{"id":5107,"date":"2015-12-18T10:26:46","date_gmt":"2015-12-18T10:26:46","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=5107"},"modified":"2016-01-15T13:01:15","modified_gmt":"2016-01-15T13:01:15","slug":"irm-functional-in-scleroza-laterala-amiotrofica","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/irm-functional-in-scleroza-laterala-amiotrofica\/","title":{"rendered":"IRM func\u021bional \u00een SCLEROZA LATERAL\u0102 AMIOTROFIC\u0102"},"content":{"rendered":"

Scleroza lateral\u0103 amiotrofic\u0103 (SLA) este o boal\u0103 neurodegenerativ\u0103 progresiv\u0103 caracterizat\u0103 de degenerarea celulelor nervoase la nivel cerebral \u0219i medular. SLA afecteaz\u0103 func\u021bia muscular\u0103 \u0219i nervoas\u0103, far\u0103 afectarea func\u021biilor mentale, auzului, v\u0103zului, mirosului \u0219i gustului. Scleroza lateral\u0103 amiotrofic\u0103 implic\u0103 neuronul motor central (UMN) \u0219i neuronul motor periferic (LMN).<\/p>\n

\u00cen 1993, cercet\u0103torii au asociat muta\u021bii ale genei SOD1<\/strong> la pacien\u021bii cu istoric familial de SLA. SOD1 este un puternic antioxidant ce protejeaz\u0103 corpul de ac\u021biunea distrug\u0103toare a radicalilor liberi. Studiile s-au focalizat \u0219i asupra rolului glutamatulu<\/strong>i \u00een degenerarea neuronal\u0103. Pacien\u021bii cu SLA au un nivel crescut de glutamat \u00een ser \u0219i \u00een LCR. S-a constatat c\u0103 neuronii \u00eencep s\u0103 moar\u0103 dac\u0103 sunt supu\u0219i perioade \u00eendelungate la glutamat (poate fi considerat un r\u0103spuns autoimun).<\/p>\n

Procesul de diagnostic diferen\u0163ial este esen\u0163ial \u00eentruc\u00e2t nu exist\u0103 markeri de diagnostic de laborator pentru SLA. Prin urmare, excluderea altor boli care pot mima SLA reprezint\u0103 o parte inclus\u0103 \u00een munca de diagnosticare. Diagnosticul diferen\u021bial: scleroz\u0103 multipla, radiculomielopatia cervical\u0103, radiculopatia lombar\u0103, Sd. Kennedy (atrofia musculara spino-bulbar\u0103 SBMA), leziuni nervoase periferice, polineuropatia multifocal\u0103. Unele infec\u021bii precum HIV, leucemia cu virus T sau Boala Lyme pot avea simptomatologie asem\u0103n\u0103toare cu cea a SLA.<\/p>\n

Metodele de investigare<\/strong> includ: teste de laborator (\u00eentruc\u00e2t nu exist\u0103 niciun test de s\u00e2nge care confirm\u0103 SLA, diagnosticarea acestei boli se realizeaz\u0103 dup\u0103 ce se exclud bolile care pot mima SLA), teste de electrodiagnostic: electromiografia (EMG) , stimulare magnetic\u0103 transcranian\u0103 \u0219i testul MUNE, punc\u0163ia lombar\u0103, evaluarea cantitativ\u0103 a mu\u0219chilor, biopsia muscular\u0103 \u0219i nervoas\u0103 \u0219i IRM.<\/p>\n

Diagnostic IRM func\u021bional \u00een SLA:<\/strong><\/p>\n

Introducerea secven\u021belor func\u021bionale de MRS<\/strong> (spectroscopie), DTI <\/strong>(imagistica tensorului de difuzie) \u0219i fMRI<\/strong> \u00een protocolul de scanare \u00een SLA permite detectarea precoce a alter\u0103rilor cortexului motor \u0219i a tracturilor piramidale.<\/p>\n

IRM<\/strong> conven\u021bional detecteaz\u0103 schimb\u0103rile morfologice \u00een substan\u021ba alb\u0103 \u0219i cenu\u0219ie. \u00cen caz de SLA prezent\u0103, pe imaginile de rezonan\u021b\u0103 magnetic\u0103 T2 \u0219i FLAIR se vizualizeaz\u0103 hipersemnal la nivelul tracturilor cortico-spinale.<\/p>\n

\u00cen 25% din cazuri boala debuteaz\u0103 \u00een teritoriul bulbar, iar 30% din celulele din cornul anterior ventricular sunt distruse \u00eenainte de apari\u021bia simptomatologiei (10% dintre pacien\u021bi sunt posibili SLA p\u00e2n\u0103 la deces).<\/p>\n

DTI<\/strong> (imagistica tensorului de difuzie) prezint\u0103 un mare poten\u021bial diagnostic, \u00een special pentru bolile neurologice precum hidrocefalia, demen\u021ba, traumatismele cerebrale, SLA etc. DTI este o tehnic\u0103 cantitativ\u0103 RM ce m\u0103soar\u0103 difuzia moleculelor de ap\u0103 \u00een \u021besutul nervos. \u00cen interiorul c\u0103ilor neuronale \u00eenconjurate de membrane nervoase, mi\u0219carea apei este directionat\u0103 (anizotrop\u0103), iar \u00een LCR este multidirec\u021bionat\u0103 (izotrop\u0103). Anizotropia frac\u021bional\u0103 (FA) se reduce odat\u0103 cu sc\u0103derea integrit\u0103\u021bii c\u0103ilor neuronale, iar difuzivitatea medie cre\u0219te odat\u0103 cu sc\u0103derea integrit\u0103\u021bii neuronale. Protocolul de achizi\u021bie a secven\u021bei DTI cu un num\u0103r ridicat de direc\u021bii de difuzie determin\u0103 cre\u0219terea senzitivit\u0103\u021bii metodei pentru SLA.<\/p>\n

DTI<\/strong> permite diferen\u021bierea pacien\u021bilor normali de cei cu SLA pe baza modific\u0103rilor valorilor FA la diferite nivele ale tracturilor cortico-spinale: sc\u0103dere FA \u00een capsul\u0103, peduncul \u0219i punte.<\/p>\n

Tractografia (DTT)<\/strong> reconstruie\u0219te tridimensional tracturile \u0219i permite vizualizarea fibrelor de substan\u021b\u0103 alb\u0103 comisurale, a celor de asocia\u021bie \u0219i a celor cortico-spinale.<\/p>\n

Spectroscopia IRM \u00a0(MRS) <\/strong>evalueaz\u0103 compozi\u021bia chimic\u0103 \u0219i integritatea neuronilor motori superiori de la nivelul creierului, \u00een special a neuronilor motori. MRS este o metod\u0103 neinvaziv\u0103 de detectarea a metaboli\u021bilor cerebrali precum NAA, Cho, Cr, Ins, Glx (glutamate+ glutamina). \u00cen 1995 Jones \u0219i colaboratorii au aplicat pentru prima dat\u0103 MRS la pacien\u021bii cu SLA \u0219i au g\u0103sit o reducere semnificativ\u0103 a raportului NAA\/Cr la nivelul cortexului motor \u0219i \u00een substan\u021ba alb\u0103 subcortical\u0103. MRS permite detectarea anomaliilor neuronului motor central \u0219i a pierderilor neuronale focale la pacien\u021bii cu SLA, pierderea neuronal\u0103 put\u00e2nd fi o cauz\u0103 real\u0103 a reducerii NAA (marker al disfunc\u021biei neuronale). Spectroscopia multivoxel aplicat\u0103 \u00eentr-un c\u00e2mp magnetic \u00eenalt permite eviden\u021bierea peak-urilor unor metaboli\u021bi precum Glu de GABA, metaboli\u021bi ce au o relevan\u021b\u0103 specific\u0103 \u00een patogenia SLA.<\/p>\n

La pacien\u021bii normali, raportul NAA\/Cr are valori cuprinse \u00eentre 2,1-2,9, iar la pacien\u021bii cu SLA este sub valoarea de 1,8. Raportul \u00a0NAA\/Cr scade \u00een SLA datorit\u0103 pierderii neuronale, iar raportul \u00a0Glx\/Cr cre\u0219te, determin\u00e2nd gradul bolii.<\/p>\n

MRS aduce rezultate cantitative la pacien\u021bii cu SLA\u00a0 \u0219i de aceea reprezint\u0103 o\u00a0 prioritate \u00een practica clinic\u0103.<\/p>\n

fMRI<\/strong> detecteaz\u0103 activit\u0103\u021bile corticale corespunz\u0103toare unor task-uri (task motor) \u0219i se bazeaz\u0103 pe participarea pacientului \u00een timpul scan\u0103rii. Tehnica resting state (rs-fMRI<\/em><\/strong>) <\/em>detecteaz\u0103 fluctua\u021biile \u00een diferite arii corticale \u00een timpul odihnei (nu sunt necesare task-uri) \u0219i vizualizeaz\u0103 diferite re\u021bele func\u021bionale precum re\u021bele neurosenzoriale, vizuale etc. De asemenea, metoda este capabil\u0103 s\u0103 detecteze diferen\u021bele \u00een activitatea cerebral\u0103 la pacien\u021bii cu SLA.<\/p>\n

Concluzie: <\/strong><\/p>\n

fMRI+ DTI<\/strong> ofer\u0103 un protocol de screening pentru identificarea pacien\u021bilor cu risc de SLA;<\/p>\n

MRS + DTI<\/strong> permit detectarea degener\u0103rii axonale la nivelul \u00a0tracturilor cortico-spinale, iar valoarea FA \u0219i a raportului NAA\/Cr calculate \u00een diferite regiuni ale CST permit evaluarea gradului de degenerare (valori semnificativ sc\u0103zute la pacien\u021bii cu SLA).<\/p>\n

\n

Fizician Lumini\u0163a P\u0102UN<\/p>\n

MEDINST Diagnostic
\nRom\u00e2no-German<\/p>\n

\"MADinst\"<\/a><\/p>\n

Medinst Diagnostic Rom\u00e2no-German func\u021bioneaz\u0103 din anul 1997 \u00een cadrul Institutului Na\u021bional de Neurologie \u0219i Boli Neurovasculare Bucure\u0219ti.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Scleroza lateral\u0103 amiotrofic\u0103 (SLA) este o boal\u0103 neurodegenerativ\u0103 progresiv\u0103 caracterizat\u0103 de degenerarea celulelor nervoase la nivel cerebral \u0219i medular. SLA afecteaz\u0103 func\u021bia muscular\u0103 \u0219i nervoas\u0103, far\u0103 afectarea func\u021biilor mentale, auzului, […]<\/p>\n","protected":false},"author":6,"featured_media":5150,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[33,277],"tags":[442],"class_list":["post-5107","post","type-post","status-publish","format-standard","has-post-thumbnail","category-articole","category-neurologie","tag-medinst"],"yoast_head":"\nIRM func\u021bional \u00een SCLEROZA LATERAL\u0102 AMIOTROFIC\u0102 - Jurmed - Medici<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/medici\/irm-functional-in-scleroza-laterala-amiotrofica\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"IRM func\u021bional \u00een SCLEROZA LATERAL\u0102 AMIOTROFIC\u0102 - Jurmed - Medici\" \/>\n<meta property=\"og:description\" content=\"Scleroza lateral\u0103 amiotrofic\u0103 (SLA) este o boal\u0103 neurodegenerativ\u0103 progresiv\u0103 caracterizat\u0103 de degenerarea celulelor nervoase la nivel cerebral \u0219i medular. 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