Hiperplasia congênita de suprarrenal (CAH) compreende um grupo de transtornos hereditários decorrentes de erros inatos do metabolismo dos esteróides adrenais. O aumento das dimensões das glândulas suprarrenais é um marco morfológico na CAH que pode ser avaliado por métodos de imagem com signifitiva correlação com o controle hormonal dos pacientes. Porém, técnicas de imagem que forneçam informações qualitativas e quantitativas relativas à citoarquitetura das glândulas ainda não foram estabelecidas neste contexto. A difusão por ressonância magnética (DWI) é uma técnica que pode fornecer informações quantitativas dos tecidos através do valor do coeficiente de difusão aparente (ADC). O papel do ADC na avaliação de lesões tumorais adrenais já foi estudado, no entanto, o valor do ADC das glândulas suprarrenais normais ainda não foi descrito. O objetivo geral desta tese foi investigar a utilidade dos métodos de imagem na avaliação da CAH. Os objetivos específicos foram apresentar uma revisão dos métodos por imagem já estabelecidos para avaliação da CAH, validar o cálculo do ADC da glândula suprarrenal e avaliar se o ADC e as dimensões das glândulas suprarrenais poderiam auxiliar no manejo de pacientes com CAH, correlacionando-os com controle hormonal. Esta tese é baseada em artigos, nos quais estão mostrados a metodologia, resultados e discussões relativos a cada uma das etapas. O primeiro artigo, The role of imaging in congenital adrenal hyperplasia, trata de uma revisão sistemática de imagem em CAH, com ênfase em genitografia, ultrassonografia, tomografia computadorizada e ressonância magnética (MRI). O segundo artigo, Apparent Diffusion Coefficient (ADC) of the normal adrenal glands: premilinary results, teve como principal objetivo validar o método de medida do ADC das glândulas suprarrenais. No terceiro artigo, Quantitative magnetic resonance imaging in the evaluation of adrenal glands in children and young adults with congenital adrenal hyperplasia due to 21-hydroxylase deficiency, foram estudados os parâmetros quantitativos por MRI (ADC, volume e medidas lineares) das glândulas suprarrenais que poderiam estar relacionados ao controle hormonal dos pacientes com CAH. Medir o ADC das suprarrenais normais é factível e reprodutível. Em indivíduos saudáveis após a adrenarca o ADC é significativamente menor. Todavia, o ADC não foi capaz de diferenciar indivíduos controles de pacientes com CAH, assim como não apresentou correlação com o status hormonal dos pacientes. O volume e as medidas lineares das glândulas adrenais foram os melhores parâmetros quantitativos por MRI para diferenciar pacientes de indivíduos controles, com correlação positiva com o status hormonal recente dos pacientes com CAH. As dimensões das glândulas suprarrenais avaliadas por MRI podem ser utilizadas como ferramenta auxiliar no acompanhamento dos pacientes e mostrar rapidamente os efeitos da exposição a altos níveis de hormônio adrenocorticotrópico. Apesar de ocorrerem modificações celulares na CAH e de ter sido mostrado neste estudo que em pacientes sem doença hormonal conhecida o ADC é mais baixo após a adrenarca, estas alterações celulares que ocorrem na CAH não foram detectadas pelas medidas de ADC. / Congenital adrenal hyperplasia (CAH) is an autossomic recessive disorder caused by impaired steroidogenesis. A morphological hallmark in CAH is enlarged adrenal glands. Imaging studies have addressed mainly morphological aspects and dimensions of the adrenal glands, which correlate to the patients hormonal statuses. However, no imaging technique was used to evaluate changes in the adrenal glands at a cellular level in these patients. Diffusion-weighted magnetic resonance imaging (DWI) is a magnetic resonance imaging (MRI) technique with the ability to provide quantitative information about intracellular and extracellular space, given by the apparent diffusion coefficient (ADC) values. The role of ADC in evaluation of adrenal lesions has already been studied. However, ADC of the normal adrenals has not yet been described. The main purposes of this study were: to investigate the role of imaging in CAH, to validate the method of calculating ADC values of the normal adrenal glands and to assess hormonal status in patients with CAH and its correlation to quantitative MRI. This is an article-based thesis divided in three articles. The first article, The role of imaging in congenital adrenal hyperplasia, is a systematic review of imaging in congenital adrenal hyperplasia, with emphasis on genitography, ultrasonography, computed tomography and MRI. The article Apparent diffusion coefficient (ADC) of the normal adrenal glands: premilinary results aimed to validate the method of measuring ADC of the adrenal glands. The study of quantitative parameters (ADC, volume and linear measurements) of the adrenals evaluated by MRI that correlate with hormonal status in patients with CAH is described in the third article, Quantitative magnetic resonance imaging in evaluation of the adrenal glands in children and young adults with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Measuring ADC of the normal adrenal glands is feasible and reproducible. In healthy subjects, ADC values were significantly lower after adrenarche. However, neither a difference between ADC values of controls and patients, nor correlations with patients hormonal statuses were found. Volume and linear measurements of the adrenal glands were the best parameter to differentiate patients from controls. Moreover, a positive correlation was found between short-term hormonal control status and adrenal size. Adrenal size assessed by MRI might be a useful tool in the follow-up of patients with CAH. Although adrenal cell structure modifications in patients with CAH have been described, they were not detectable by DWI.

L'IRM joue un rôle important dans l'évaluation de l'AVC ischémique et la détermination des stratégies de traitement. L'IRM de diffusion et l’IRM de perfusion sont deux séquences essentielles dans l'évaluation de l'AVC ischémique. L'objectif principal de ce travail était d'explorer le rôle prédictif de l'IRM dans l'AVC ischémique, y compris le rôle des paramètres dérivés de l'IRM dans la prédiction de la viabilité des tissus ; la relation entre le volume lésionnel ischémique pré-traitement et le résultat fonctionnel ainsi que l'efficacité de la thrombectomie mécanique ; l'impact de la localisation ischémique pré-traitement sur le résultat fonctionnel après une thrombectomie mécanique. Nos résultats ont montré que le coefficient de diffusion apparent et le débit sanguin cérébral relatif étaient des candidats potentiels pour prédire la viabilité des tissus ; le volume lésionnel de prétraitement était un prédicteur indépendant pour le résultat fonctionnel ; le bénéfice clinique de l'adjonction de la thrombectomie mécanique à la thrombolyse diminuait avec l'augmentation du volume lésionnel; les patients ayant un gros volume lésionnel peuvent encore bénéficier du traitement ; la localisation ischémique a fourni également des informations pronostics importantes pour le résultat fonctionnel. Les résultats globaux de la thèse ont permis de mieux comprendre le rôle de l'IRM dans l'évaluation de l'AVC ischémique aigu, en particulier chez les patients traités par thrombectomie mécanique. Notre travail a fourni une nouvelle perspective dans l'application clinique de l'IRM et a permis de suggérer de futures recherches sur l'imagerie cérébrale ischémique / MRI plays an important role in evaluating ischemic stroke and determining the treatment strategies. Diffusion weighted imaging and perfusion weighted imaging are two essential sequences in ischemic stroke assessment. The principal objective of this work was to study the predictive role of MRI in ischemic stroke, including the role of MRI-derived parameters in tissue viability prediction; the relationship of the ischemic lesional volume and the functional outcome and mechanical thrombectomy efficacy; and the impact of the pretreatment ischemic location on functional outcome after mechanical thrombectomy. Our results suggested that apparent diffusion coefficient and relative cerebral blood flow were potential candidates to predict tissue viability; pretreatment lesional volume was an independent predictor for functional outcome; the clinical benefit of adding mechanical thrombectomy to thrombolysis decreased with the increase of lesional volume; however, patients with large lesional volume could still benefit from reperfusion treatment; the pretreatment ischemic location provided important prognostic information for functional outcome. The overall results of the thesis provided a better understanding of the role of MRI in acute ischemic stroke assessment, especially in patients treated with mechanical thrombectomy. Our work provided new perspective in clinical application of MRI and suggested future research of ischemic stroke imaging

Leucoencefalopatia com substância branca evanescente é uma doença geneticamente determinada, causada por mutação no gene do eIF2B. A idade varia do período pré-natal até idade adulta, as manifestações geralmente são desencadeadas por trauma ou infecção. Os sintomas são variáveis, incluem ataxia cerebelar, espasticidade e relativa preservação cognitiva. Os achados de ressonância magnética (RM) são típicos e caracterizam-se por extenso comprometimento da substância branca. Estudamos 10 pacientes, com evolução súbita ou progressiva dos primeiros sintomas, entre 1 a 12 anos de idade. Ataxia e espasticidade estavam presentes em todos os pacientes e funções cognitivas relativamente preservadas. A clínica associada à RM, que demonstrava comprometimento difuso da substância branca, permitiu o diagnóstico / Leukoencephalopathy with vanishing white matter is an inherited disorder caused by mutation in one of five subunits of eIF2B gene. Age of onset varies from prenatal to adulthood and manifestations are commonly triggered by trauma or infection. Symptoms are variable and include cerebellar ataxia and spasticity, with relative sparing of cognitive function. Magnetic resonance imaging (MRI) findings are typically characterized by widespread white matter abnormality. We studied 10 patients, with sudden or slowly progressive symptoms starting between 1-12 years of age. Ataxia and spasticity were present in all patients, and cognitive functions were relatively preserved. MRI studies demonstrated diffuse white matter abnormalities which, combined with clinical findings, allow diagnosis

<p>Akutni pankreatitis predstavlja zbirni pojam dinamičkih, lokalnih i sistemskih patofiziolo&scaron;kih procesa nastalih iznenadnim prodorom aktivnih litičkih pankreasnih enzima u žlezdani parenhim. Cilj istraživanja je da se Utvrditi senzitivnost difuzione sekvence magnetne rezonance (DWI) radi utvrđivanja morfolo&scaron;kih promena parenhima kod akutnog pankreatitisa. Poređenje difuzione mape i difuzionog koeficijenta kod pacijenata sa akutnim pankreatitisom i kod pacijenata sa morfolo&scaron;ki urednim parenhimom pankreasa na magnetnoj rezonanci. Utvrditi da li postoje statistički značajne razlike difuzionog koeficijenta kod pacijenata sa akutnim pankreatitisom u odnosu na pol. Utvrditi da li postoje statistički značajne razlike difuzionog koeficijenta kod pacijenata sa akutnim pankreatitisom u odnosu na godine. Odrediti prelomnu tačku difuzionog koeficijenta kod pacijenata sa akutnim pankreatitisom. Studija je bila prospektivnog karaktera i obuhvatilo je 30 ispitanika sa morfolo&scaron;ki urednim parenhimom pankreasa i 30 sa dijagnozom akutnog pankreatitisa unutar 72 sata od početka simptoma. Svi pacijenti su pregledani magnetnom rezonancom u Centru za radiologiju, Kliničkog Centra Vojvodine. Rezultati ukazuju da postoje razlike difuzionog koeficijenta kod pacijenata sa akutnim pankreatitisom i kontrolne grupe. Takođe smo dokazali da difuzioni koeficijent zavisi od pola i starosti i utvrdili smo prelomnu tačku difuzije za rano dijagnostikovanje akutnog pankreatitisa.</p> / <p>Acute pancreatitis is defined as cumulative term of dynamic local and general pathophysiological processes caused by sudden penetration of active lithic pancreatic enzymes in the glandular parenchyma. Goal of this research is to note the changes (sensitivity) in values of diffusion weighted images (DWI) in acute pancreatitis and to determine morphological changes in glandular parenchyma of pancreas. Comparation of DWI between patients with acute pancreatitis and patients with normal pancreatic parenchyma based on magnetic resonance (MRI). We also want to determine whether there were statistically significant differences of DWI in patients with acute pancreatitis in relation to sex and age. One of our goals also was to determine breakpoint of DWI as a sure sign of acute pancreatitis. This was prospective study and included 30 patients with morphologically healthy parenchyma of the pancreas (control group) and 30 with the diagnosis of acute pancreatitis &ndash; in first 72 hours of the onset of symptoms. All patients were examined on MRI in department of Radiology of Clinical Center of Vojvodina. Our results indicate that was a big difference of DWI between patients with acute pancreatitis and control group. We prove that DWI depends on the sex and age. 1,77x10-6mm/s2 was breakpoint which indicates acute pancreatitis.</p>

Diffusion Tensor Imaging (DTI) is a well-established magnetic resonance technique that can non-invasively interpret tissue geometry and track neural pathways by sampling the diffusion of water molecules in the brain tissue. However, it is currently limited to tracking large nerve fiber bundles and fails to faithfully resolve thinner fibers. Conventional DTI studies use a diffusion time, t[subscript diff] of 30 ms - 55 ms for diffusion measurements. This work proposes the use of DTI at long t[subscript diff] to enhance the sensitivity of the method towards regions of low diffusion anisotropy and improve tracking of smaller fibers. The Stimulated Echo Acquisition Mode (STEAM) sequence was modified to allow DTI measurements at long t[subscript diff] (approximately 200 ms), while avoiding T2 signal loss. For comparison, DTI data was acquired using STEAM at the shorter value of t[subscript diff] and with the standard Double Spin Echo sequence with matched signal-to-noise ratio. This approach was tested on phantoms and fixed monkey brains and then translated to in vivo studies in rhesus macaques. Qualitative and quantitative comparison of the techniques was based on fractional anisotropy, diffusivity, three-phase plots and directional entropy. Tensor-field maps and probabilistic connectivity fronts were evaluated for all three acquisitions. Comparison of the tracked nerve pathways showed that fibers obtained at long t[subscript diff] were much longer. Further, the optic tract was tracked in ex vivo fixed rhesus brains for cross validation. The optic tract, traced at long t[subscript diff], conformed to the well documented anatomical description, thus confirming the accuracy of tract tracing at long t[subscript diff]. The benefits of DTI at long t[subscript diff] indeed help to realize the potential of tensor based tractography towards studying neural development and diagnosing neuro-pathologies, albeit the improvement is more significant ex vivo than in vivo.

L'encéphalopathie associée au sepsis (EAS) est définie comme un dysfonctionnement cérébral diffus induit par une réponse systémique à une infection. Chez les patients septiques, l'imagerie par résonance magnétique (IRM) a indiqué à la fois des anomalies de la substance grise (SG) et blanche (SB) associées à des troubles cognitifs graves, y compris le delirium. Pour améliorer notre compréhension des changements hémodynamiques, métaboliques et structuraux associés au sepsis, différentes séquences d'IRM ont été réalisées chez des rats ayant subi une injection ip de solution saline ou de lipopolysaccharide bactérien (LPS) 2,5h plus tôt ou une ligature et ponction caecale 24h plus tôt. Après ip LPS, l'IRM de contraste de phase a été réalisée pour étudier le flux des artères cérébrales antérieures et moyennes et le marquage des spins artériels (ASL) pour étudier la perfusion des structures cérébrales de la SB et SG. Des séquences d'imagerie par diffusion pondérée (DWI) ont été utilisées pour évaluer les changements structurels. Après la chirurgie CLP, ASL a été utilisé pour étudier les changements de la microcirculation. L'imagerie pondérée en T2, l'imagerie du tenseur de diffusion (DTI) et les statistiques spatiales basées sur les faisceaux (TBSS) ont été réalisées pour caractériser les événements structurels dans différentes structures cérébrales. Après imagerie, les animaux ont été sacrifiés et leur cerveau a été traité pour l'histologie afin de détecter l'enzyme synthétisant les prostaglandines vasoactives cyclooxygénase-2 (COX-2) et le canal hydrique astrocytaire aquaporin-4 (AQP4) dont l'expression peut être régulée à la hausse, évaluer la présence d'immunoglobulines périvasculaires (Ig) indiquant une rupture de la barrière hémato-encéphalique (BHE) et étudier la morphologie des glies puisque la microglie et l’astroglie changent de morphologie lors des conditions inflammatoires. L'IRM n'a indiqué aucun changement hémodynamique dans la substance grise après l'administration de ip LPS, alors qu'une perfusion cérébrale accrue a été montrée au niveau du corps calleux comme indiqué par l'ASL. DTI a indiqué une augmentation de la diffusion des molécules d’eau parallèlement aux fibres du corps calleux. Ces changements étaient accompagnés d'une dégradation de BHE dans la SB ainsi que la substance grise corticale et striatale adjacente tel est indiqué par la présence périvasculaire d'IgG, sans aucun changement majeur de COX-2 vasculaire ou de morphologie des glies du coprs calleux. Le dysfonctionnement du SNC induit par le sepsis a résulté en une augmentation du contraste pondéré en T2 dans le cortex, le striatum et la base du cerveau, une diminution de la perfusion sanguine dans le cortex et une augmentation de la diffusion hydrique du corps calleux et du striatum ventral. Ces changements ont été associés dans la SB à des modifications de la morphologie des glies et dans la substance grise à une expression constitutive de COX-2 et AQP4 plus faible dans le cortex cérébral. La comparaison entre CLP ayant subit ou non une IRM sous anesthésie à l'isoflurane a montré une réponse inflammatoire réduite tel est indiqué par l'expression de COX- 2, une activation réduite des glies ainsi qu’une lésion réduite de la BHE dans le CLP subissant une IRM sous anesthésie. Collectivement, nos résultats suggèrent que des changements hémodynamiques peuvent survenir en l'absence de flux altéré dans les artères irriguant le cerveau antérieur. Ensuite, l'altération de la structure de la SB est une étape précoce de la pathogenèse de l’EAS qui peut résulter soit de la dégradation de la BHE, soit de l'activation des glies. Cette étude sous-tend l'effet délétère d'une seule exposition à l'anesthésie à l'isoflurane qui peut être atténuée par une seconde exposition chez les rats ayant subi une laparotomie ainsi que les effets de l'inflammation systémique induite par le CLP sur les glies pouvant être atténués par imagerie sous anesthésie à l'isoflurane. / Sepsis-associated encephalopathy (SAE) refers to central nervous system dysfunction during the systemic inflammatory response to infection. In septic patients with encephalopathy MRI has indicated both gray and white matter abnormalities that were associated with worse cognitive outcome including delirium. To improve our understanding of sepsis-associated hemodynamic, metabolic, and structural changes, different MRI sequences were performed in rats that either underwent an i.p injection of saline or bacterial lipopolysaccharide (LPS) 2.5h earlier or cecal ligation and puncture (CLP) 24h earlier. After ip LPS, phase contrast MRI was performed to study anterior and middle cerebral arteries flow and Arterial Spin Labeling (ASL) to study perfusion of white and grey matter brain structures. Diffusion Weighted Imaging (DWI) sequences was used to assess structural changes. After CLP surgery, ASL was used to study microcirculation changes. T2-Weighted Imaging, Diffusion Tensor Imaging (DTI) and tract-based spatial statistics (TBSS) were performed to characterize structural events in different brain structures. After imaging, animals were sacrificed and their brains processed for histology to detect the vasoactive prostaglandin-synthesizing enzyme cyclooxygenase-2 (COX-2) and the astrocytic aquaporin-4 water channel (AQP4) the expression of which can be upregulated during inflammation, to assess the presence of perivascular immunoglobulins (Ig) indicating blood-brain barrier (BBB) leakage and to study glia cell morphology as both microglia and astrocytes are known to change their morphology in inflammatory conditions. Magnetic resonance rat brain imaging indicated no hemodynamic changes in the grey matter after ip LPS administration while an increased CBF was shown in corpus callosum white matter as indicated by ASL. DTI indicated increased water diffusion parallel to fibers of the corpus callosum white matter. These changes were accompanied by BBB breakdown in the white matter and adjacent cortical and striatal grey matter as indicated by the perivascular presence of IgG, but no major changes in vascular COX-2 or white matter glia cell morphology. CLP induced sepsis-associated CNS dysfunction resulted in higher T2-weighted contrast intensities in the cortex, striatum and base of the brain, decreased blood perfusion distribution to the cortex and increased water diffusion in the corpus callosum and ventral striatum compared to sham surgery. These changes were associated in the white matter with modifications in glia cells morphology and in the grey matter with lower expression of constitutive COX-2 expression and AQP4 in the cerebral cortex. The comparison between CLP that underwent or not MRI under isoflurane anesthesia indicated reduced inflammatory response as indicated by COX-2 expression, reduced glia activation and reduced BBB damage in CLP that underwent MRI under isoflurane anesthesia. Collectively, our results suggest that hemodynamic changes may occur in the absence of altered flow in forebrain irrigating arteries. Then, altered white matter structure is an early step in SAE pathogenesis that may result either from BBB breakdown or glial cells activation. This study underlies the deleterious effects of a single exposure to isoflurane anesthesia that may be mitigated by a second exposure in sham-operated rats and the effects of CLP-induced systemic inflammation on glial cells that can be attenuated by imaging under isoflurane anesthesia.

Hiperplasia congênita de suprarrenal (CAH) compreende um grupo de transtornos hereditários decorrentes de erros inatos do metabolismo dos esteróides adrenais. O aumento das dimensões das glândulas suprarrenais é um marco morfológico na CAH que pode ser avaliado por métodos de imagem com signifitiva correlação com o controle hormonal dos pacientes. Porém, técnicas de imagem que forneçam informações qualitativas e quantitativas relativas à citoarquitetura das glândulas ainda não foram estabelecidas neste contexto. A difusão por ressonância magnética (DWI) é uma técnica que pode fornecer informações quantitativas dos tecidos através do valor do coeficiente de difusão aparente (ADC). O papel do ADC na avaliação de lesões tumorais adrenais já foi estudado, no entanto, o valor do ADC das glândulas suprarrenais normais ainda não foi descrito. O objetivo geral desta tese foi investigar a utilidade dos métodos de imagem na avaliação da CAH. Os objetivos específicos foram apresentar uma revisão dos métodos por imagem já estabelecidos para avaliação da CAH, validar o cálculo do ADC da glândula suprarrenal e avaliar se o ADC e as dimensões das glândulas suprarrenais poderiam auxiliar no manejo de pacientes com CAH, correlacionando-os com controle hormonal. Esta tese é baseada em artigos, nos quais estão mostrados a metodologia, resultados e discussões relativos a cada uma das etapas. O primeiro artigo, The role of imaging in congenital adrenal hyperplasia, trata de uma revisão sistemática de imagem em CAH, com ênfase em genitografia, ultrassonografia, tomografia computadorizada e ressonância magnética (MRI). O segundo artigo, Apparent Diffusion Coefficient (ADC) of the normal adrenal glands: premilinary results, teve como principal objetivo validar o método de medida do ADC das glândulas suprarrenais. No terceiro artigo, Quantitative magnetic resonance imaging in the evaluation of adrenal glands in children and young adults with congenital adrenal hyperplasia due to 21-hydroxylase deficiency, foram estudados os parâmetros quantitativos por MRI (ADC, volume e medidas lineares) das glândulas suprarrenais que poderiam estar relacionados ao controle hormonal dos pacientes com CAH. Medir o ADC das suprarrenais normais é factível e reprodutível. Em indivíduos saudáveis após a adrenarca o ADC é significativamente menor. Todavia, o ADC não foi capaz de diferenciar indivíduos controles de pacientes com CAH, assim como não apresentou correlação com o status hormonal dos pacientes. O volume e as medidas lineares das glândulas adrenais foram os melhores parâmetros quantitativos por MRI para diferenciar pacientes de indivíduos controles, com correlação positiva com o status hormonal recente dos pacientes com CAH. As dimensões das glândulas suprarrenais avaliadas por MRI podem ser utilizadas como ferramenta auxiliar no acompanhamento dos pacientes e mostrar rapidamente os efeitos da exposição a altos níveis de hormônio adrenocorticotrópico. Apesar de ocorrerem modificações celulares na CAH e de ter sido mostrado neste estudo que em pacientes sem doença hormonal conhecida o ADC é mais baixo após a adrenarca, estas alterações celulares que ocorrem na CAH não foram detectadas pelas medidas de ADC. / Congenital adrenal hyperplasia (CAH) is an autossomic recessive disorder caused by impaired steroidogenesis. A morphological hallmark in CAH is enlarged adrenal glands. Imaging studies have addressed mainly morphological aspects and dimensions of the adrenal glands, which correlate to the patients hormonal statuses. However, no imaging technique was used to evaluate changes in the adrenal glands at a cellular level in these patients. Diffusion-weighted magnetic resonance imaging (DWI) is a magnetic resonance imaging (MRI) technique with the ability to provide quantitative information about intracellular and extracellular space, given by the apparent diffusion coefficient (ADC) values. The role of ADC in evaluation of adrenal lesions has already been studied. However, ADC of the normal adrenals has not yet been described. The main purposes of this study were: to investigate the role of imaging in CAH, to validate the method of calculating ADC values of the normal adrenal glands and to assess hormonal status in patients with CAH and its correlation to quantitative MRI. This is an article-based thesis divided in three articles. The first article, The role of imaging in congenital adrenal hyperplasia, is a systematic review of imaging in congenital adrenal hyperplasia, with emphasis on genitography, ultrasonography, computed tomography and MRI. The article Apparent diffusion coefficient (ADC) of the normal adrenal glands: premilinary results aimed to validate the method of measuring ADC of the adrenal glands. The study of quantitative parameters (ADC, volume and linear measurements) of the adrenals evaluated by MRI that correlate with hormonal status in patients with CAH is described in the third article, Quantitative magnetic resonance imaging in evaluation of the adrenal glands in children and young adults with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Measuring ADC of the normal adrenal glands is feasible and reproducible. In healthy subjects, ADC values were significantly lower after adrenarche. However, neither a difference between ADC values of controls and patients, nor correlations with patients hormonal statuses were found. Volume and linear measurements of the adrenal glands were the best parameter to differentiate patients from controls. Moreover, a positive correlation was found between short-term hormonal control status and adrenal size. Adrenal size assessed by MRI might be a useful tool in the follow-up of patients with CAH. Although adrenal cell structure modifications in patients with CAH have been described, they were not detectable by DWI.

Leucoencefalopatia com substância branca evanescente é uma doença geneticamente determinada, causada por mutação no gene do eIF2B. A idade varia do período pré-natal até idade adulta, as manifestações geralmente são desencadeadas por trauma ou infecção. Os sintomas são variáveis, incluem ataxia cerebelar, espasticidade e relativa preservação cognitiva. Os achados de ressonância magnética (RM) são típicos e caracterizam-se por extenso comprometimento da substância branca. Estudamos 10 pacientes, com evolução súbita ou progressiva dos primeiros sintomas, entre 1 a 12 anos de idade. Ataxia e espasticidade estavam presentes em todos os pacientes e funções cognitivas relativamente preservadas. A clínica associada à RM, que demonstrava comprometimento difuso da substância branca, permitiu o diagnóstico / Leukoencephalopathy with vanishing white matter is an inherited disorder caused by mutation in one of five subunits of eIF2B gene. Age of onset varies from prenatal to adulthood and manifestations are commonly triggered by trauma or infection. Symptoms are variable and include cerebellar ataxia and spasticity, with relative sparing of cognitive function. Magnetic resonance imaging (MRI) findings are typically characterized by widespread white matter abnormality. We studied 10 patients, with sudden or slowly progressive symptoms starting between 1-12 years of age. Ataxia and spasticity were present in all patients, and cognitive functions were relatively preserved. MRI studies demonstrated diffuse white matter abnormalities which, combined with clinical findings, allow diagnosis

INTRODUÇÃO: Os transtornos mentais psicóticos são condições frequentes na população geral e estão associados a grande morbidade e disfuncionalidade. Apesar disso, as bases fisiopatológicas destes transtornos ainda estão em investigação. Estudos neuropatológicos post-mortem e de neuroimagem in vivo sugerem haver comprometimento da microestrutura de substância branca (SB) cerebral nestas condições clínicas, associado a alterações da conectividade cerebral. No entanto, nenhuma investigação prévia de neuroimagem avaliou especificamente se tais anormalidades microestruturais podem ser dependentes do estado clínico do paciente, i.e., se tais alterações podem variar de acordo com a fase da doença. Outra linha de investigação biológica em psicoses aponta para alterações na atividade da fosfolipase A2 (PLA2), uma enzima essencial a diversas funções na homeostase cerebral, incluindo manutenção de membrana celular, mielinização e atividade inflamatória. Estudos prévios sugerem haver relação entre alterações na atividade desta enzima e as fases da esquizofrenia. Entretanto, não há estudos translacionais que tenham avaliado como tais alterações se relacionam com anormalidades microestruturais de SB em pacientes psicóticos. OBJETIVOS: Investigar a hipótese de que alterações de microestrutura de SB presentes em pacientes em fase aguda do primeiro episódio psicótico (PEP) sejam potencialmente reversíveis após estabilização clínica; investigar também possíveis alterações estado-dependentes da atividade de PLA2 no PEP; e examinar interações entre manifestações clínicas, microestrutura de SB cerebral e atividade de PLA2 na fisiopatologia do PEP. METODOLOGIA: Pacientes em PEP não afetivo foram avaliados em dois períodos no tempo: durante a fase aguda da doença (T0); após remissão estável de sintomas (T1). Um grupo controle de voluntários saudáveis (CS) também foi avaliado longitudinalmente. Para investigar alterações de microestrutura de SB estado-dependentes, análises voxel-a-voxel de mapas cerebrais de índices de anisotropia (fractional anisotropy, FA) e difusividade (trace, TR) foram conduzidas, assim como o cálculo de correlações entre tais índices de DTI, variáveis clínicas e atividade de PLA2. A atividade dos três principais subgrupos de PLA2 em plaquetas foi estimada através de um método radioenzimático. RESULTADOS: 25 pacientes PEP e 51 CS foram avaliados em T0, com coleta de dados clínico-demográficos, ressonância magnética (RM) e amostra de sangue. Destes, 21 PEP e 36 CS realizaram a segunda aquisição de RM. No baseline (T0), os pacientes PEP apresentaram redução difusa de FA (p < 0,05, FDR), afetando principalmente SB fronto-límbica e fascículos associativos, projetivos e comissurais. As análises longitudinais demonstraram que a remissão clínica se associou a aumentos de FA em tratos de SB acometidos em T0 (p < 0,001, não corrigido), além de robustas correlações inversas entre aumentos de FA e redução sintomas ao longo do tempo (p < 0,05, FDR). As análises de PLA2 não demostraram efeitos estado-dependentes ou correlações consistentes com os índices de DTI. CONCLUSÃO: Alterações da microestrutura de SB afetando tratos cerebrais essenciais para a integração de informação perceptual, cognição e emoções são detectáveis logo após o início do PEP e podem ser parcialmente revertidas em relação direta com a remissão de sintomas psicóticos agudos. Nossos achados reforçam a visão de que anormalidades de SB de tratos cerebrais são um componente neurobiológico central nos transtornos psicóticos agudos, e que a recuperação de tal patologia de SB pode levar à melhora clínica. Por outro lado, a atividade de PLA2 não parece ter associação direta com o estado de doença ou moderar as alterações microestruturais dinâmicas de SB aqui observadas. Estudos com amostras maiores e com um maior número de avaliações ao longo do tempo são necessários para confirmar e ampliar os resultados aqui apresentados / INTRODUCTION: Psychotic disorders are frequent conditions in the general population and are associated to severe morbidity and functional impairment. Notwithstanding, the pathophysiological basis of such disorders is still under investigation. Post-mortem neuropathologic investigations and in vivo neuroimaging studies have pointed to the occurrence of abnormalities in the microstructure of brain white matter (WM) in such clinical conditions, which are associated to changes in brain connectivity. However, no previous neuroimaging investigation has specifically examined whether such microstructural abnormalities would be state-dependent, i.e., whether such changes could relate to the illness phase. Another field of biological investigation in psychosis points to changes in the activity of phospholipase A2 enzyme (PLA2), which is essential to several functions implicated in brain homeostasis, such as the maintenance of cellular membrane, myelination and inflammatory activity. Previous studies suggest the existence of a relationship between changes on PLA2 activity and schizophrenia phase. Nonetheless, no translational study to date has examined the potential interplay between PLA2 activity and WM microstructural abnormalities in psychotic patients. OBJECTIVES: To investigate the hypothesis that WM microstructural changes observed in patients during the acute first-episode psychosis (FEP) are potentially reversible following clinical remission; to investigate possible state-dependent changes in PLA2 activity in FEP; and to examine interactions between clinical manifestations, brain WM microstructure and PLA2 activity in the pathophysiology of FEP. METODOLOGY: Patients with non-affective FEP were evaluated in two time points: during the acute phase (T0) and following sustained remission (T1). A control group of healthy volunteers (HC) was also longitudinally studied. In order to investigate state-dependent WM microstructure changes, voxelwise analyses of brain maps of anisotropy (fractional anisotropy, FA) and diffusivity (trace, TR) indexes were conducted, as well as correlations between such DTI metrics, clinical variables and PLA2 activity. The activity of the three main PLA2 subgroups was assessed in platelets using a radioenzymatic method. RESULTS: 25 FEP and 51 HC were evaluated at T0 (clinical and demographic data, MRI scanning, and blood collection). Out of these, 21 FEP and 36 HC also underwent a second MRI acquisition. At baseline (T0), FEP patients presented widespread reduction of FA (p < 0.05, FDR), affecting mainly fronto-limbic WM and associative, projective and commissural fasciculi. Longitudinal analyses showed that clinical remission was associated with FA increase in WM tracts that were affected at T0 (p < 0.001, uncorrected), besides robust inverse correlations between FA increase and symptoms reduction over time (p < 0.05, FDR). PLA2 analyses failed to show state-dependent effects or consistent correlations to DTI indexes. CONCLUSION: WM changes affecting brain tracts critical to the integration of perceptual information, cognition and emotions are detectable soon after the onset of FEP and may partially reverse in direct relation to the remission of acute psychotic symptoms. Our findings reinforce the view that WM abnormalities are a key neurobiological feature of acute psychotic disorders, and that recovery from such WM pathology can lead to amelioration of symptoms. In the other hand, it seems that PLA2 activity has no direct relationship to the disease state or modulatory effects on the dynamic WM changes observed herein. Studies with larger samples and with more time points evaluations are necessary to confirm and expand the findings reported herein

A lesão do plexo braquial é considerada a alteração neural mais grave das extremidades. A principal causa é o trauma de alta energia, especialmente acidentes envolvendo veículos a motor. Por este motivo, as lesões traumáticas do plexo braquial são cada vez mais frequentes. O presente estudo avaliou a acurácia da ressonância magnética (RM) no diagnóstico das lesões traumáticas do plexo braquial no adulto, utilizando o achado intraoperatório como padrão-ouro. Também foi avaliada a acurácia da neurografia pesada em difusão (neurografia DW) em relação à RM convencional e a capacidade de diferenciação dos três tipos de lesão: avulsão, ruptura e lesão em continuidade. Trinta e três pacientes com história e diagnóstico clínico de lesão traumática do plexo braquial foram prospectivamente estudados por RM. Os achados obtidos pela RM sem e com o uso da neurografia DW, e os achados de exame clínico foram comparados com os achados intraoperatórios. A análise estatística foi feita com associação de significância de 5%. Observou-se alta correlação entre a RM com neurografia DW e a cirurgia (rs=0,79), e baixa correlação entre a RM convencional e a cirurgia (rs=0,41). A correlação interobservador foi maior para a RM com neurografia DW (rs = 0,94) do que para a RM sem neurografia DW (rs = 0,75). Os resultados de sensibilidade, acurácia e valor preditivo positivo foram acima de 95% para as RM com e sem neurografia DW no estudo de todo o plexo. As especificidades foram, em geral, maiores para a neurografia DW (p < 0,05). Em relação à diferenciação dos tipos de lesão, a RM com neurografia DW apresentou altas acurácias e sensibilidades no diagnóstico da avulsão/rotura, e alta especificidade no diagnóstico da lesão em continuidade. A acurácia da RM (93,9%) foi significativamente maior que a do exame clínico (76,5%) no diagnóstico das lesões de todo o plexo braquial (p < 0,05). / Brachial plexus injury is considered the most severe neural disorder in the extremities and in general resulting from high-energy trauma in young patients, usually involving motor vehicles. For this reason, traumatic brachial plexus injuries are becoming more frequent. This study evaluated the accuracy of magnetic resonance imaging (MRI) in the diagnosis of traumatic brachial plexus injuries in adults, using surgical findings as the gold standard method. We also evaluated the accuracy of diffusion weighted image neurography (DW neurography) compared to conventional MRI and the ability to differentiate the three types of injuries by MRI: avulsion, rupture and lesion-in-continuity. Thirty-three patients with clinical history and diagnosis of traumatic brachial plexus injury were prospectively studied by MRI. MRI findings (obtained with and without use of DW neurography) and clinical examination were compared with intraoperative findings. The statistical analysis was performed with 5% significance association. There was high correlation between MRI with DW neurography and surgery (rs = 0.79) and low correlation between conventional MRI and surgery (rs = 0.41). The interobserver correlation was higher for MRI with DW neurography (rs = 0.94) than for regular MRI (rs = 0.75). The sensitivities, accuracies and positive predictive values were above 95% for MRI (with and without DW neurography) in the evaluation of the entire plexus. The specificities were generally higher for DW neurography (p < 0.05). Regarding the differentiation between types of lesions, MRI with DW neurography demonstrated high accuracies and sensitivities in the diagnosis of avulsion / rupture and high specificity in the diagnosis of lesion-in-continuity. MRI accuracy (93.9%) was significantly higher than clinical examination (76.5%) in diagnosis of brachial plexus traumatic lesions (p < 0.05).