Quantitative magnetic resonance assessment of brain atrophy related to selected aspects of disability in patients with multiple sclerosis : preliminary results

Purpose: The aim of this volumetric study was to evaluate the relationship between brain atrophy quantification in multiple sclerosis (MS) patients and the progression of disability measured by neurological standardised tests. Material and methods: Seventeen patients (mean age 40.89 years) with clinically definite MS and 24 control subjects (mean age 38.45 years) were enrolled in the study. Brain examinations were performed on a 1.5T MR scanner. Automatic brain segmentation was done using FreeSurfer. Neurological disability was assessed in all patients in baseline and after a median follow-up of two years, using EDSS score evaluation. Results: In MS patients we found significantly (p < 0.05) higher atrophy rates in many brain areas compared with the control group. The white matter did not show any significant rate of volume loss in MS patients compared to healthy controls. Significant changes were found only in grey matter volume in MS subjects. At the follow-up evaluation after two years MS patients with deterioration in disability revealed significantly decreased cerebral volume in 14 grey matter areas at baseline magnetic resonance imaging (MRI) compared to MS subjects without disability progression. Conclusions: Grey matter atrophy is associated with the degree of disability in MS patients. Our results suggest that morphometric measurements of brain volume could be a promising non-invasive biomarker in assessing the volumetric changes in MS patients as related to disability progression in the course of the disease

A rare case of pancraniosynostosis observed in a historical skull from the 19 th century cranial collection named “Królestwo Polskie” (“Polish Kingdom”)

Rare diseases are a challenge in paleopathological research, mainly due to the ambiguity of skeletal signs, bad preservation state of the material, and lack of the reference material. The aim of our article is to present the skull characterized by the decreased values of the metrical traits and numerous pathological features of the cranial morphology and make an attempt to determine the possible cause of the observed anomalies. The subject of our study is a cranium No KP 131 belonging to Polish skeletal collection named „Polish Kingdom”. We used both standard anthropometric methods, as well as the imaging techniques to detect the probable causes of the observed pathological changes. This specimen presents a complex of pathologies. Decreased values of the metrical features, thinning of the lateral walls of the neurocranium and the presence of platybasia were probably caused by premature closure of all main cranial sutures. Pathologies observed in cranium No 131 XIX might have had a common cause in some form of syndromic disorders

Zapalenie krążka międzykręgowego oraz trzonów kręgów &#8212; opis przypadku

Autorzy przedstawili przypadek chorego z zapaleniem krążka międzykręgowego i przyległych trzonów kręgowych. Rozpoznanie kliniczne ustalono na podstawie współistnienia dolegliwości bólowych o charakterze korzeniowym, niedowładu wiotkiego kończyn dolnych, towarzyszących objawów procesu zapalnego oraz obrazu rezonansu magnetycznego. Czynnikami sprzyjającymi wystąpieniu schorzenia były marskość wątroby i cukrzyca. Etiologię choroby oraz kierunek leczenia ustalono na podstawie wyników badań bakteriologicznego krwi i antybiogramu. Autorzy zwrócili uwagę na szczególne znaczenie badań obrazowych w rozpoznaniu oraz ocenie wyników leczenia procesu zapalnego w obrębie krążków międzykręgowych. Polski Przegląd Neurologiczny 2010; 6 (1): 50&#8211;5

A rare case of pancraniosynostosis observed in a historical skull from the 19 th century cranial collection named “Królestwo Polskie” (“Polish Kingdom”)

Rare diseases are a challenge in paleopathological research, mainly due to the ambiguity of skeletal signs, bad preservation state of the material, and lack of the reference material. The aim of our article is to present the skull characterized by the decreased values of the metrical traits and numerous pathological features of the cranial morphology and make an attempt to determine the possible cause of the observed anomalies

Value of perfusion-weighted MR imaging in the assessment of early cerebral alterations in neurologically asymptomatic HIV-1-positive and HCV-positive patients.

BACKGROUND AND PURPOSE: Asymptomatic central nervous system (CNS) involvement occurs in the early stage of the human immunodeficiency virus (HIV) infection. It has been documented that the hepatitis C virus (HCV) can replicate in the CNS. The aim of the study was to evaluate early disturbances in cerebral microcirculation using magnetic resonance (MR) perfusion-weighted imaging (PWI) in asymptomatic HIV-1-positive and HCV-positive patients, as well as to assess the correlation between PWI measurements and the clinical data. MATERIALS AND METHODS: Fifty-six patients: 17 HIV-1-positive non-treated, 18 HIV-1-positive treated with combination antiretroviral therapy (cART), 7 HIV-1/HCV-positive non-treated, 14 HCV-positive before antiviral therapy and 18 control subjects were enrolled in the study. PWI was performed with a 1.5T MR unit using dynamic susceptibility contrast (DSC) method. Cerebral blood volume (CBV) measurements relative to cerebellum (rCBV) were evaluated in the posterior cingulated region (PCG), basal ganglia (BG), temporoparietal (TPC) and frontal cortices (FC), as well as in white matter of frontoparietal areas. Correlations of rCBV values with immunologic data and liver histology activity index (HAI) were analyzed. RESULTS: Significantly lower rCBV values were found in the right TPC and left FC as well as in PCG in HIV-1-positive naïve (p = 0.009; p = 0.020; p = 0.012), HIV-1 cART treated (p = 0.007; p = 0.009; p = 0.033), HIV-1/HCV-positive (p = 0.007; p = 0.027; p = 0.045) and HCV-positive patients (p = 0.010; p = 0.005; p = 0.045) compared to controls. HIV-1-positive cART treated and HIV-1/HCV-positive patients demonstrated lower rCBV values in the right FC (p = 0.009; p = 0.032, respectively) and the left TPC (p = 0.036; p = 0.005, respectively), while HCV-positive subjects revealed lower rCBV values in the left TPC region (p = 0.003). We found significantly elevated rCBV values in BG in HCV-positive patients (p = 0.0002; p<0.0001) compared to controls as well as to all HIV-1-positive subjects. There were no significant correlations of rCBV values and CD4 T cell count or HAI score. CONCLUSIONS: PWI examination enables the assessment of HIV-related as well as HCV-related early cerebral dysfunction in asymptomatic subjects. HCV-infected patients seem to reveal the most pronounced perfusion changes

Analysis of metabolic changes of brain in HIV-1 seropositive patients with proton magnetic resonance spectroscopy

Background: Asymptomatic central nervous system involvement may occur in the early stages of the HIV infection. The aim of the study was to evaluate early brain metabolic changes by means of proton MR spectroscopy (H1MRS) in the HIV-1 seropositive patients without neurological deficits or significant abnormalities in the plain MR study. Material/Methods: The H1MRS examinations were performed with the use of a MR GE Signa 1,5T system. There were 39 subjects examined, aged 21 to 57 years (mean age 35 years) were examined, including 25 patients infected with HIV-1 and 14 healthy volunteers who constituted a control group. The examinations were performed using the Single Voxel Spectroscopy technique with the PRESS sequence, with following parameters: TR=1500 ms, TE=35 ms, number of acquisitions =128, time of acquisition =3 min. 43 sec. Voxels of 8 cm3 (20×20×20 mm) in size were located in the following 5 regions: posterior cingulate gyrus, grey matter of the frontal area, left basal ganglia, white matter of the left parietal area and white matter of the frontal area. The NAA/Cr, Cho/Cr, mI/Cr ratios in the defined regions of interest were statistically analyzed. Results: There was a statistically significant decrease (p<0.05) in the NAA/Cr ratios in the posterior cingulate area and white matter of the left parietal area in HIV-1 seropositive patients, as compared to the control group. Other metabolite ratios in all the above mentioned locations showed no statistically significant differences, as was also the case for NAA/Cr ratios in grey matter of the frontal area, left basal ganglia and white matter of the frontal area. Conclusions: The reduction of NAA/Cr values revealed in H1MRS studies suggests loss of neurons/neuronal activity in the posterior cingulate area and white matter of the left parietal area, in patients with HIV-1 at the stage before clinical manifestations of retroviral infection and structural changes in the plain MR study. This may reflect a direct neurotropic activity of HIV

Clinical characteristics of studied patients.

<p>*IDU-intravenous drug users.</p><p>**cART-combination antiretroviral therapy.</p><p>***ADC stage-AIDS dementia complex stage.</p><p>****The Karnofsky Scale allows patients to be classified according to their functional impairment. The lower the Karnofsky score, the worse the survival for most serious illnesses.</p

Perfusion-weighted MR examination.

<p>Regions of interest (ROI) on a perfusion map of cerebral blood volume (CBV) were located in the following regions: bilateral temporoparietal cortices (<b>A</b>), bilateral frontal association cortices and the posterior cingulate gyrus region (<b>B</b>), bilateral frontoparietal white matter (<b>C</b>), bilateral basal ganglia regions (<b>D</b>).</p

Comparisons of rCBV measurements in the basal ganglia regions among HIV-1 naive, HIV-1 cART treated, HIV-1/HCV and HCV naive patients with the results of the post hoc Tukey LSD test (p values).

<p>G1-the group of HIV-1 positive non-treated (naive) patients.</p><p>G2-the group of HIV-1 positive cART treated patients.</p><p>G3-the group of HIV-1/HCV-positive non-treated (naive) patients.</p><p>G4-the group of HCV-positive non-treated (naive) patients.</p>a<p>statistically significant changes (p<0.05).</p>b<p>statistically significant changes with the Bonferroni correction (p<0.0055).</p

Mean values and standard deviations (SD) of rCBV values in different brain regions in HIV-1 as well as HCV-infected patients compared to the control group (CG) with the results of the post-hoc Tukey LSD test.

a<p>statistically significant changes (p<0.05).</p>b<p>statistically significant changes with the Bonferroni correction (p<0.0055).</p