scholarly journals MRI diagnosis of cortical dysplasia in the immature brain

2020 ◽  
Vol 12 (1) ◽  
pp. 36-50
Author(s):  
M. V. Polyanskaya ◽  
A. A. Demushkina ◽  
F. A. Kostylev ◽  
F. A. Kurbanova ◽  
I. G. Vasilyev ◽  
...  
Keyword(s):  
Young Children ◽  
Focal Epilepsy ◽  
High Amplitude ◽  
Immature Brain ◽  
Diagnostic Significance ◽  
Mri Scans ◽  
Mri Protocol ◽  
Cortical Dysplasias ◽  
Mri Diagnosis ◽  
T2 Weighted Images

Introduction. Cortical dysplasias (CDs) encompass a wide variety of disorders that in most cases lead to epilepsy, especially in infants and young children. MRI diagnosis of CDs is a major part of presurgical examination of pediatric patients with resistant focal epilepsy.Aim. To identify MR markers of CD in the immature brain and develop an MRI protocol for early diagnosis of CDs.Materials and methods. Children aged <2 y.o. (total 128) diagnosed with focal epilepsy were examined over 2017-2019. All MRI scans were performed using the GE 3 T system (General Electric, USA) in the standard MR sequences including T2WI FSE, T1 SE, FLAIR, DWI, SWAN, and FSPGR BRAVO supported with anesthesiological assistance. Аll patients were divided into 3 groups according to the degree of brain maturity; of those, 28 patients had MR signs of CD.Results. The rate of detection of small-size cortical malformations, such as nodular heterotopies or focal cortical dysplasias was significantly higher in groups of patients whose brains (according to MR images) were at the infantile or adult phases of myelination. In children with the isointensive phase myelination, only large cortical dysplasias could be identified. In the first phase, the focal malformations had low amplitude signals in T2-weighted images and high amplitude signals in T1, unlike those in adult patients. In the isointensive phase, the quality of visualization was significantly reduced and provided poor diagnostic information.Conclusion. The results confirm the diagnostic significance of early (before age of 5 months) MRI testing in cases with suspected CD-associated focal epilepsy. However, at the period between 5 and 12 months of age, MR imaging was ineffective for CD diagnosing. Later, in the period from 12 to 15 months, the MRI ability to identify the CDs gradually increased. We consider the standard T2 weighted images with high TR values, the most effective MR modality for diagnosing CDs in young children.

scholarly journals Diagnostic significance of clinical and para-clinical signs of community-acquired pneumonia in children

2020 ◽  
Vol 24 (2) ◽  
pp. 244-249
Author(s):  
V.Yu. Pasik
Keyword(s):  
Young Children ◽  
Sensitivity And Specificity ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
The Body ◽  
Diagnostic Methods ◽  
Statistical Hypothesis ◽  
Diagnostic Significance ◽  
Operational Characteristics ◽  
Gallbladder Dyskinesia

Annotation. Respiratory diseases are relevant in pediatric practice, which is associated with its widespread and frequent complications, especially in young children. The aim of the study was to assess the diagnostic value of clinical symptoms, laboratory and ultra-sonographic parameters in pneumonia in children of the first 3 years of life. A retrospective study of medical records of 218 children who were hospitalized in the department for young children diagnosed with pneumonia for the period from 2016 to 2018. The average age of children was 11.67±9.97 months and it was within the range from 1 month to 3 years. The ration of boys and girls was practically identical (51.8% and 48.2% accordingly). The first group included children aged under one year (the average age is 4.57±0.84 months; n=88). The second group included children aged from 1 to 3 years (the average age is 18.2±4.25 months; n=130). To characterize the information content of clinical and laboratory symptoms the study has used objective parameters defined as the operational characteristics of tests. The most important operational characteristics of diagnostic methods included: sensitivity (Se, sensitivity) and specificity (Sp, specificity). To check the statistical hypothesis on differences of absolute and relative frequencies, fractions, and ratios in two independent samples, the criteria of хі-square (χ2) was used. While detailing an anamnesis, the disease was more often related to untimely treatment and outpatient care. Various data were obtained on the absolute and relative risk, as well as the sensitivity and specificity of the localization of pneumonia depending on age. Therefore, the incidence of bilateral pneumonia was considered an indicator of risk. On admission to hospital, the body temperature of patients was 38.2±0.66°С. Most of the complaints were on the unproductive or productive cough. Besides, in some cases, shortness of breath and runny nose were mentioned. Thus, in young children with pneumonia, a diagnostically significant clinical symptom is a bilateral lung impression (82.6%), compared with right-handed (15.1%) and left-handed (2.3%), which is significantly more common in children under 1-th year of life compared with patients 1–3 years; laboratory features are probably higher levels of liver-specific enzymes – ALT and AST in children under 1 year; ultrasonographic indicators associated with the presence of pneumonia in young children include increased liver size, gallbladder deformity, the presence of sediment in the gallbladder, dyskinesia of the biliary tract, thickening of the gallbladder wall; children under 1 year of age have a risk of liver enlargement and biliary dyskinesia.

scholarly journals MRI Surveillance of Plastic Material Surgical Meshes: Experimental Model - Interim Results

2021 ◽  
Vol 58 (3) ◽  
pp. 231-238
Author(s):  
Adrian Carabineanu ◽  
Ramona Gadea ◽  
Dan Costachescu ◽  
Adelina Mocanu ◽  
Dan Navolan ◽  
...  
Keyword(s):  
Experimental Model ◽  
Plastic Material ◽  
Accurate Determination ◽  
Subcutaneous Fat ◽  
Modern Technology ◽  
Surrounding Tissue ◽  
Abdominal Wall Defects ◽  
Surgical Meshes ◽  
Mri Scans ◽  
Mri Protocol

The number of surgical procedures for abdominal wall defects is increasing, often requiring the insertion of plastic material meshes. Surveillance of patients with inserted plastic meshes requires an accurate determination of the position of the mesh. However, this is a difficult task, depending on the kind of mesh, magnetic resonance imaging (MRI) protocol or consistence of the surrounding tissue (fat, muscle, aponeurosis). The aim of our research was to develop an experimental model to test the ability of MRI to identify the exact position of surgical plastic meshes: polypropylene or polyester. To simulate the placement of a mesh in human body we developed a model built up from two pieces of tissue with dimensions of 40 cm x 20 cm, harvested from a pig with a weight of 120 kg. The meshes were situated for MRI evaluation between the two pieces: abdominal pig muscle respectively suprajacent abdominal pig wall subcutaneous fat, approximately 2 cm high. Five surgical meshes were scanned through six MRI sequences, in view of establishing an optimal MRI scanning protocol and best visible meshes. The MRI scans were evaluated by 5 radiologists with different degrees of training. Our results showed that the experimental model developed by us can be successfully used to test the ability of MRI to visualize different kind of plastic meshes. Also, our experiment has revealed that T1fl2D sequence is the best in highlighting meshes from surrounding tissue, and the best visualized Mesh was number 4, made of polyester. In conclusion, based on our experimental model, we should select a plastic mesh or MRI protocol which will allow an optimal post implantation monitoring. Modern technology of material�s fabrication can help to better identify the mesh itself using MRI scanning.

Efficacy and safety of lacosamide in infants and young children with refractory focal epilepsy

2014 ◽  
Vol 18 (1) ◽  
pp. 55-59 ◽  
Author(s):  
Salvatore Grosso ◽  
Pasquale Parisi ◽  
Alberto Spalice ◽  
Alberto Verrotti ◽  
Paolo Balestri
Keyword(s):  
Young Children ◽  
Focal Epilepsy ◽  
Efficacy And Safety ◽  
Infants And Young Children

scholarly journals P.048 Characterization of somatic mutations in mTOR pathway genes in focal cortical dysplasias

2019 ◽  
Vol 46 (s1) ◽  
pp. S26-S27
Author(s):  
E Krochmalnek ◽  
A Accogli ◽  
J St-Onge ◽  
N Addour ◽  
R Dudley ◽  
...  
Keyword(s):  
Somatic Mutations ◽  
Focal Epilepsy ◽  
Mtor Pathway ◽  
High Yield ◽  
Structural Abnormalities ◽  
Causal Variants ◽  
Cortical Dysplasias ◽  
Custom Panel ◽  
The Brain

Background: Focal cortical dysplasias (FCDs) are congenital structural abnormalities of the brain, and represent the most common cause of medication-resistant focal epilepsy in children and adults. Recent studies have shown that somatic mutations (i.e. mutations arising in the embryo) in mTOR pathway genes underlie some FCD cases. Specific therapies targeting the mTOR pathway are available. However, testing for somatic mTOR pathway mutations in FCD tissue is not performed on a clinical basis, and the contribution of such mutations to the pathogenesis of FCD remains unknown. Aim: To investigate the feasibility of screening for somatic mutations in resected FCD tissue and determine the proportion and spatial distribution of FCDs which are due to low-level somatic mTOR pathway mutations. Methods: We performed ultra-deep sequencing of 13 mTOR pathway genes using a custom HaloPlexHS target enrichment kit (Agilent Technologies) in 16 resected histologically-confirmed FCD specimens. Results: We identified causal variants in 62.5% (10/16) of patients at an alternate allele frequency of 0.75–33.7%. The spatial mutation frequency correlated with the FCD lesion’s size and severity. Conclusions: Screening FCD tissue using a custom panel results in a high yield, and should be considered clinically given the important potential implications regarding surgical resection, medical management and genetic counselling.

scholarly journals Flow-metabolism uncoupling in patients with asymptomatic unilateral carotid artery stenosis assessed by multi-modal magnetic resonance imaging

2018 ◽  
Vol 39 (11) ◽  
pp. 2132-2143 ◽  
Author(s):  
Jens Göttler ◽  
Stephan Kaczmarz ◽  
Michael Kallmayer ◽  
Isabel Wustrow ◽  
Hans-Henning Eckstein ◽  
...  
Keyword(s):  
Contralateral Side ◽  
Blood Oxygenation ◽  
Carotid Revascularization ◽  
Asymptomatic Patients ◽  
Metabolic States ◽  
Oxygenation Level ◽  
Mri Scans ◽  
Mri Protocol ◽  
Revascularization Therapy ◽  
Continuous Arterial Spin Labeling

Oxygen extraction (OEF), oxidative metabolism (CMRO2), and blood flow (CBF) in the brain, as well as the coupling between CMRO2 and CBF due to cerebral autoregulation are fundamental to brain's health. We used a clinically feasible MRI protocol to assess impairments of these parameters in the perfusion territories of stenosed carotid arteries. Twenty-nine patients with unilateral high-grade carotid stenosis and thirty age-matched healthy controls underwent multi-modal MRI scans. Pseudo-continuous arterial spin labeling (pCASL) yielded absolute CBF, whereas multi-parametric quantitative blood oxygenation level dependent (mqBOLD) modeling allowed imaging of relative OEF and CMRO2. Both CBF and CMRO2 were significantly reduced in the stenosed territory compared to the contralateral side, while OEF was evenly distributed across both hemispheres similarly in patients and controls. The CMRO2-CBF coupling was significantly different between both hemispheres in patients, i.e. significant interhemispheric flow-metabolism uncoupling was observed in patients compared to controls. Given that CBF and CMRO2 are intimately linked to brain function in health and disease, the proposed easily applicable MRI protocol of pCASL and mqBOLD imaging might serve as a valuable tool for early diagnosis of potentially harmful cerebral hemodynamic and metabolic states with the final aim to select clinically asymptomatic patients who would benefit from carotid revascularization therapy.

P236 Utility of TMS for presurgical motor and language mapping in young children with refractory focal epilepsy and brain tumor

2020 ◽  
Vol 131 (4) ◽  
pp. e151-e152
Author(s):  
S. Narayana ◽  
S. Fulton ◽  
A. McGregor ◽  
B. Mudigoudar ◽  
S. Weatherspoon ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Young Children ◽  
Focal Epilepsy ◽  
Language Mapping ◽  
Motor And Language Mapping

Tolosa-Hunt syndrome: Focus on MRI Diagnosis

Cephalalgia ◽  
1999 ◽  
Vol 19 (25_suppl) ◽  
pp. 36-38 ◽  
Author(s):  
J Pascual ◽  
L Cerezal ◽  
A Canga ◽  
A Alvarez de Arcaya ◽  
JM Polo ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Hunt Syndrome ◽  
Mri Scans ◽  
Ihs Criteria ◽  
Mri Diagnosis ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Study ◽  
Conventional Ct ◽  
Ideal Technique ◽  
Abnormal Tissue

Experience with modern neuroimaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI) scans, in the diagnosis of Tolosa-Hunt syndrome (THS) is reviewed. Conventional CT scan remains normal in about two-thirds of these patients. In the reported 22 patients meeting the IHS criteria for a THS diagnosis on whom an MRI study was performed, MRI revealed a convex enlargement of the symptomatic cavernous sinus by an abnormal tissue isointense with gray matter on short TR/TE images and isohypointense on long TR/TE images. This abnormal tissue markedly increases in signal intensity after contrast injection. MRI seems also to be the ideal technique to follow progressive resolution of the abnormal tissue after steroids. Therefore, normal MRI would probably exclude THS, whereas in the appropriate clinical setting of steroid-responsive painful ophthalmoplegia, MRI showing the cavernous sinus abnormality described here suggests a diagnosis of THS. From these data, we propose that the fourth IHS criterion for THS diagnosis, “Exclusion of other causative lesions by neuroimaging and (not compulsory) carotid angiogram” should be changed to “Finding by MRI of specific cavernous sinus abnormalities (with the characteristics described herein) which slowly resolve with steroid treatment”.

The Nature and Fate of Punctate (Type IV) Cavernous Malformations

Neurosurgery ◽  
2001 ◽  
Vol 49 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Richard E. Clatterbuck ◽  
Ilhan Elmaci ◽  
Daniele Rigamonti
Keyword(s):  
Cavernous Malformation ◽  
Proton Density ◽  
Type I ◽  
Gradient Echo ◽  
Cavernous Malformations ◽  
Type Iv ◽  
Mri Scans ◽  
T1 And T2 ◽  
Over Time ◽  
T2 Weighted Images

Abstract OBJECTIVE Four types of cavernous malformations (Types I–IV) have been described on the basis of their magnetic resonance imaging (MRI) appearance. The nature of the Type IV cavernous malformation is unclear. It has been suggested that these small lesions, which are well observed only on gradient echo MRI scans, are capillary telangiectasias. We sought to understand the relationship of Type IV cavernous malformations to the other cavernous malformation subtypes. METHODS We examined serial MRI scans obtained between 1987 and 2000 from 68 patients with more than 228 cavernous malformations. Sixteen patients harbored Type IV cavernous malformations (total, &gt;114 Type IV lesions). Spin echo T1-weighted, T2-weighted, proton density, and (when available) gradient echo MRI scans were reviewed. Cavernous malformations that met the Zabramski criteria for Type IV (poorly observed on T1- and T2-weighted images) were reviewed in serial scans from individual patients to characterize their radiographic behavior over time. RESULTS Type IV cavernous malformations were best observed on gradient echo images and have an MRI appearance distinct from capillary telangiectasias. Proton density images demonstrate more Type IV lesions than T1- and T2-weighted images, but far fewer Type IV lesions than gradient echo images. When observed on T1- and T2-weighted images, Type IV cavernous malformations are generally punctate and hypointense. These lesions rarely enhance with gadolinium. Four of the Type IV cavernous malformations observed serially evolved into Type I and Type II cavernous malformations, for an approximate rate of progression of 0.05 per patient year. CONCLUSION Although most Type IV cavernous malformations remain stable over time, a small subset of these lesions progress into Types I and II cavernous malformations.

scholarly journals Spatiotemporal Patterns of High-Frequency Activity (80-170 Hz) in Long-term Intracranial EEG

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011408
Author(s):  
Zhuying Chen ◽  
David B. Grayden ◽  
Anthony N. Burkitt ◽  
Udaya Seneviratne ◽  
Wendyl J. D'Souza ◽  
...  
Keyword(s):  
Circadian Rhythms ◽  
High Frequency ◽  
Focal Epilepsy ◽  
High Amplitude ◽  
Oscillatory Behavior ◽  
Patient Specific ◽  
Intracranial Eeg ◽  
Large Variability ◽  
High Frequency Activity

Objective:To determine the utility of high-frequency activity (HFA) and epileptiform spikes as biomarkers for epilepsy, we examined the variability in their rates and locations using long-term ambulatory intracranial EEG (iEEG) recordings.Methods:This study used continuous iEEG recordings obtained over an average of 1.4 years from 15 patients with drug-resistant focal epilepsy. HFA was defined as 80-170 Hz events with amplitudes clearly larger than the background, which was automatically detected using a custom algorithm. The automatically detected HFA was compared with visually annotated high-frequency oscillations (HFOs). The variations of HFA rates were compared with spikes and seizures on patient-specific and electrode-specific bases.Results:HFA included manually annotated HFOs and high-amplitude events occurring in the 80-170 Hz range without observable oscillatory behavior. HFA and spike rates had high amounts of intra- and inter-patient variability. Rates of HFA and spikes had large variability after electrode implantation in most of the patients. Locations of HFA and/or spikes varied up to weeks in more than one-third of the patients. Both HFA and spike rates showed strong circadian rhythms in all patients and some also showed multiday cycles. Furthermore, the circadian patterns of HFA and spike rates had patient-specific correlations with seizures, which tended to vary across electrodes.Conclusions:Analysis of HFA and epileptiform spikes should consider post-implantation variability. HFA and epileptiform spikes, like seizures, show circadian rhythms. However, the circadian profiles can vary spatially within patients and their correlations to seizures are patient-specific.

scholarly journals Role of contrast-free MR-perfusion in the diagnosis of potential epileptogenic foci in children with focal epilepsia

2018 ◽  
Vol 10 (2) ◽  
pp. 6-18
Author(s):  
M. V. Polyanskaya ◽  
A. A. Demushkina ◽  
I. G. Vasiliev ◽  
H. Sh. Gazdieva ◽  
A. A. Kholin ◽  
...  
Keyword(s):  
Focal Epilepsy ◽  
Clinical Status ◽  
Brain Perfusion ◽  
Arterial Perfusion ◽  
Arterial Blood ◽  
Russian State ◽  
Epileptogenic Lesion ◽  
Mri Scans ◽  
Epileptogenic Foci

ASL (Arterial Spin Labeling) – a novel modality of MR angiography – is based on radio-frequency labeling of aqueous protons in the arterial blood; the method is used to monitor blood supply to  organs, including the brain. So far there has been little information on the use of ASL in children with focal epilepsy, especially in the pre-surgery period.Aim:to evaluate the perfusion patterns in seizure-free children with drug resistant focal epilepsy (FE) using the ASL mode of MRI.Materials and methods.We studied the ASL data of 54 (23-boys/31 girls) patients with FE  treated in the Dpt. of Neurology at the Russian State Children Hospital from 2015 to 2018. The  patients’ age varied from 4 months to 17 years. All images were produced with a 3T GE Discovery  750W system.Results. We found several brain perfusion patterns in children with FE; among other factors, those patterns depended on the clinical status of the patient, i. e. the interictal period or the early post- seizure period. The main pattern of the interictal period was characterized by a focal decrease in  perfusion located around a structural focus identified on MRI scans. In the early post-seizure  period, there was an increase in the arterial perfusion in the area of a structural epileptogenic lesion.Conclusion.ASL-MRI is an effective diagnostic method providing more information on children  with FE during their pre-surgery phase. The ASL modality needs further research to rationalize its wider use as a preferred diagnostic tool or as a combination with the more complex PET and SPECT.

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