Взаимосвязь клинико-анамнестических характеристик больных классической тригеминальной невралгией с анатомическими характеристиками нейроваскулярного конфликта

Introduction. Classical trigeminal neuralgia (TN) is a common disease, largely diagnosed by measuring the anatomical parameters of the trigeminal nerve and the adjacent artery using MRI. For an adequate assessment the significance of the identified changes, it may be necessary to adjust for the individual characteristics of the patient, such as gender, age, duration of the TN, and clinical severity of TN.The aim of the study was to identify the relationship of anatomical changes in the intercisternal portions of the trigeminal nerves and adjacent arteries with the clinical and anamnestic data of patients with classic trigeminal neuralgia.Materials and methods. The FIESTA MR sequences of 133 patients were analyzed: 86 patients with verified trigeminal neuralgia (55±11 years) and 47 patients of the control group (51±16 years). The cross-sectional areas (CSA) and diameter ratio of nerves, diameters of adjacent arteries and neurovascular distances were measured in the context of gender, age, duration and therapy of neuralgia.Results. After dividing the group of TN patients into three conditional age groups (up to 50 years old, 50–65 years old, and over 65 years old), the ANOVA analysis revealed a decrease in the CSA in older age groups (medians 3,2 mm2; 2,15 mm2; 1,85 mm2; p=0,0193) and an increase in the diameter of the adjacent artery (median 1 mm; 1,3 mm; 1,2 mm; p=0,018). At the same time, on the opposite sides of the TN, only a tendency towards a decrease in the CSA remained (median 4,45 mm2; 3,45 mm2; 3,05 mm2; p=0,0016). The CSA of the nerves in the operated patients were less than ones in the patients with conservative treatment (median 2,9  mm2 and 2  mm2; p<0,05). In patients with TN, right-sided lesion prevailed. The duration of the TN was 9±7,8 years (from 1 year to 33 years) for patients who had an accurately documented date of manifestation of TN (N=56), no direct correlations of the MR-parameters with the duration of TN were found. A simple correlation analysis between MR-parameters and the patients age revealed a linear relationship only for the decrease of the CSA: on the right side (p=0,014) in patients with TN and on both sides in control patients (р=0,005–0,013).Conclusion. Theas data make it possible to more clearly distinguish significant MR changes in TN, taking into account the clinical and anamnestic data of patients.The revealed MR patterns of an increase in the caliber of the adjacent artery and a decrease in the CSA, which are pathognomonic for a clinically significant neurovascular conflict, are often asymptomatic age-related changes in elderly patients, which reduces their potential diagnostic value. In connection with this circumstance, the comparison of seemingly significant anatomical changes with similar ones on the opposite side of the lesion is of exceptional importance. Введение. Классическая тригеминальная невралгия (ТН) — распространенное заболевание, во многом диагностируемое измерением анатомических параметров тройничного нерва и прилежащей артерии при помощи МРТ. Для адекватной оценки значимости выявленных изменений может потребоваться поправка на индивидуальные особенности пациента — пол, возраст, длительность течения и клиническую выраженность ТН.Цель исследования: выявление взаимосвязи анатомических изменений интерцистернальных порций тройничных нервов и прилежащих артерий с клинико-анамнестическими данными больных классической ТН.Материалы и методы. Проанализированы МР-последовательности FIESTA 133 пациентов — 86 больных с верифицированной ТН (55±11 лет) и 47 пациентов группы контроля (51±16 лет). Оценены площади сечений и отношения диаметров нервов, диаметры прилежащих артерий и нейроваскулярные расстояния в контексте пола, возраста, длительности течения и терапии невралгии.Результаты. При групповом анализе ANOVA (до 50 лет, 50–65 лет и старше 65 лет) выявлено возрастное уменьшение площади сечения тройничных нервов (медианы 3,2 мм2; 2,15 мм2; 1,85 мм2; p=0,0193) и увеличение диаметра прилежащих артерий (медианы 1 мм; 1,3 мм; 1,2 мм; p=0,018) у больных невралгией. При этом на противоположенных поражению сторонах сохранялась только тенденция к уменьшению сечения нерва (медианы 4,45 мм2; 3,45 мм2; 3,05 мм2; p=0,0016). Площади сечений нервов у прооперированных больных оказались меньше таковых у  больных, получающих консервативное лечение (медианы 2,9  мм2 и  2  мм2; p<0,05).У больных ТН преобладало правостороннее поражение. Продолжительность течения ТН составила 9±7,8 года (от 1 года до 33 лет) для пациентов, имевших точно задокументированную дату манифестации ТН (n=56), прямые корреляции измеренных МР-параметров с продолжительностью ТН выявлены не были. При простом корреляционном анализе между МР-параметрами и возрастом больных линейную обратную зависимость удалось выявить только для площади сечения тройничного нерва справа (р=0,014), но в группе контроля — с обеих сторон (р=0,005–0,013).Заключение. Полученные результаты позволяют четче выделить значимые МР-изменения при ТН с учетом клинико-анамнестических данных больных. Выявленные патогномоничные для клинически значимого нейроваскулярного конфликта МР-паттерны увеличения калибра прилежащей артерии и уменьшения сечения тройничного нерва зачастую являются асимптомными возрастными изменениями у пожилых пациентов, что снижает их потенциальную диагностическую ценность. В связи с данным обстоятельством исключительную значимость приобретает сравнение кажущихся значимыми анатомических изменений с аналогичными на противоположенной поражению стороне исследования.

Геолого-геофизические модели земной коры Беломорья

The study of the White Sea region and the adjacent area aimed to model the structure of the crystalline portion of the crust at the contact of the northeastern slope of the Fennoscandian Shield and the Russian Plate. Modeling was based on geological, geophysical and DSS profile data, State Geological Map of the Russian Federation (scale 1:1 000 000), Explanatory Notes to Sheets Q-35, 36, 37, and 38 (third generation, 2009), and Tectonic Map of the White Sea and Adjacent Areas (2012). A model was constructed using GIS INTEGRO software (VNIIgeosystems), specifically its procedures for calculation and visualization of 2D and 3D models showing crust density and magnetic fields. The model of the study area shows the structure of the crust and the characteristics of its horizons.Объектом изучения является район Белого моря и прилегающей суши – Беломорье, расположенный на сочленении северо-восточного склона Фенноскандинавского щита и Русской плиты. Цель представляемой работы – составление на основе комплексного анализа геолого-геофизических данных модели строения кристаллической части земной коры региона. Для анализа использованы данные по профилям ГСЗ (глубинное сейсмическое зондирование), материалы Госгеолкарты РФ масштаба 1:1 000 000 и Объяснительных записок к листам Q-35, 36, 37, 38 (третье поколение, 2009), а также Тектоническая карта Белого моря и прилегающих территорий (2012). Моделирование проводили программным комплексом ГИС «INTEGRO», разработанным отделением ВНИИгеосистем, который включает процедуры, необходимые для расчета плотностных и магнитных моделей и их 2D- и 3D-визуализации. В результате показана структура земной коры, приведены характеристики ее горизонтов

CLINICAL USE OF PROTON MAGNETIC RESONANCE SPECTROSCOPY IN BRAIN TUMORS AND ADJACENT TISSUES

Magnetic resonance spectroscopy (MRS) is a noninvasive technique to measure the concentration of chemical substances, which estimates biochemical changes in health and different diseases in vivo. The technique opens up a wide range of possibilities for both primary diagnosis and evaluation of the efficiency of further treatment – medical or surgical one. This review of literature is dedicated to proton MRS used in different tumors of the brain, its tunics, and adjacent nerves. It contains and systematizes data related to the problems of primary diagnosis, differential diagnosis, and evaluation of the efficiency of treatment for tumors and gives references to both basic researches in this area and recent investigations

MAGNETIC RESONANCE CHARACTERISTICS OF THE NEUROVASCULAR RELATIONSHIP AS A PROBABLE PREDICTOR OF TRIGEMINAL NEURALGIA

Objective. To validate MR-criteria used for diagnosis of trigeminal neuralgia (TN).Material and methods. Study population consisted of 133 patients: with trigeminal neuralgia (86, surgically (56) and clinically (30) verified; 55 ± 11 years) and control group (47; 51 ± 16 years). The data were obtained using the FIESTA sequence (slice thickness 0.5 mm) on 3T and 1.5T (Discovery 750w and Optima 450w, General Electric).Results. The diameters of the adjacent vessels on the symptomatic side were significantly bigger than the diameters on the asymptomatic side in patients with neuralgia (medians 1.2 and 1 mm, p<0.001). The shortest distances between nerves and vessels on the symptomatic side were significantly smaller than the distances on the asymptomatic side (medians 0 and 1.6 mm, p<0.001). The distances between points of closest neurovascular contact and pons on the symptomatic side were significantly smaller in comparison with the controls (medians 2.7 and 5.3 mm, p<0.001); the distances between the symptomatic and asymptomatic side were not statistically different (medians 2.7 and 3.9 mm, p=0.09) in this parameter. The lengths of closest neurovascular contact was bigger in patient with TN (medians 3 and 0 mm, p<0.05), as well as in comparison with the asymptomatic side (medians 3 and 0 mm, p<0.0001). Conclusion. Noninvasive MR-measurements of the posterior cranial fossa vessels show the differences between the symptomatic and asymptomatic side in the patients with TN as well as healthy individuals. This result may be used as a predictor of TN

Magnetic Resonance Spectroscopy in the Diagnosis and Prognosis of Breast Cancer

Objective. To evaluate the efficiency of magnetic resonance spectroscopy in the diagnosis and prognosis of breast cancer (BC).Material and methods. Twenty-eight patients aged 37 to 80 years with established primary invasive BC were examined. Its grade was determined according to pathomorphological verification with immunohistochemical analysis. Breast MRI was performed using the standard protocol, by determining the measured diffusion coefficient (MDC), dynamic contrast enhancement (DCE). Proton magnetic resonance spectroscopy was carried out using the Breeze software package. The clinical and morphological findings and the results of radiation studies were compared to determine Nottingham prognostic index (NPI) scores. To identify the Spearman rank correlation coefficient between MRI findings (the type of pharmacokinetic curves, the total choline-containing (tCho) peak integral) and the values characterizing tumor size and grade.Results. NPI calculation showed that the scoring range was 2.4 to 6.76; the expected 5-year survival rates reached 93%. The mean MDC was 0.856×10-3 mm2/sec; type II pharmacokinetic curve prevailed (n=16; 57.1%). There was a statistically significant negative correlation between the values of MDC, the type of a contrast agent accumulation curve, the levels of HER2/neu and the proliferation marker Ki-67; there was a statistically significant strong positive correlation between the presence of 1H-MPC tCho peak and the indicators determining tumor malignancy (the levels of HER2/neu and Ki-67). Statistically significant differences between the type of a pharmacokinetic curve in DCE and the level of tCho in the prognostic groups defined when calculating NPI were determined in patients with moderate (n=4; 14.2%) and poor (n=10; 35.7%) prognosis.Conclusion. The capabilities of MR spectroscopy are superior in information content to the data obtained by determining the MDC, the nature of contrast medium accumulation in breast tumor, and are comparable with the data determining the type of a tumor (the presence of the HER2/neu gene, Ki-67 proliferation marker) in predicting BC cancer grade and 5-year survival rates

Estimation of the Diagnostic Value of the Shape of Trigeminal Nerves and Their Neurovascular Relationships in the Diagnosis of Trigeminal Neuralgia

Objective: to estimate the diagnostic value of the anatomical characteristics of the intracisternal portions of the trigeminal nerves and adjacent arteries in diagnosing classical trigeminal neuralgia (TN).Material and methods. Fast Imaging Employing Steady-state Acquisition (FIESTA) using an isotropic MRI sequence was used to analyze the anatomical characteristics of the intracisternal portions of the trigeminal nerves and adjacent arteries in 133 patients, including 86 patients aged 55±11 years with clinically and surgically verified TN and in 47 patients aged 51±16 years in the control group. The investigators measured the cross-sectional areas of the trigeminal nerves at 5 mm from the pons cerebelli, the ratio of the largest-to-smallest nerve diameters at similar points, the distance to the adjacent arteries, and that between the closest neurovascular contact (NVC) point and the pons cerebelli. Characteristic curves (CC) were constructed and reference points with the highest specificity were selected with an acceptable sensitivity level for all parameters. Positive and negative predictive values (PPV and NPV, respectively) are determined for each reference point.Results. The area under the CC was equal to 0.77 for the ratio to the diameters of the trigeminal nerves near the pons cerebelli. At a reference point of 1.89, the sensitivity/specificity (Se/Sp) ratio was 0.57/0.82 with a PPV of 0.74 and an NPV of 0.83. The area under the curve for the cross-sectional areas of the trigeminal nerves at the pons cerebelli was 0.76. The reference point with an area of 3.65 mm2 yielded a Se/Sp ratio of 0.52/0.8 with a PPV of 0.51 and an NPV of 0.91. The distance to the adjacent artery gave an area under the CC of 0.72. The Se/Sp ratio at a reference point of 1.65 mm turned out to be 0.53/0.789 at a PPV of 0.55 and an NPV of 0.92. The area under the CC for the distances between the NVC point and the pons cerebelli was 0.75. The reference point of 4.05 mm with a Se/Sp index of 0.6/0.78 was characterized by a PPV of 0.77 and an NPV of 0.94.Conclusion. All the analyzed anatomical parameters showed an acceptable diagnostic value in diagnosing TN. Certain reference values of the parameters can be used to diagnose TN with the highest acceptable specificity at the maximum NPV to reduce frequent false-positive results

Detection of Toxicity of heavy metal pollution in soils based on their respiratory activity in native soils and simulated substrates (a case-study of the protected area “YAMSKAYA steppe”)

The area “Yamskaya Steppe” of “Belogorye” preserve is located in Belgorod Oblast near the concentration of mining factories: Lebedinskiy and Stoylenskiy mining and concentration complex (MCC), complexes of “KMA-ore” and Oskol metallurgical, TPP etc. Taking into account that the “Yamskaya Steppe” is a SPNR and along with that bears a significant technogenic burden, it is necessary to investigate the properties of dominating soils and to provide the assessment of its contamination by heavy metals (HM). The main purpose of the work was to assess the toxicity of contamination of the soils of “Yamskaya Steppe” by HM in correlation to the investigated respiration activity of microorganisms of native soils of monitoring areas (MA) and artificially created mixes of soils with the dust from shops of factories, containing high concentrations of HM. The investigation of the native soils did not show the correlation of the basal respiration and the type of the soil. However weak and single case showed the correlation of basal breath and the type land use. Only in two soils of the whole 21 soils from the investigated MA the signs of disturbance of functioning of microbial community were revealed. The measurement of the bulk forms of HM showed relative increase in concentrations of Сu, Zn, Zr, Sn, Pb, As on these MA. The experiments with artificial mixtures allowed us to conclude that the implementation of the dust with HM, taken from the shops of Lebedinskiy MCC, affect the microbial activity. That causes the intensification of СО2 emission as incase of measuring of basal respiration rate and in case of substrata-induced respiration. However, that impact might be possible only in conditions of equal amount of the soil and dust in artificial mixtures, but this is impossible in natural conditions. It is necessary to find more senstive indicators of HM contamination for the investigated soils

Geological-geophysical models of the crust for the White Sea region

The study of the White Sea region and the adjacent area aimed to model the structure of the crystalline portion of the crust at the contact of the northeastern slope of the Fennoscandian Shield and the Russian Plate. Modeling was based on geological, geophysical and DSS profile data, State Geological Map of the Russian Federation (scale 1:1 000 000), Explanatory Notes to Sheets Q-35, 36, 37, and 38 (third generation, 2009), and Tectonic Map of the White Sea and Adjacent Areas (2012). A model was constructed using GIS INTEGRO software (VNIIgeosystems), specifically its procedures for calculation and visualization of 2D and 3D models showing crust density and magnetic fields. The model of the study area shows the structure of the crust and the characteristics of its horizons