unsupervised outlier detection on brain multiparametric magnetic resonance imaging: Application to epilepsy lesion screening. Med Image Anal 2019; 60:101618. [PMID: 31841950 DOI: 10.1016/j.media.2019.101618] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 11/14/2018] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
In this study, we propose a novel anomaly detection model targeting subtle brain lesions in multiparametric MRI. To compensate for the lack of annotated data adequately sampling the heterogeneity of such pathologies, we cast this problem as an outlier detection problem and introduce a novel configuration of unsupervised deep siamese networks to learn normal brain representations using a series of non-pathological brain scans. The proposed siamese network, composed of stacked convolutional autoencoders as subnetworks is designed to map patches extracted from healthy control scans only and centered at the same spatial localization to 'close' representations with respect to the chosen metric in a latent space. It is based on a novel loss function combining a similarity term and a regularization term compensating for the lack of dissimilar pairs. These latent representations are then fed into oc-SVM models at voxel-level to produce anomaly score maps. We evaluate the performance of our brain anomaly detection model to detect subtle epilepsy lesions in multiparametric (T1-weighted, FLAIR) MRI exams considered as normal (MRI-negative). Our detection model trained on 75 healthy subjects and validated on 21 epilepsy patients (with 18 MRI-negatives) achieves a maximum sensitivity of 61% on the MRI-negative lesions, identified among the 5 most suspicious detections on average. It is shown to outperform detection models based on the same architecture but with stacked convolutional or Wasserstein autoencoders as unsupervised feature extraction mechanisms.
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Affiliation(s)
- Zaruhi Alaverdyan
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F69621, Lyon, France
| | - Julien Jung
- Lyon Neuroscience Research Center, CRNL, INSERM U1028, CNRS UMR5292, University Lyon 1, Lyon, France
| | - Romain Bouet
- Lyon Neuroscience Research Center, CRNL, INSERM U1028, CNRS UMR5292, University Lyon 1, Lyon, France
| | - Carole Lartizien
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F69621, Lyon, France.
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Puranik AD, Boon M, Purandare N, Rangarajan V, Gupta T, Moiyadi A, Shetty P, Sridhar E, Agrawal A, Dev I, Shah S. Utility of FET-PET in detecting high-grade gliomas presenting with equivocal MR imaging features. World J Nucl Med 2019; 18:266-272. [PMID: 31516370 PMCID: PMC6714153 DOI: 10.4103/wjnm.wjnm_89_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 12/25/2022] Open
Abstract
High-grade gliomas, metastases, and primary central nervous system lymphoma (PCNSL) are common high-grade brain lesions, which may have overlapping features on magnetic resonance (MR) imaging. Our objective was to assess the utility of 18-fluoride-fluoro-ethyl-tyrosine positron emission tomography (FET-PET) in reliably differentiating between these lesions, by studying their metabolic characteristics. Patients with high-grade brain lesions suspicious for glioma, with overlapping features for metastases and PCNSL were referred for FET-PET by Neuroradiologists from Multidisciplinary Neuro-Oncology Joint Clinic. Tumor-to-contralateral white mater ratio (T/Wm) at 5 and 20 min was derived and compared to histopathology. Receiver operating characteristic curve analysis was used to find the optimal T/Wm cutoff to differentiate between the tumor types. T/Wm was higher for glial tumors compared to nonglial tumors (metastases, PCNSL, tuberculoma, and anaplastic meningioma). A cutoff of 1.9 was derived to reliably diagnose a tumor of glial origin with a sensitivity and specificity of 93.8% and 91%, respectively. FET-PET can be used to diagnose glial tumors presenting as high-grade brain lesions when MR findings show overlapping features for other common high-grade lesions.
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Affiliation(s)
- Ameya D Puranik
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Mathew Boon
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Aliasgar Moiyadi
- Department of Neurosurgery, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Prakash Shetty
- Department of Neurosurgery, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Epari Sridhar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Indraja Dev
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University, Mumbai, Maharashtra, India
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Wilmskoetter J, Fridriksson J, Gleichgerrcht E, Stark BC, Delgaizo J, Hickok G, Vaden KI, Hillis AE, Rorden C, Bonilha L. Neuroanatomical structures supporting lexical diversity, sophistication, and phonological word features during discourse. Neuroimage Clin 2019; 24:101961. [PMID: 31398554 PMCID: PMC6699249 DOI: 10.1016/j.nicl.2019.101961] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/15/2019] [Accepted: 07/26/2019] [Indexed: 11/23/2022]
Abstract
Deficits in lexical retrieval are commonly observed in individuals with post-stroke aphasia. Successful lexical retrieval is related to lexical diversity, lexical sophistication, and phonological word properties; however, the crucial brain regions supporting these different features are not fully understood. We performed MRI-based lesion symptom mapping in 58 individuals with a chronic left hemisphere stroke to assess how regional damage relates to spoken discourse-extracted measures of lexical diversity, lexical sophistication, and phonological word properties. For discourse transcription and word feature analysis, we used the Computerized Language Analysis (CLAN) program, Stanford Core Natural Language Processing, Irvine Phonotactic Online Dictionary, Lexical Complexity Analyzer, and Gramulator. Lesions involving the left posterior insula and supramarginal gyri and inferior fronto-occipital fasciculus were significant predictors of utterances with, on average, lower lexical diversity. Low lexical sophistication was associated with damage to the left pole of the superior temporal gyrus. Production of words with lower phonological complexity (fewer phonemes, higher phonological similarity) was associated with damage to the left supramarginal gyrus. Our findings indicate that discourse-extracted features of lexical retrieval depend on the integrity of specific brain regions involving insular and peri-Sylvian areas. The identified regions provide insight into potentially underlying mechanisms of lexically diverse, sophisticated and phonologically complex words produced during discourse. Word production in connected speech of individuals with post-stroke aphasia depends on lesion locations Low lexical diversity is linked to lesions to the left insula, supramarginal gyrus and inferior fronto-occipital fasciculus Lexical sophistication is linked to lesions to the left pole of the temporal gyrus Phonological word features are linked to lesions to the left supramarginal gyrus Features of lexical retrieval in connected speech depend on the integrity of ventral and dorsal language processing streams
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Affiliation(s)
- Janina Wilmskoetter
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States of America.
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, United States of America
| | - Ezequiel Gleichgerrcht
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States of America
| | - Brielle C Stark
- Department of Speech and Hearing Sciences, Indiana University, Bloomington, IN 47405, United States of America; Program in Neuroscience, Indiana University, Bloomington, IN 47405, United States of America
| | - John Delgaizo
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States of America
| | - Gregory Hickok
- Department of Cognitive Sciences, University of California, Irvine, CA 92697, United States of America
| | - Kenneth I Vaden
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, United States of America
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21287, United States of America
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC 29208, United States of America
| | - Leonardo Bonilha
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States of America
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Cao L, Wang J, Gao Y, Liang Y, Yan J, Zhang Y, Zhu M, Luo T, Chen J. Magnetic resonance imaging and magnetic resonance venography features in heat stroke: a case report. BMC Neurol 2019; 19:133. [PMID: 31215399 PMCID: PMC6580543 DOI: 10.1186/s12883-019-1363-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/24/2019] [Accepted: 06/11/2019] [Indexed: 11/19/2022] Open
Abstract
Background Heat stroke (HS) is a critical illness that can cause multiple organ dysfunction, including damage to the central nervous system (CNS), which can be life-threatening in severe cases. Brain lesions in patients with HS who present with CNS damage have been rarely reported before, and they usually vary in different cases, hence, patients with such lesions may present a clinical challenge in terms of diagnosis and management. Cerebral venous thrombosis (CVT) is a rare cause of stroke that mostly affects young individuals and children. The pathogenesis of brain damage caused by HS is complex, and CVT may be involved in the pathogenesis of HS with CNS damage. In this manuscript, we have reported a case of a patient with HS having CVT with symmetrical lesions in the bilateral putamen, posterior limb of the internal capsule, external capsule, insular lobe, and subcortical white matter in the brain. Case presentation We encountered a 48-year-old man who presented with HS in the summer season. During admission, he had a high body temperature and was in coma and shock. Then, he developed rhabdomyolysis syndrome, acute kidney and liver damage, electrolyte imbalance, and acid–base balance disorders, and his D-dimer level was elevated. After several days of anti-shock treatment, the patient’s level of consciousness improved. However, he experienced a decline in vision. Cerebral magnetic resonance imaging (MRI) showed symmetrical lesions in the bilateral posterior limb of the internal capsule, putamen, external capsule, insula, and subcortical white matter, and cerebral magnetic resonance venography (MRV) showed the development of CVT. Therefore, anti-coagulation treatment was provided. After timely clinical intervention, the symptoms of the patient gradually improved. Conclusions This case showed that HS can cause CVT. Therefore, cerebral MRI findings in HS must be assessed; in addition, early MRV can help in the diagnosis of the disease, which can effectively improve prognosis.
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Affiliation(s)
- Lizhi Cao
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Juan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Yaxuan Gao
- Norman Bethune Health Science Center of Jilin University, Changchun, 130000, Jilin, China
| | - Yumei Liang
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Jinhua Yan
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Yunhai Zhang
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China
| | - Mingqin Zhu
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China.
| | - Tianfei Luo
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China.
| | - Jiafeng Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, Jilin, China.
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Nakamura Y, Gaetano L, Matsushita T, Anna A, Sprenger T, Radue EW, Wuerfel J, Bauer L, Amann M, Shinoda K, Isobe N, Yamasaki R, Saida T, Kappos L, Kira JI. A comparison of brain magnetic resonance imaging lesions in multiple sclerosis by race with reference to disability progression. J Neuroinflammation 2018; 15:255. [PMID: 30185189 PMCID: PMC6125988 DOI: 10.1186/s12974-018-1295-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 03/30/2018] [Accepted: 08/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We compared the magnetic resonance imaging (MRI) features between Japanese and Caucasian patients with multiple sclerosis (MS), and identified the relationships between MRI features and disability. METHODS From the baseline data of phase II fingolimod trials, 95 Japanese and 246 Caucasian relapsing-remitting MS patients were enrolled. The number, volume, and distribution of brain MRI lesions were evaluated using T2-weighted (T2W) images. Cross-sectional total normalized brain volume (NBV), normalized cortical gray matter volume, normalized deep gray matter volume (NDGMV), normalized white matter volume (NWMV), and normalized thalamic volume were measured. RESULTS Japanese patients had significantly lower Expanded Disability Status Scale (EDSS) scores than Caucasian patients (mean 2.0 vs. 2.3, p = 0.008), despite a similar disease duration. Japanese patients showed a trend towards fewer T2W-lesions (median 50 vs. 65, p = 0.08) and significantly lower frequencies of cerebellar and parietal lobe lesions (p = 0.02 for both) than Caucasian patients. There were no differences in T2W-lesion volume between races, whereas Japanese patients had a significantly larger T2W-lesion volume per lesion compared with Caucasian patients (median 140 mm3 vs. 85 mm3, p < 0.0001). T2W-lesion volumes were positively correlated with EDSS scores in Japanese patients (p < 0.0001). In both races, NBV, normalized cortical gray matter volume, NDGMV, and thalamic volume were negatively correlated with disease duration and EDSS scores (p < 0.01 for all). NWMV was negatively correlated with disease duration and EDSS scores only in Caucasian patients (p = 0.03 and p = 0.004, respectively). NBV, NDGMV, NWMV, and thalamic volume were consistently smaller in Japanese compared with Caucasian patients throughout the entire examined disease duration (p = 0.046, p = 0.01, p = 0.005, and p = 0.04, respectively). Japanese patients had a significantly faster reduction in NDGMV (p = 0.001), particularly for thalamic volume (p = 0.001), with disease duration compared with Caucasian patients. CONCLUSIONS Gray matter atrophy is a common denominator for disability in Japanese and Caucasian patients. Additional contributory factors for disability include T2W-lesion volume in Japanese patients and white matter atrophy in Caucasian patients. Less frequent parietal and cerebellar involvement with fewer T2W-lesions may underlie milder disability in Japanese patients.
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Affiliation(s)
- Yuri Nakamura
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Laura Gaetano
- Medical Image Analysis Center (MIAC AG), Marktgasse 8, 4051, Basel, Switzerland.,Neurology and Department of Biomedicine, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Takuya Matsushita
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Altermatt Anna
- Medical Image Analysis Center (MIAC AG), Marktgasse 8, 4051, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Marktgasse 8, 4051, Basel, Switzerland
| | - Till Sprenger
- DKD Helios Klinik Wiesbaden, Aukammallee 33, 65191, Wiesbaden, Germany
| | - Ernst-Wilhelm Radue
- Biomedical Research and Education GmbH, Mittlere Strasse 91, 4031, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center (MIAC AG), Marktgasse 8, 4051, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Marktgasse 8, 4051, Basel, Switzerland
| | - Lorena Bauer
- Medical Image Analysis Center (MIAC AG), Marktgasse 8, 4051, Basel, Switzerland.,Klinikum rechts der Isar, Department of Neurology, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michael Amann
- Medical Image Analysis Center (MIAC AG), Marktgasse 8, 4051, Basel, Switzerland.,Neurology and Department of Biomedicine, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Koji Shinoda
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Noriko Isobe
- Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ryo Yamasaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takahiko Saida
- Institute of Neurotherapeutics, 16-1 Nishinokyoukasugachou, Nakagyo-ku, Kyoto, 604-8453, Japan.,Department of Neurology, Kyoto Min-Iren-Central Hospital, 16-1 Nishinokyoukasugachou, Nakagyo-ku, Kyoto, 604-8453, Japan
| | - Ludwig Kappos
- Neurology and Department of Biomedicine, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Singh T, Phillip L, Behroozmand R, Gleichgerrcht E, Piai V, Fridriksson J, Bonilha L. Pre-articulatory electrical activity associated with correct naming in individuals with aphasia. Brain Lang 2018; 177-178:1-6. [PMID: 29421267 PMCID: PMC5835213 DOI: 10.1016/j.bandl.2018.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 12/13/2017] [Accepted: 01/15/2018] [Indexed: 05/17/2023]
Abstract
Picture naming is a language task that involves multiple neural networks and is used to probe aphasia-induced language deficits. The pattern of neural activation seen in healthy individuals during picture naming is disrupted in individuals with aphasia, but the time-course of the disruption remains unclear. Specifically, it remains unclear which anatomical and temporal aspects of neural processing are necessary for correct naming. Here, we tested two individuals with stroke induced aphasia, and compared the differences in the event-related potentials (ERPs) and current sources when they made correct vs. erroneous responses during picture naming. The pre-articulatory ERP activity was significantly different between the two responses. Current source analysis revealed that the ability to recruit left temporal and frontal areas within a 300-550 ms time window after stimulus onset contributed to correct responses. These results suggest that targeted neuromodulation in these areas could lead to better treatment outcomes in patients with aphasia.
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Affiliation(s)
- Tarkeshwar Singh
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Lorelei Phillip
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, United States
| | - Roozbeh Behroozmand
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, United States
| | - Ezequiel Gleichgerrcht
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Vitória Piai
- Donders Centre for Cognition, Radboud University, Nijmegen, Netherlands
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC 29208, United States
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, United States.
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25
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Cameron CD, Reber J, Spring VL, Tranel D. Damage to the ventromedial prefrontal cortex is associated with impairments in both spontaneous and deliberative moral judgments. Neuropsychologia 2018; 111:261-8. [PMID: 29382558 DOI: 10.1016/j.neuropsychologia.2018.01.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/27/2017] [Accepted: 01/25/2018] [Indexed: 11/22/2022]
Abstract
Implicit moral evaluations-spontaneous, unintentional judgments about the moral status of actions or persons-are thought to play a pivotal role in moral experience, suggesting a need for research to model these moral evaluations in clinical populations. Prior research reveals that the ventromedial prefrontal cortex (vmPFC) is a critical area underpinning affect and morality, and patients with vmPFC lesions show abnormalities in moral judgment and moral behavior. We use indirect measurement and multinomial modeling to understand differences in implicit moral evaluations among patients with vmPFC lesions. Our model quantifies multiple processes of moral judgment: implicit moral evaluations in response to distracting moral transgressions (Unintentional Judgment), accurate moral judgments about target actions (Intentional Judgment), and a directional tendency to judge actions as morally wrong (Response Bias). Compared to individuals with non-vmPFC brain damage and neurologically healthy comparisons, patients with vmPFC lesions showed a dual deficit in processes of moral judgment. First, patients with vmPFC lesions showed reduced Unintentional Judgment about moral transgressions, but not about non-moral negative affective distracters. Second, patients with vmPFC lesions showed reduced Intentional Judgment about target actions. These findings highlight the utility of a formal modeling approach in moral psychology, revealing a dual deficit in multiple component processes of moral judgment among patients with vmPFC lesions.
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26
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Bianucci R, Charlier P, Evans P, Appenzeller O. Temporal lobe epilepsy and anorexia nervosa in St. Catherine of Siena (1347-1380). J Neurol Sci 2017; 379:122-3. [PMID: 28716223 DOI: 10.1016/j.jns.2017.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/31/2017] [Indexed: 11/22/2022]
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27
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Morales S, Bernabeu-Sanz A, López-Mir F, González P, Luna L, Naranjo V. BRAIM: A computer-aided diagnosis system for neurodegenerative diseases and brain lesion monitoring from volumetric analyses. Comput Methods Programs Biomed 2017; 145:167-179. [PMID: 28552122 DOI: 10.1016/j.cmpb.2017.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 03/14/2017] [Accepted: 04/12/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE This paper presents BRAIM, a computer-aided diagnosis (CAD) system to help clinicians in diagnosing and treatment monitoring of brain diseases from magnetic resonance image processing. BRAIM can be used for early diagnosis of neurodegenerative diseases such as Parkinson, Alzheimer or Multiple Sclerosis and also for brain lesion diagnosis and monitoring. METHODS The developed CAD system includes different user-friendly tools for segmenting and determining whole brain and brain structure volumes in an easy and accurate way. Specifically, three types of measurements can be performed: (1) total volume of white, gray matter and cerebrospinal fluid; (2) brain structure volumes (volume of putamen, thalamus, hippocampus and caudate nucleus); and (3) brain lesion volumes. RESULTS As a proof of concept, some study cases were analyzed with the presented system achieving promising results. In addition to be used to quantify treatment effectiveness in patients with brain lesions, it was demonstrated that BRAIM is able to classify a subject according to the brain volume measurements using as reference a healthy control database created for this purpose. CONCLUSIONS The CAD system presented in this paper simplifies the daily work of clinicians and provides them with objective and quantitative volume data for prospective and retrospective analyses.
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Affiliation(s)
- Sandra Morales
- Instituto de Investigación e Innovación en Bioingeniería, I3B, Universitat Politècnica de València, Camino de Vera s/n, Valencia 46022, Spain.
| | | | - Fernando López-Mir
- Instituto de Investigación e Innovación en Bioingeniería, I3B, Universitat Politècnica de València, Camino de Vera s/n, Valencia 46022, Spain
| | - Pablo González
- Instituto de Investigación e Innovación en Bioingeniería, I3B, Universitat Politècnica de València, Camino de Vera s/n, Valencia 46022, Spain
| | - Luis Luna
- Inscanner S.L, Magnetic Resonance Department, Alicante, Spain
| | - Valery Naranjo
- Instituto de Investigación e Innovación en Bioingeniería, I3B, Universitat Politècnica de València, Camino de Vera s/n, Valencia 46022, Spain
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28
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Minjoli S, Saturnino GB, Blicher JU, Stagg CJ, Siebner HR, Antunes A, Thielscher A. The impact of large structural brain changes in chronic stroke patients on the electric field caused by transcranial brain stimulation. Neuroimage Clin 2017; 15:106-117. [PMID: 28516033 PMCID: PMC5426045 DOI: 10.1016/j.nicl.2017.04.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 04/03/2017] [Accepted: 04/15/2017] [Indexed: 11/02/2022]
Abstract
Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (TDCS) are two types of non-invasive transcranial brain stimulation (TBS). They are useful tools for stroke research and may be potential adjunct therapies for functional recovery. However, stroke often causes large cerebral lesions, which are commonly accompanied by a secondary enlargement of the ventricles and atrophy. These structural alterations substantially change the conductivity distribution inside the head, which may have potentially important consequences for both brain stimulation methods. We therefore aimed to characterize the impact of these changes on the spatial distribution of the electric field generated by both TBS methods. In addition to confirming the safety of TBS in the presence of large stroke-related structural changes, our aim was to clarify whether targeted stimulation is still possible. Realistic head models containing large cortical and subcortical stroke lesions in the right parietal cortex were created using MR images of two patients. For TMS, the electric field of a double coil was simulated using the finite-element method. Systematic variations of the coil position relative to the lesion were tested. For TDCS, the finite-element method was used to simulate a standard approach with two electrode pads, and the position of one electrode was systematically varied. For both TMS and TDCS, the lesion caused electric field "hot spots" in the cortex. However, these maxima were not substantially stronger than those seen in a healthy control. The electric field pattern induced by TMS was not substantially changed by the lesions. However, the average field strength generated by TDCS was substantially decreased. This effect occurred for both head models and even when both electrodes were distant to the lesion, caused by increased current shunting through the lesion and enlarged ventricles. Judging from the similar peak field strengths compared to the healthy control, both TBS methods are safe in patients with large brain lesions (in practice, however, additional factors such as potentially lowered thresholds for seizure-induction have to be considered). Focused stimulation by TMS seems to be possible, but standard tDCS protocols appear to be less efficient than they are in healthy subjects, strongly suggesting that tDCS studies in this population might benefit from individualized treatment planning based on realistic field calculations.
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Affiliation(s)
- Sena Minjoli
- Danish Research Center for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark
| | - Guilherme B Saturnino
- Danish Research Center for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark; Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Jakob Udby Blicher
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Denmark; Department of Neurology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte J Stagg
- Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Oxford Centre for Human Brain Activity (OHBA), Department of Psychiatry, University of Oxford, UK
| | - Hartwig R Siebner
- Danish Research Center for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - André Antunes
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Axel Thielscher
- Danish Research Center for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark; Max Planck Institute for Biological Cybernetics, Tübingen, Germany; Center for Magnetic Resonance, Technical University of Denmark, Kgs. Lyngby, Denmark.
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Abstract
There is little doubt that, in the adult, specific brain lesions cause specific language deficits. Yet, brain localizations of linguistic functions are made problematic by several reported cases of normal language in spite of major brain anomalies, mostly, but not exclusively, occurring early in life. The signal cases are hydrocephaly, spina bifida and hemispherectomy. These cases are discussed and possible solutions are suggested: namely a vast redundancy of neurons and/or the role of microtubules as neuron-internal processors and key factors in signaling and guiding the growth and reconfiguration of the brain.
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Pichler A, Sellner J, Harutyunyan G, Sonnleitner A, Klobassa DS, Archelos-Garcia JJ, Rock H, Gattringer T, Fazekas F. Magnetic resonance imaging and clinical findings in adults with tick-borne encephalitis. J Neurol Sci 2017; 375:266-269. [PMID: 28320144 DOI: 10.1016/j.jns.2017.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 11/18/2016] [Revised: 01/08/2017] [Accepted: 02/01/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) in tick-borne encephalitis (TBE) is often performed for differential diagnosis, but only a few reports on the morphologic changes in TBE patients and their relation to the disease severity exist. METHODS We retrospectively searched for all TBE patients who were admitted to the Departments of Neurology of the Medical University of Graz (Austria) and the Paracelsus Medical University of Salzburg (Austria) between 2003 and 2014. We recorded the clinical and demographic variables and rated overall disease severity as mild, moderate, severe or leading to death due to TBE. MRI scans were screened for morphologic abnormalities. RESULTS Of an initial cohort of 88 patients with TBE, 45 patients with an available MRI of the brain were included in this study (median age 58.0years, range: 18-80; men n=28). Their median time spent in the hospital was 18days (range: 4-174days). 16 patients had a mild, 18 a moderate and 10 a severe disease course. One patient died due to TBE. TBE related brain abnormalities could be identified in 4 cases. They consisted of diffuse areas of T2-signal hyperintensity, which were located in the crura cerebri in three patients and in the right centrum semiovale in one patient. No contrast enhancement was observed in any of the lesions and their presence was not related to specific clinical findings or the severity of TBE. CONCLUSION MRI brain lesions in TBE are rare and do not correlate with the course of the disease. Diffuse areas of signal hyperintensity in the crura cerebri appear suggestive of TBE.
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Affiliation(s)
- Alexander Pichler
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria.
| | - Johann Sellner
- Department of Neurology, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
| | - Gayane Harutyunyan
- Department of Neurology, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
| | - Astrid Sonnleitner
- Department of Pediatrics and Adolescent Medicine, Medical University Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria
| | - Daniela Sabine Klobassa
- Department of Pediatrics and Adolescent Medicine, Medical University Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria
| | | | - Hannah Rock
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria
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31
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Till C, Noguera A, Verhey LH, O'Mahony J, Yeh EA, Mah JK, Sinopoli KJ, Brooks BL, Aubert-Broche B, Collins DL, Narayanan S, Arnold DL, Banwell BL. Cognitive and Behavioral Functioning in Childhood Acquired Demyelinating Syndromes. J Int Neuropsychol Soc 2016; 22:1050-60. [PMID: 27903328 DOI: 10.1017/S1355617716000308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The aim of this study was to describe cognitive, academic, and psychosocial outcomes after an incident demyelinating event (acquired demyelinating syndromes, ADS) in childhood and to investigate the contribution of brain lesions and confirmed MS diagnosis on outcome. METHODS Thirty-six patients with ADS (mean age=12.2 years, SD=2.7, range: 7-16 years) underwent brain MRI scans at presentation and at 6-months follow-up. T2-weighted lesions on MRI were assessed using a binary classification. At 6-months follow-up, patients underwent neuropsychological evaluation and were compared with 42 healthy controls. RESULTS Cognitive, academic, and behavioral outcomes did not differ between the patients with ADS and controls. Three of 36 patients (8.3%) were identified with cognitive impairment, as determined by performance falling ≤1.5 SD below normative values on more than four independent tests in the battery. Poor performance on a visuomotor integration task was most common, observed among 6/32 patients, but this did not differ significantly from controls. Twelve of 36 patients received a diagnosis of MS within 3 years post-ADS. Patients with MS did not differ from children with monophasic ADS in terms of cognitive performance at the 6-months follow-up. Fatigue symptoms were reported in 50% of patients, irrespective of MS diagnosis. Presence of brain lesions at onset and 6 months post-incident demyelinating event did not associate with cognitive outcome. CONCLUSIONS Children with ADS experience a favorable short-term neurocognitive outcome, even those confirmed to have MS. Longitudinal evaluations of children with monophasic ADS and MS are required to determine the possibility of late-emerging sequelae and their time course. (JINS, 2016, 22, 1050-1060).
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Kamnitsas K, Ledig C, Newcombe VFJ, Simpson JP, Kane AD, Menon DK, Rueckert D, Glocker B. Efficient multi-scale 3D CNN with fully connected CRF for accurate brain lesion segmentation. Med Image Anal. 2017;36:61-78. [PMID: 27865153 DOI: 10.1016/j.media.2016.10.004] [Citation(s) in RCA: 1292] [Impact Index Per Article: 161.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 09/09/2016] [Accepted: 10/12/2016] [Indexed: 12/13/2022]
Abstract
We propose a dual pathway, 11-layers deep, three-dimensional Convolutional Neural Network for the challenging task of brain lesion segmentation. The devised architecture is the result of an in-depth analysis of the limitations of current networks proposed for similar applications. To overcome the computational burden of processing 3D medical scans, we have devised an efficient and effective dense training scheme which joins the processing of adjacent image patches into one pass through the network while automatically adapting to the inherent class imbalance present in the data. Further, we analyze the development of deeper, thus more discriminative 3D CNNs. In order to incorporate both local and larger contextual information, we employ a dual pathway architecture that processes the input images at multiple scales simultaneously. For post-processing of the network's soft segmentation, we use a 3D fully connected Conditional Random Field which effectively removes false positives. Our pipeline is extensively evaluated on three challenging tasks of lesion segmentation in multi-channel MRI patient data with traumatic brain injuries, brain tumours, and ischemic stroke. We improve on the state-of-the-art for all three applications, with top ranking performance on the public benchmarks BRATS 2015 and ISLES 2015. Our method is computationally efficient, which allows its adoption in a variety of research and clinical settings. The source code of our implementation is made publicly available.
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Zavaglia M, Forkert ND, Cheng B, Gerloff C, Thomalla G, Hilgetag CC. Technical considerations of a game-theoretical approach for lesion symptom mapping. BMC Neurosci 2016; 17:40. [PMID: 27349961 PMCID: PMC4924231 DOI: 10.1186/s12868-016-0275-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 01/19/2016] [Accepted: 06/15/2016] [Indexed: 08/27/2023] Open
Abstract
Background Various strategies have been used for inferring brain functions from stroke lesions. We explored a new mathematical approach based on game theory, the so-called multi-perturbation Shapley value analysis (MSA), to assess causal function localizations and interactions from multiple perturbation data. We applied MSA to a dataset composed of lesion patterns of 148 acute stroke patients and their National Institutes of Health Stroke Scale (NIHSS) scores, to systematically investigate the influence of different parameter settings on the outcomes of the approach. Specifically, we investigated aspects of MSA methodology including the choice of the predictor algorithm (typology and kernel functions), training dataset (original versus binary), as well as the influence of lesion thresholds. We assessed the suitability of MSA for processing real clinical lesion data and established the central parameters for this analysis. Results We derived general recommendations for the analysis of clinical datasets by MSA and showed that, for the studied dataset, the best approach was to use a linear-kernel support vector machine predictor, trained with a binary training dataset, where the binarization was implemented through a median threshold of lesion size for each region. We demonstrated that the results obtained with different MSA variants lead to almost identical results as the basic MSA. Conclusions MSA is a feasible approach for the multivariate lesion analysis of clinical stroke data. Informed choices need to be made to set parameters that may affect the analysis outcome.
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Affiliation(s)
- Melissa Zavaglia
- Department of Computational Neuroscience, University Medical Center Eppendorf, Hamburg University, Martinistraße 52, 20246, Hamburg, Germany. .,School of Engineering and Science, Jacobs University Bremen, Campus Ring 1, 28759, Bremen, Germany.
| | - Nils D Forkert
- Department of Computational Neuroscience, University Medical Center Eppendorf, Hamburg University, Martinistraße 52, 20246, Hamburg, Germany.,Department of Radiology and Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Bastian Cheng
- Department of Neurology, University Medical Center Eppendorf, Hamburg University, Martinistraße 52, 20246, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Eppendorf, Hamburg University, Martinistraße 52, 20246, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Eppendorf, Hamburg University, Martinistraße 52, 20246, Hamburg, Germany
| | - Claus C Hilgetag
- Department of Computational Neuroscience, University Medical Center Eppendorf, Hamburg University, Martinistraße 52, 20246, Hamburg, Germany.,Department of Health Sciences, Boston University, 635 Commonwealth Ave., Boston, MA, 02215, USA
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34
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Baranello G, Rossi Sebastiano D, Pagliano E, Visani E, Ciano C, Fumarola A, Arnoldi MT, Corlatti A, Foscan M, Marchi A, Erbetta A, Riva D. Hand function assessment in the first years of life in unilateral cerebral palsy: Correlation with neuroimaging and cortico-spinal reorganization. Eur J Paediatr Neurol 2016; 20:114-24. [PMID: 26439103 DOI: 10.1016/j.ejpn.2015.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 02/09/2015] [Accepted: 09/08/2015] [Indexed: 11/16/2022]
Abstract
AIM The purpose of the present study was to correlate early hand function assessment during the first years of life with neuroimaging findings and the different patterns of cortico-motor reorganization in children with unilateral cerebral palsy (UCP). METHODS We conducted a long prospective observational study, in which 17 children with UCP (8 left-sided hemiplegia; Manual Ability Classification System level 1-3) were first assessed at a mean age of 24 months (range 18-28), and followed up by means of the Besta Scale, a new standardized protocol assessing both unimanual and bimanual hand function. They also underwent Melbourne Assessment of Unilateral Upper Limb Function (MUUL) and single-pulse Transcranial Magnetic Stimulation (TMS) at a mean age of 10 years 5 months (range 9 y 1 m-12 y 8 m). Brain MRIs of all the 17 children were independently assessed and scored by two blinded observers, according to a defined protocol. Possible correlations between hand function at first assessment, neuroimaging and TMS data were analyzed. RESULTS Early hand function impairment significantly correlated with the extension of brain damage (ρ = -0.531, p = 0.028), number of involved areas (ρ = -0.608, p = 0.010), presence of radiological signs of cortico-spinal degeneration (ρ = -0.628, p = 0.007), and basal ganglia involvement (ρ = -0.485, p = 0.049). Additionally, higher hand function scores (i.e. better hand function) at first assessment significantly correlated with contralateral cortico-spinal projections, while lower scores significantly correlated with either mixed or ipsilateral cortico-spinal projections to the affected hand (χ(2)(2) = 11.418, p = 0.003; post-hoc tests: contralateral TMS group versus ipsilateral: Z = -2.943, p = 0.002 and contralateral TMS group versus mixed: Z = -2.775, p = 0.006). CONCLUSIONS To our knowledge, this is the first study correlating hand function assessment in the first years of life, and its evolution over time, with neuroimaging and cortico-spinal projection patterns in children with UCP. These findings could contribute to an improved prediction of prognosis and a better delineation of therapeutic interventions in young children with UCP.
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Affiliation(s)
- Giovanni Baranello
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Davide Rossi Sebastiano
- Department of Neurophysiology-Epilepsy Centre, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Emanuela Pagliano
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Elisa Visani
- Department of Neurophysiology-Epilepsy Centre, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Claudia Ciano
- Department of Neurophysiology-Epilepsy Centre, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Adriana Fumarola
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Maria Teresa Arnoldi
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Alice Corlatti
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Maria Foscan
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Alessia Marchi
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Alessandra Erbetta
- Neuroradiology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Daria Riva
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
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Dolapcioglu C, Dolapcioglu H. Structural brain lesions in inflammatory bowel disease. World J Gastrointest Pathophysiol 2015; 6:124-130. [PMID: 26600970 PMCID: PMC4644876 DOI: 10.4291/wjgp.v6.i4.124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/07/2015] [Accepted: 09/07/2015] [Indexed: 02/07/2023] Open
Abstract
Central nervous system (CNS) complications or manifestations of inflammatory bowel disease deserve particular attention because symptomatic conditions can require early diagnosis and treatment, whereas unexplained manifestations might be linked with pathogenic mechanisms. This review focuses on both symptomatic and asymptomatic brain lesions detectable on imaging studies, as well as their frequency and potential mechanisms. A direct causal relationship between inflammatory bowel disease (IBD) and asymptomatic structural brain changes has not been demonstrated, but several possible explanations, including vasculitis, thromboembolism and malnutrition, have been proposed. IBD is associated with a tendency for thromboembolisms; therefore, cerebrovascular thromboembolism represents the most frequent and grave CNS complication. Vasculitis, demyelinating conditions and CNS infections are among the other CNS manifestations of the disease. Biological agents also represent a risk factor, particularly for demyelination. Identification of the nature and potential mechanisms of brain lesions detectable on imaging studies would shed further light on the disease process and could improve patient care through early diagnosis and treatment.
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Baldo JV, Kacinik NA, Moncrief A, Beghin F, Dronkers NF. You may now kiss the bride: Interpretation of social situations by individuals with right or left hemisphere injury. Neuropsychologia 2015; 80:133-141. [PMID: 26546561 DOI: 10.1016/j.neuropsychologia.2015.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 05/29/2015] [Revised: 09/14/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
While left hemisphere damage (LHD) has been clearly shown to cause a range of language impairments, patients with right hemisphere damage (RHD) also exhibit communication deficits, such as difficulties processing prosody, discourse, and social contexts. In the current study, individuals with RHD and LHD were directly compared on their ability to interpret what a character in a cartoon might be saying or thinking, in order to better understand the relative role of the right and left hemisphere in social communication. The cartoon stimuli were manipulated so as to elicit more or less formulaic responses (e.g., a scene of a couple being married by a priest vs. a scene of two people talking, respectively). Participants' responses were scored by blind raters on how appropriately they captured the gist of the social situation, as well as how formulaic and typical their responses were. Results showed that RHD individuals' responses were rated as significantly less appropriate than controls and were also significantly less typical than controls and individuals with LHD. Individuals with RHD produced a numerically lower proportion of formulaic expressions than controls, but this difference was only a trend. Counter to prediction, the pattern of performance across participant groups was not affected by how constrained/formulaic the social situation was. The current findings expand our understanding of the roles that the right and left hemispheres play in social processing and communication and have implications for the potential treatment of social communication deficits in individuals with RHD.
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Affiliation(s)
- Juliana V Baldo
- Department of Veterans Affairs, Northern California Health Care System, 150 Muir Rd. (126R), Martinez, CA 94553, United States.
| | - Natalie A Kacinik
- Brooklyn College and Graduate Center of the City University of New York
| | - Amber Moncrief
- Department of Veterans Affairs, Northern California Health Care System, 150 Muir Rd. (126R), Martinez, CA 94553, United States
| | - Francesca Beghin
- Department of Veterans Affairs, Northern California Health Care System, 150 Muir Rd. (126R), Martinez, CA 94553, United States
| | - Nina F Dronkers
- Department of Veterans Affairs, Northern California Health Care System, 150 Muir Rd. (126R), Martinez, CA 94553, United States; University of California, Davis, United States
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Tauhid S, Chu R, Sasane R, Glanz BI, Neema M, Miller JR, Kim G, Signorovitch JE, Healy BC, Chitnis T, Weiner HL, Bakshi R. Brain MRI lesions and atrophy are associated with employment status in patients with multiple sclerosis. J Neurol 2015. [PMID: 26205635 PMCID: PMC4639581 DOI: 10.1007/s00415-015-7853-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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] [Indexed: 01/02/2023]
Abstract
Multiple sclerosis (MS) commonly
affects occupational function. We investigated the link between brain MRI and employment status. Patients with MS (n = 100) completed a Work Productivity and Activity Impairment (WPAI) (general health version) survey measuring employment status, absenteeism, presenteeism, and overall work and daily activity impairment. Patients “working for pay” were considered employed; “temporarily not working but looking for work,” “not working or looking for work due to age,” and “not working or looking for work due to disability” were considered not employed. Brain MRI T1 hypointense (T1LV) and T2 hyperintense (T2LV) lesion volumes were quantified. To assess lesional destructive capability, we calculated each subject’s ratio of T1LV to T2LV (T1/T2). Normalized brain parenchymal volume (BPV) assessed brain atrophy. The mean (SD) age was 45.5 (9.7) years; disease duration was 12.1 (8.1) years; 75 % were women, 76 % were relapsing-remitting, and 76 % were employed. T1LV, T1/T2, Expanded Disability Status Scale (EDSS) scores, and activity impairment were lower and BPV was higher in the employed vs. not employed group (Wilcoxon tests, p < 0.05). Age, disease duration, MS clinical subtype, and T2LV did not differ between groups (p > 0.05). In multivariable logistic regression modeling, adjusting for age, sex, and disease duration, higher T1LV predicted a lower chance of employment (p < 0.05). Pearson correlations showed that EDSS was associated with activity impairment (p < 0.05). Disease duration, age, and MRI measures were not correlated with activity impairment or other WPAI outcomes (p > 0.05). We report a link between brain atrophy and lesions, particularly lesions with destructive potential, to MS employment status.
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Affiliation(s)
- Shahamat Tauhid
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Renxin Chu
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Bonnie I Glanz
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Mohit Neema
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer R Miller
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Gloria Kim
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Brian C Healy
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Howard L Weiner
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Rohit Bakshi
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. .,Laboratory for Neuroimaging Research, Department of Radiology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. .,Laboratory for Neuroimaging Research, One Brookline Place, Brookline, MA, 02445, USA.
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Kamarajan C, Pandey AK, Chorlian DB, Porjesz B. The use of current source density as electrophysiological correlates in neuropsychiatric disorders: A review of human studies. Int J Psychophysiol 2014; 97:310-22. [PMID: 25448264 DOI: 10.1016/j.ijpsycho.2014.10.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 06/30/2014] [Revised: 10/23/2014] [Accepted: 10/27/2014] [Indexed: 11/28/2022]
Abstract
The use of current source density (CSD), the Laplacian of the scalp surface voltage, to map the electrical activity of the brain is a powerful method in studies of cognitive and affective phenomena. During the last few decades, mapping of CSD has been successfully applied to characterize several neuropsychiatric conditions such as alcoholism, schizophrenia, depression, anxiety disorders, childhood/developmental disorders, and neurological conditions (i.e., epilepsy and brain lesions) using electrophysiological data from resting state and during cognitive performance. The use of CSD and Laplacian measures has proven effective in elucidating topographic and activation differences between groups: i) patients with a specific diagnosis vs. healthy controls, ii) subjects at high risk for a specific diagnosis vs. low risk or normal controls, and iii) patients with specific symptom(s) vs. patients without these symptom(s). The present review outlines and summarizes the studies that have employed CSD measures in investigating several neuropsychiatric conditions. The advantages and potential of CSD-based methods in clinical and research applications along with some of the limitations inherent in the CSD-based methods are discussed in the review, as well as future directions to expand the implementation of CSD to other potential clinical applications. As CSD methods have proved to be more advantageous than using scalp potential data to understand topographic and source activations, its clinical applications offer promising potential, not only for a better understanding of a range of psychiatric conditions, but also for a variety of focal neurological disorders, including epilepsy and other conditions involving brain lesions and surgical interventions.
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Affiliation(s)
- Chella Kamarajan
- Henri Begleiter Neurodynamics Laboratory, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
| | - Ashwini K Pandey
- Henri Begleiter Neurodynamics Laboratory, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
| | - David B Chorlian
- Henri Begleiter Neurodynamics Laboratory, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Bernice Porjesz
- Henri Begleiter Neurodynamics Laboratory, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
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Kim TW, Kim YW. Treadmill sideways gait training with visual blocking for patients with brain lesions. J Phys Ther Sci 2014; 26:1415-8. [PMID: 25276026 PMCID: PMC4175247 DOI: 10.1589/jpts.26.1415] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/09/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to verify the effect of sideways treadmill training
with and without visual blocking on the balance and gait function of patients with brain
lesions. [Subjects] Twenty-four stroke and traumatic brain injury subjects participated in
this study. They were divided into two groups: an experimental group (12 subjects) and a
control group (12 subjects). [Methods] Each group executed a treadmill training session
for 20 minutes, three times a week, for 6 weeks. The sideways gait training on the
treadmill was performed with visual blocking by the experimental group and with normal
vision by the control group. A Biodex Gait Trainer 2 was used to assess the gait function.
It was used to measure walking speed, walking distance, step length, and stance time on
each foot. The Five-Times-Sit-To-Stand test (FTSST) and Timed Up and Go test (TUG) were
used as balance measures. [Results] The sideways gait training with visual blocking group
showed significantly improved walking speed, walking distance, step length, and stance
time on each foot after training; FTSST and TUG times also significantly improved after
training in the experimental group. Compared to the control group, the experimental group
showed significant increases in stance time on each foot. [Conclusion] Sideways gait
training on a treadmill with visual blocking performed by patients with brain lesions
significantly improved their balance and gait function.
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Affiliation(s)
- Tea-Woo Kim
- Department of Rehabilitation Science, The Graduate School, Jeonju University, Republic of Korea
| | - Yong-Wook Kim
- Department of Physical Therapy, College of Medical Sciences, Jeonju University, Republic of Korea
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Abstract
Memory complaints are common after stroke, yet there have been very few studies of the outcome of memory rehabilitation in these patients. The present study evaluated the effectiveness of a new manualised, group-based memory training programme. Forty outpatients with a single-stroke history and ongoing memory complaints were enrolled. The six-week course involved education and strategy training and was evaluated using a wait-list crossover design, with three assessments conducted 12 weeks apart. Outcome measures included: tests of anterograde memory (Rey Auditory Verbal Learning Test: RAVLT; Complex Figure Test) and prospective memory (Royal Prince Alfred Prospective Memory Test); the Comprehensive Assessment of Prospective Memory (CAPM) questionnaire and self-report of number of strategies used. Significant training-related gains were found on RAVLT learning and delayed recall and on CAPM informant report. Lower baseline scores predicted greater gains for several outcome measures. Patients with higher IQ or level of education showed more gains in number of strategies used. Shorter time since onset was related to gains in prospective memory, but no other stroke-related variables influenced outcome. Our study provides evidence that a relatively brief, group-based training intervention can improve memory functioning in chronic stroke patients and clarified some of the baseline factors that influence outcome.
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Affiliation(s)
- Laurie A Miller
- a Neuropsychology Unit , Royal Prince Alfred Hospital , Sydney , Australia
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Lipszyc J, Levin H, Hanten G, Hunter J, Dennis M, Schachar R. Frontal white matter damage impairs response inhibition in children following traumatic brain injury. Arch Clin Neuropsychol 2014; 29:289-99. [PMID: 24618405 DOI: 10.1093/arclin/acu004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Inhibition, the ability to suppress inappropriate cognitions or behaviors, can be measured using computer tasks and questionnaires. Inhibition depends on the frontal cortex, but the role of the underlying white matter (WM) is unclear. We assessed the specific impact of frontal WM damage on inhibition in 29 children with moderate-to-severe traumatic brain injury (15 with and 14 without frontal WM damage), 21 children with orthopedic injury, and 29 population controls. We used the Stop Signal Task to measure response inhibition, the Behavior Rating Inventory of Executive Function to assess everyday inhibition, and T2 fluid-attenuated inversion recovery magnetic resonance imaging to identify lesions. Children with frontal WM damage had impaired response inhibition compared with all other groups and poorer everyday inhibition than the orthopedic injury group. Frontal WM lesions most often affected the superior frontal gyrus. These results provide evidence for the critical role of frontal WM in inhibition.
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Affiliation(s)
- Jonathan Lipszyc
- Department of Psychiatry, Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
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Allen AL, Goupil BA, Valentine BA. A retrospective study of brain lesions in goats submitted to three veterinary diagnostic laboratories. J Vet Diagn Invest 2013; 25:482-9. [PMID: 23794017 DOI: 10.1177/1040638713493627] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A retrospective study of brain lesions in goats was conducted to identify the range of lesions and diseases recognized and to make recommendations regarding the best tissues to examine and tests to conduct in order to maximize the likelihood of making a definitive diagnosis in goats that may have had clinical signs referable to the brain. One hundred thirty-nine goats with a brain lesion were identified. The most common lesion, in 52.5% of the goats, was suppurative inflammation. Approximately two-thirds of these goats had encephalitic listeriosis. Other goats were found to have suppurative inflammation in association with septicemia, pituitary abscesses, dehorning injury, and otitis. Thirty goats (21.6%) were diagnosed with polioencephalomalacia. Twenty-one goats (15.1%) were diagnosed with nonsuppurative inflammation. In more than half of these goats, no definitive diagnosis was made, while 8 were infected with Caprine arthritis encephalitis virus and 1 with Rabies virus. However, few goats were tested for rabies. Based on these findings, it is recommended that, in addition to appropriate handling of the brain, the head should be examined with attention paid to the sella turcica and the temporal bones for evidence of a pituitary abscess and otitis, respectively. Histologic examination should include multiple areas of the brain, including the brainstem, for lesions of encephalic listeriosis; the cerebral cortex, for lesions of polioencephalomalacia; and the hippocampus, for Negri bodies associated with Rabies virus infection. Consideration should be given to collecting samples of other tissues including, but not limited to, the spinal cord and liver for ancillary testing if warranted.
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Affiliation(s)
- Andrew L Allen
- Department of Veterinary Pathology and Prairie Diagnostic Services Inc., Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Buschmann J, Fuhst R, Tillmann T, Ernst H, Kolling A, Pohlmann G, Preiss A, Berger-Preiss E, Hansen T, Kellner R, Rusch GM. Unexpected brain lesions in lactating Sprague-Dawley rats in a Two-generation Inhalation Reproductive Toxicity Study with pentafluoropropane (HFC-245fa). ACTA ACUST UNITED AC 2013; 65:875-82. [PMID: 23332645 DOI: 10.1016/j.etp.2012.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/29/2012] [Revised: 10/19/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
Abstract
The study presented was conducted following the reproductive study guideline OECD Guideline 416 Two-Generation Reproduction Toxicity Study. Sprague-Dawley rats were exposed to 2000, 10,000 and 50,000 ppm of HFC-245fa. There was an unexpected mortality of lactating dams in the medium and high dose group beginning at day 10 of lactation. Statistically significant histopathological alterations were observed in the cerebellum of a total of 9/30 females of the high dose group of the F0-generation and in 10/27 females of the high dose group of the F1-generation. In contrast there were no brain lesions found in males or non-pregnant females of all dose groups. Neuronal necrosis and degeneration in the cerebellar cortex were observed as the most severe finding. Furthermore vacuolation of the neuropil in different degrees was diagnosed in 7/30 females of the F0-generation and in 9/30 females of the F1-generation. Acute hemorrhages - in particular perivascular - occurred in 5/30 females of the F0- and in 5/30 females of the F1-generation indicating a disturbed vascular integrity. The main lesions found in the cerebrum were glial scars in the corpus callosum and restricted to 2/30 females of the F0-generation of the high dose group. The increased incidence of myocardial fibrosis and mononuclear cell infiltration in males - indicating myocarditis - was only seen in the F0-generation of the high dose group. Females of the F1-generation of the high dose group showed an increased incidence of minimal myocardial fibrosis. In summary, histopathology revealed that the brain, particularly the cerebellum, and to a minor degree the heart turned out to be the toxicological target organs of the substance. Presumably substance-related energy deprivation may be responsible for the observed changes. One of the metabolites, 3,3,3-trifluoropropanoic acid has been shown to be capable of causing this effect.
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Affiliation(s)
- J Buschmann
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany.
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