Orientador: Fernando Cendes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T23:00:31Z (GMT). No. of bitstreams: 1 Bovi_AnaCarolinaNunes_M.pdf: 869097 bytes, checksum: 13486e80f1bc1dfd4cfb4d480a9031d0 (MD5) Previous issue date: 2011 / Resumo: Epilepsia do Lobo Temporal (ELT) é uma doença que apresenta atrofia das estruturas mesiais temporais, como resultado da esclerose mesial temporal (EMT), presente em 60-70% dos casos em que a cirurgia é a mais recomendada. A ELTM associada EMT possui um alto grau de refratariedade, em que pequena percentagem de indivíduos alcança o controle das crises, uma vez que a causa do EMT é desconhecida. Muitos estudos mostram que a atrofia do hipocampo contralateral ao foco epileptogênico também sofre alterações. A ressonância magnética tem sido uma ferramenta fundamental para o diagnóstico e quantificação dessas mudanças. Assim, o estudo avaliou 60 pacientes, sendo 30 indivíduos em tratamento medicamentoso e 30 em tratamento cirúrgico, com o objetivo de avaliar e quantificar essas alterações morfológicas encontradas nas estruturas envolvidas na ELTM por meio de um software manual que permite o traçado das estruturas e a sua associação com os achados clínicos da doença, a fim de elucidar o impacto dos tratamentos clínico e cirúrgicos. Os resultados mostraram que o grupo controle não apresentou progressão da atrofia tanto o hipocampo considerado menor (p = 0,533), o hipocampo considerado maior (p = 0,494) e nem do corpo caloso (p = 0,260). A análise do grupo clínico identificou uma redução no volume do hipocampo, tanto ipsilateral quanto contralateral nos dois subgrupos, refratários e benignos, e em relação ao hipocampo ipsilateral (atrófico) ocorreu redução volumétrica significativa no subgrupo benigno (p = 0,001) e também no subgrupo refratário (p = 0,003). O hipocampo contralateral ao foco epileptogênico no grupo CLR apresentou um grau significativo de atrofia (p = 0,001) sendo que o mesmo ocorreu com o subgrupo CLB (p = 0,011). No grupo cirúrgico (CX), o hipocampo contralateral (remanescente/saudável) mostrou uma progressão de atrofia que foi pronunciada em ambos os casos, sendo para o subgrupo CX sem controle de crises (CXR) (p = 0,001) e para o subgrupo CX com controle de crises após a cirurgia (CXB) (p = 0,002). A comparação do volume do hipocampo na RM1 entre os dois subgrupos não revelou diferenças significativas tanto para o hipocampo ipsilateral (p = 0,852) e para o hipocampo contralateral (p = 0,290), afirmando que os pacientes foram igualmente selecionados para a cirurgia. A análise pareada entre os grupos revelou uma diminuição significativa no volume do corpo caloso para o 4 subgrupos / Abstract: Temporal Lobe Epilepsy (TLE) is a condition that is associated to atrophy of the mesial temporal structures as a result of mesial temporal sclerosis (MTS), present in 60 to 70% of patients who undergo surgery. The MTLE associated with MTS has a high degree of resistance to antiepileptic drugs, as a small proportion of individuals can achieve seizure control. Many studies show that the atrophy of the hippocampus contralateral to the epileptogenic focus also undergoes changes. The MR imaging has been a fundamental tool for the diagnosis and quantification of these changes. Thus the study investigate 60 patients, being 30 individuals in drug treatment and 30 in surgical treatment, with the objective of assessing and quantifying these morphological changes found in structures involved in MTLE by means of a software which enables the tracing of the structure; and the association of these volumes with the clinical findings, in order to elucidate on the different responses to medical and surgical treatments. The results shown that the control group had no progression of atrophy of either hippocampus (p > 0.05) or corpus callosum (p = 0.260). The analysis of clinical group identified a reduction in the volume of the hippocampi, both the ipsilateral (affected) and the contralateral in both subgroups, resistant and benign. In relation to the hippocampus ipsilateral there was significant volumetric reduction in the benign group (p = 0.001) and also in the refractory group (p = 0.003). The hippocampus contralateral to the epileptogenic focus in the CLR group presented a significant atrophy (p = 0.001) and the same occurred to CLB (p = 0.011). In the surgery group (SG), the contralateral hippocampus (healthy remnant) showed a progression of atrophy that was pronounced in both the subgroup who continued with seizures after surgery (p = 0.001) and the subgroup who became seizure-free after surgery (p = 0.002). The paired analysis between the subgroups revealed a significant decrease in volume of the corpus callosum for the 4 subgroups / Mestrado / Neurociencias / Mestre em Fisiopatologia Médica

L’analyse statistique de la forme de structures anatomiques est un enjeu essentiel pour de nombreuses applications: modélisation de la variabilité normale et pathologique, prédiction de paramètres cliniques et biologiques à partir de données anatomiques… Ces dernières années ont vu l’émergence de grandes bases de données en neuroimagerie, offrant une puissance statistique considérablement accrue. Cette thèse a pour thème l’étude statistique de la variabilité anatomique de l’hippocampe sur de grandes populations. Après un état de l’art, la première partie de la thèse porte sur l’étude d’une variante anatomique appelée inversion incomplète de l’hippocampe (IHI). Pour ce faire, nous avons mis au point une échelle de cotation de ces IHI. Elle a été ensuite appliquée à 2000 sujets sains et jeunes de la base de données IMAGEN. Les résultats ont permis de montrer que les IHI sont fréquentes chez les sujets sains, avec une prédominance à gauche. C’est la première fois que les IHI sont étudiés sur une telle population. La seconde partie de la thèse porte sur la mise au point d’une méthode d’analyse statistique de formes utilisant les grandes déformations difféomorphiques et les courants mathématiques, utilisable pour l’analyse de grandes populations. Nous avons en particulier introduit une nouvelle approche rapide pour construire des prototypes anatomiques. Cette approche a été validée sur 1000 sujets sains jeunes de la base de données IMAGEN et 294 sujets (sujets sains âgés et patients atteints de maladie d’Alzheimer) de la base ADNI. Les résultats montrent que la méthode permet de représenter la variabilité anatomique de l’hippocampe avec un nombre raisonnable de dimensions. / Statistical shape analysis of anatomical structures is a key challenge for many applications: modeling of the normal and pathological variability, prediction of clinical or biological parameters from anatomical data... Recent years have seen the emergence of large databases in neuro-imaging, potentially increasing the statistical power of new studies. This thesis is about the statistical analysis of the anatomical variability of hippocampi in large populations. After a state of the art, the first part of the thesis focuses on the study of an anatomical variant named Incomplete Hippocampal Inversion (IHI). We developed a new robust scale for IHI assessments. We then applied the evaluation to 2000 young healthy subjects from the European database IMAGEN. Results show that IHI are frequent on healthy population, with a left side predominance. This is the first time that IHI are studied on a large database composed of healthy subjects. The second part of this thesis develops a method for the statistical analysis of shapes based on Large Diffeomorphic Deformations Metric Mapping and mathematical currents, applicable for the analysis of large datasets. In particular we have introduced a new fast approach for the estimation of anatomical templates. This approach has been validated on 1000 young healthy subjects of the IMAGEN database and on 294 subjects from the ADNI database (healthy aging subjects and patients with Alzheimer disease). Results show that the method allows the modeling of the anatomical variability of hippocampi with a reasonable number of dimensions.