Obrazowanie tensora dyfuzji u pacjentów z chorobą Alzheimera i łagodnymi zaburzeniami poznawczymi

A wide range of imaging studies provides growing support for the potential role of diffusion tensor imaging (DTI) in evaluating microstructural white matter integrity in Alzheimer disease (AD) and mild cognitive impairment (MCI). Our review aims to present DTI principles, post-processing and analysis frameworks and to report the results of particular studies. The distribution of AD-related white matter abnormalities is widely discussed in the light of deteriorated connectivity within certain tracts due to secondary white matter degeneration; primary alterations are also assumed to contribute to the pattern. The question whether it is more effective to assess the whole-brain diffusion or to directly concentrate on specific regions remains an interesting issue. Assessing white matter microstructure alterations, as evaluated by group-level differences of tensor-derived parameters, may be a promising neuroimaging tool for differential diagnosis between AD, MCI and other cognitive disorders, as well as being particularly helpful in the interpretation of underlying pathological processes.Rosnąca liczba badań naukowych wskazuje na znaczenie obrazowania tensora dyfuzji (DTI) w ocenie mikrostrukturalnej integralności istoty białej w chorobie Alzheimera (ChA) i łagodnych zaburzeniach poznawczych (ŁZP). W niniejszej pracy przeglądowej omówiono zasady obróbki danych oraz analizy DTI i przedstawiono wyniki poszczególnych badań prezentujących różne modele charakterystycznych dla ChA zmian w istocie białej. Szeroko dyskutowane jest rozmieszczenie uszkodzeń w istocie białej, głównie w odniesieniu do wtórnego zwyrodnienia poszczególnych włókien wskutek zaniku istoty szarej lub pierwotnego zwyrodnienia istoty białej. Interesujący i nierozstrzygnięty pozostaje dylemat, czy bardziej efektywne jest obrazowanie zmian dyfuzji w całym mózgu, czy skupianie się na konkretnych strukturach. Zastosowanie DTI w ocenie mikrostrukturalnych zmian zachodzących w istocie białej mózgu może być obiecującym narzędziem w różnicowaniu pomiędzy ChA, ŁZP i innymi zaburzeniami poznawczymi; jest szczególnie przydatne przy interpretacji leżących u ich podłoża procesów patologicznych

Thoracic Outlet Syndrome: A Significant Family Genetic Phenotypic Presentation

We report on a very rare case of diagnosis and successful surgical treatment of three young family members with a four-fold presentation of thoracic outlet syndrome. In the relevant family case, we are considering and discussing the population incidence, a possible HOX genes disorder, and a significant phenotypic presentation

Clinical Question Influence on Radiation Dose of Cardiac CT Scan in Children

Background: To assess the impact of different clinical questions on radiation doses acquired during cardiac computed tomography in children. Methods: A total of 116 children who underwent cardiac CT on a third-generation dual-source CT scanner were included. The clinical questions were divided into three main categories: the extent of scanning in the z-axis, coronary artery assessment and cardiac function assessment. Radiation dose values represented as a dose-length product (DLP) in mGy*cm were recorded from the CT scanner protocols. Results: There were significantly higher doses in cases with cardiac function assessment (median DLP 348 versus 59 mGy*cm, p p < 0.01). Conclusion: The most important factor was the assessment of cardiac function, where the median radiation dose was 4.3× higher in patients with a request for cardiac function assessment. We strongly recommend that clinical requests for cardiac CT should be carefully considered in the paediatric population

Cortical and subcortical atrophy in alzheimer disease: Parallel atrophy of thalamus and hippocampus

Avsikten med studien är att kvalitativt kartlägga konsekvenser av mobbning i skolan. Eftersom studien riktar sig till skolans studie- och yrkesvägledare är fokus lagd på vad som händer med individens självbild och inre trygghet samt självständighet och målsättningar i studie- och yrkesvalsprocessen. Ett av huvudsyftena är även kartläggning av mobbningens långsiktiga konsekvenser för individens arbetsliv. I studien har personer i åldrarna 26-50 år och som är uppvuxna i olika delar av landet intervjuats. De har under sin skoltid blivit utsatta för mobbning och är idag yrkesverksamma eller på väg ut i arbetslivet. Valda teorier kommer från använd kurslitteratur. Resultatet visar på stora likheter i konsekvenser för individernas självbild vad gäller självkänsla och självförtroende. Aspekter som påverkar individens inre trygghet och som påverkar studie- och yrkesvalsprocessen i form av tvekan att välja och svårigheter med självständigheten kommer fram. Senarelagd etablering och otrygghet i det sociala samspelet inom yrkeslivet kommer också fram som konsekvenser av mobbning.

Distinctive Patterns of Seizure-Related White Matter Alterations in Right and Left Temporal Lobe Epilepsy

Background: We hypothesized that right and left temporal lobe epilepsy (RTLE and LTLE, respectively) have distinctive spatial patterns of white matter (WM) changes that can be differentiated and interpreted with the use of multiple diffusion parameters. We compared the global microstructure of fiber bundles with regard to WM alterations in both RTLE and LTLE, addressing some of the methodological issues of previous studies. Methods: Diffusion tensor imaging data from 17 patients with RTLE (age: 40.7 ± 10.4), 15 patients with LTLE (age: 37.3 ± 10.4), and 15 controls (age: 34.8 ± 11.2) were used in the study. WM integrity was quantified by fractional anisotropy (FA), mean diffusivity (MD), longitudinal diffusivity (LD), and radial diffusivity (RD). The diffusion parameters were compared between the groups in tracts representing the core of the fiber bundles. The volumes of hippocampi and amygdala were subsequently compared across the groups, while the data were adjusted for the effect of hippocampal sclerosis. Results: Significantly reduced FA and increased MD, LD, and RD were found bilaterally over widespread brain regions in RTLE. An increase in MD and RD values was observed in widespread WM fiber bundles ipsilaterally in LTLE, largely overlapping with regions where FA was lower, while no increase in LD was observed. We also found a difference between the LTLE and RTLE groups for the right hippocampal volume (with and without adjustment for HS), whereas no significant volume differences were found between patients and controls. Conclusions: It appears that patients with RTLE exhibit a more widespread pattern of WM alterations that extend far beyond the temporal lobe in both ipsilateral and contralateral hemisphere; furthermore, these changes seem to reflect more severe damage related to chronic degeneration. Conversely, more restrained changes in the LTLE may imply a pattern of less severe axonal damage, more restricted to ipsilateral hemisphere. Comprehensive finding of more prominent hippocampal atrophy in the RTLE raises an interesting issue of seizure-induced implications on gray matter and WM microstructure that may not necessarily mean a straightforward causal relationship. Further correlations of diffusion-derived metrics with neuropsychological and functional imaging measures may provide complementary information on underlying WM abnormalities with regard to functional hemispheric specialization. © Copyright © 2019 Buksakowska, Szabó, Martinkovič, Faragó, Király, Vrána, Kincses, Meluzín, Šulc, Kynčl, Roček, Tichý, Charvát, Hořínek and Marusič