{"id":5111,"date":"2015-12-18T10:48:12","date_gmt":"2015-12-18T10:48:12","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=5111"},"modified":"2016-01-15T13:00:30","modified_gmt":"2016-01-15T13:00:30","slug":"investigatii-neuroimagistice-speciale-aplicatii-in-patologia-neurologica","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/investigatii-neuroimagistice-speciale-aplicatii-in-patologia-neurologica\/","title":{"rendered":"Investiga\u021bii neuroimagistice speciale – aplica\u021bii \u00een patologia neurologic\u0103"},"content":{"rendered":"

I. PWI (PERFUSION WEIGHTED IMAGING)<\/strong>
\nPerfuzia IRM (PWI) aduce indicii asupra func\u021biei cerebrale prin m\u0103surarea unor parametri hemodinamici. Este o tehnic\u0103 imagistic\u0103 care permite m\u0103surarea volumului (CBV) \u0219i a debitului sangvin (CBF \u2013 raportul volum de s\u00e2nge\/timp), a timpului de \u00eenc\u0103rcare maxim\u0103 (TPP) \u0219i a timpului mediu de tranzit (MTT) la nivelul microcircula\u021biei cerebrale \u0219i a altor organe parenchimatoase.<\/p>\n

Aplica\u021bii ale PWI:<\/span><\/strong>
\n\u00cen stroke:<\/strong>
\n\u2022 delimiteaz\u0103 zona de \u201epenumbr\u0103\u201d de \u021besutul infarctat (core) eviden\u021biat prin DWI;
\n\u2022 \u201emismatch-ul\u201d \u00eentre PWI \u0219i DWI este un indicator important pentru ini\u021bierea tratamentului trombolitic \u00een managementul stroke-ului acut.<\/p>\n

\u00cen tumori cerebrale:<\/strong>
\n\u2022 face diagnosticul diferen\u021bial rest\/recidiv\u0103 tumoral\u0103 versus necroz\u0103 postiradiere, c\u00e2nd secven\u021bele conven\u021bionale IRM sunt echivoce;
\n\u2022 evalueaz\u0103 neovasculariza\u021bia intratumoral\u0103, care se coreleaz\u0103 cu gradul tumoral (diferen\u021biere glioame \u201clow grade\u201d de glioame \u201chigh grade\u201d);
\n\u2022 evalueaz\u0103 noninvaziv tumorile: prin combinarea mai multor parametri de difuzie \u0219i perfuzie (ADCmin, rCBV max) se pot diferen\u021bia tumori maligne intracerebrale gadolinofile;
\n\u2022 util\u0103 \u00een planningul preterapeutic, pentru optimizarea managementului pacientului (chimioterapie, radioterapie, chirurgie);
\n\u2022 evalueaz\u0103 precoce eficien\u021ba agen\u021bilor terapeutici, \u00een special a celor care suprim\u0103 cre\u0219terea vaselor de s\u00e2nge intratumorale.
\nAlte aplica\u021bii:<\/strong>
\n\u2022 boli inflamatorii \u0219i demielinizante;
\n\u2022 \u00een evaluarea bolilor neurodegenerative precum Alzheimer \u2013 rCBV redus \u00een regiunile temporale \u0219i parietale;
\n\u2022 \u00een cefaleea migrenoas\u0103 – s-a observat sc\u0103derea volumului \u0219i fluxului sangvin cerebral \u00een timpul aurei fa\u021b\u0103 de statusul post-aura.<\/p>\n

II. ANGIOGRAFIA<\/strong> prin tomografie computerizat\u0103 (CTA) \u0219i cea prin rezonan\u021b\u0103 magnetic\u0103 (MRA) sunt un set de tehnici imagistice neinvazive, capabile s\u0103 pun\u0103 \u00een eviden\u021b\u0103 circula\u021bia extra- \u0219i intracranian\u0103.
\nAceste tehnici angiografice se folosesc pentru evaluarea:
\n\u2022 anevrismelor \u0219i malforma\u021biilor arterio-venoase la nivel cerebral;
\n\u2022 boala aterosclerotic\u0103 \u00een arterele carotide de la nivel cervical;
\n\u2022 disec\u021biilor vasculare;
\n\u2022 stenozelor sau obstruc\u021biilor de artere carotide;
\n\u2022 vasculariz\u0103rii tumorilor pentru pregatirea chirurgical\u0103 sau pentru tratamente precum chimio-embolizarea sau radioterapia selectiv\u0103 intern\u0103.<\/p>\n

III. SWI ( SUSCEPTIBILITY WEIGHTED IMAGING)<\/strong>
\nEste o tehnic\u0103 recent\u0103 \u00een neuroimagistic\u0103 medical\u0103, care folose\u0219te diferen\u021bele de susceptibilitate magnetic\u0103 dintre \u021besuturi \u0219i ofer\u0103 un contrast net superior fa\u021b\u0103 de imaginile PD, T1, T2 \u0219i T2* 2D GRE. SWI este cea mai bun\u0103 metod\u0103 de vizualizare a sistemului venos cerebral. SWI detecteaz\u0103 depozitele de fier din \u021besuturi, microcalcific\u0103rile \u0219i microhemoragiile intraparenchimatoase.<\/p>\n

Aplica\u021bii clinice ale SWI:<\/span><\/strong><\/p>\n

Malforma\u021bii vasculare: \u00een detectarea cavernoamelor \u0219i malforma\u021biilor arteriovenoase, bolii Sturge-Weber, telangiectaziilor;
\nTraumatisme craniocerebrale:<\/strong>
\n\u2022 \u00een detectarea microhemoragiilor \u0219i monitorizarea acestora;
\n\u2022 \u00een vizualizarea leziunilor axonale difuze;
\n\u2022 \u00een detectarea hematoamelor intraparenchimatoase sau pericerebrale.
\nStroke (infarct cerebral):<\/strong>
\n\u2022 \u00een detectarea componentelor hemoragice din regiunile infarctizate (ischemie-hemoragie);
\n\u2022 \u00een monitorizarea tratamentului trombolitic, pentru estimarea eventualelor transform\u0103ri hemoragice post tromboliz\u0103.
\nTromboza venoas\u0103 cerebral\u0103: util\u0103 \u00een diagnosticul trombozelor venoase corticale;
\nPatologia tumoral\u0103:<\/strong>
\n\u2022 \u00een detectarea hemoragiilor intratumorale;
\n\u2022 \u00een delimitarea \u0219i caracterizarea tumorilor;
\n\u2022 \u00een eviden\u021bierea venelor de drenaj.
\nEncefalopatia hipertensiv\u0103:<\/strong>
\n\u2022 eviden\u021biaz\u0103 microhemoragiile \u00een stadiu cronic de la nivelul nucleilor bazali, trunchiului cerebral, emisferelor cerebeloase, corticale \u2013 nedecelabile cusecven\u021bele conven\u021bionale RM.
\nAngiopatia cerebral\u0103 amiloid\u0103:<\/strong>
\n\u2022 detecteaz\u0103 microhemoragiile \u00een angiopatia amiloid\u0103, care poate precede demen\u021ba vascular\u0103;
\n\u2022 SWI permite, mai bine dec\u00e2t secven\u021bele T2 EG 2D, vizualizarea leziunilor subcorticale cu semnal sc\u0103zut, deoarece imaginile de faz\u0103 accentueaz\u0103 efectul dat de hemosiderin\u0103.
\nBoli neurodegenerative
\n\u2022 sindromul Hallervorden-Spatz, scleroza lateral\u0103 amiotrofic\u0103, Parkinson, Huntington, Alzheimer; diferen\u021biaza demen\u021ba vascular\u0103 de boala Alzheimer.<\/p>\n

IV. DWI (DIFFUSION WEIGHTED IMAGING)<\/strong>
\nDWI investigheaz\u0103 difuzia apei la nivel celular, oferind informa\u021bii func\u021bionale esen\u021biale despre \u021besuturi. DWI caracterizeaz\u0103 leziunile infracentimetrice \u0219i modific\u0103rile intraparenchimatoase, \u00eenainte ca acestea s\u0103 fie vizibile \u00een secven\u021bele conven\u021bionale (morfologice). M\u0103sur\u0103torile DWI sunt rapide (1\u20135 minute) \u0219i nu necesit\u0103 administrarea de substan\u021b\u0103 de contrast. Difuzia ofer\u0103 evalu\u0103ri calitative \u0219i cantitative \u2013 coeficientul aparent de difuzie (ADC) este util \u00een diagnosticul diferen\u021bial al leziunilor intraparenchimatoase.
\nRecent, difuzia s-a dezvoltat dincolo de patologia cerebral\u0103 \u0219i are azi diverse aplica\u021bii extracraniene.<\/p>\n

Aplica\u021bii clinice ale DWI:<\/strong><\/span>
\nPatologia cerebral\u0103:<\/strong>
\n\u2022 \u00een diagnosticul precoce al ischemiei cerebrale, cu impact major \u00een managementul pacientului (restric\u021bia de difuzie apare \u00een teritoriul ischemiat \u00een prima or\u0103, mult \u00eenainte ca modific\u0103rile s\u0103 devin\u0103 vizibile pe secven\u021bele IRM conven\u021bionale sau CT);
\n\u2022 diagnosticul epilepsiei;
\n\u2022 detectarea leziunilor active de scleroz\u0103 multipl\u0103;
\n\u2022 caracterizarea tumorilor \u0219i ghidarea biopsiei;
\n\u2022 urm\u0103rirea evolu\u021biei tumorilor postradioterapie\/chimioterapie;
\n\u2022 detectarea leziunilor subtile posttraumatice nevizualizate cu tehnici conven\u021bionale;
\n\u2022 \u00een alte patologii cu restric\u021bie de difuzie (abcces vs tumor\u0103 necrozat\u0103, limfom, Creutzfeld-Jacobs etc.)
\nPatologia vertebral\u0103:<\/strong>
\n\u2022 diagnostic diferen\u021bial al fracturilor acute benigne vs maligne;
\n\u2022 \u00een patologia medular\u0103: diagnostic diferen\u021bial tumori versus infarct medular, leziuni demielinizante, contuzii medulare etc.
\nPatologia oncologic\u0103:<\/strong>
\n\u2022 detectarea \u0219i caracterizarea forma\u021biunilor tumorale primare \u0219i secundare;
\n\u2022 diagnosticul diferen\u021bial benign vs malign.
\n\u201eWhole Body Diffusion MRI\u201d<\/strong>
\n\u2022 Screening al \u00eentregului corp pentru depistarea focarelor tumorale la distan\u021b\u0103 (ganglionare, hepatice, osoase etc.); studii recente au demonstrat o sensibilitate \u0219i specificitate similare cu ale imaginilor PET;
\n\u2022 caracterizarea \u00een detaliu a tumorilor primare\/secundare;
\n\u2022 monitorizarea evolu\u021biei \u00een cursul radio- \u0219i chimioterapiei.<\/p>\n

V. SPECTROSCOPIA IRM (MRS)<\/strong>
\nOfer\u0103, non-invaziv, informa\u021bii despre metabolismul \u0219i structura biochimic\u0103 a unor organe \u0219i \u021besuturi. MRS pune \u00een eviden\u021b\u0103 metaboli\u021bi al c\u0103ror dezechilibru poate indica diverse afec\u021biuni.
\nPrincipalii metaboli\u021bi detecta\u021bi de 1H MRS:
\n\u2022 N-acetil aspartat (NAA) \u2013 metabolit observat doar \u00een \u021besutul nervos.
\n\u2022 Cholina (Cho) este un marker membranar cu concentra\u021bie crescut\u0103 \u00een multiplicarea\/distruc\u021bia membranelor celulare.
\n\u2022 Creatina (Cr) este un marker pentru status-ul energetic al celulelor. Este un metabolit cu o concentra\u021bie relativ constant\u0103, folosit ca referin\u021b\u0103 pentru evaluarea celorlal\u021bi metaboli\u021bi.
\n\u2022 Lactatul este un marker specific hipoxiei celulare.
\n\u2022 Mio-inozitolul (mI) este deseori crescut \u00een cazul bolii Alzheimer \u0219i al tumorilor maligne.
\n\u2022 complexul glutamat (Glu) \u0219i glutamin\u0103 (Gln) apare ca o combina\u021bie de peak-uri care ajut\u0103 la monitorizarea metabolismului (pentru activit\u0103\u021bile epileptice cronice).<\/p>\n

MRS este o tehnic\u0103 de diagnosticare pentru afec\u021biuni precum: tumori, accidente vasculare cerebrale, boli de substan\u021b\u0103 alb\u0103 \u0219i neurodegenerative, afec\u021biuni metabolice, epilepsie, inflama\u021bii, infec\u021bii.<\/p>\n

Aplica\u021bii ale spectroscopiei \u00een patologia cerebral\u0103:<\/strong><\/span>
\n\u2022 caracterizeaz\u0103 \u0219i diferen\u021biaz\u0103 leziunile focale intraparenchimatoase cerebrale: tumori (stadializarea gradului de malignitate), metastaze, abcese, leziuni demielinizante, limfom, encefalite;
\n\u2022 este util\u0103 \u00een monitorizarea postterapeutic\u0103 a tumorilor cerebrale (diferen\u021biaz\u0103 restul\/recidiva tumoral\u0103 de modific\u0103rile posttratament);
\n\u2022 depisteaz\u0103 modific\u0103rile metabolice care apar \u00een cazul bolilor neurodegenerative, precum boala Alzheimer sau demen\u021ba vascular\u0103;
\n\u2022 este util\u0103 \u00een evaluarea accidentelor vasculare cerebrale \u0219i a encefalopatiei hipoxic-ischemice, prin urm\u0103rirea evolu\u021biei lactatului \u00een teritoriul cerebral afectat;
\n\u2022 \u00een diagnosticul epilepsiei.<\/p>\n

VI. DTI (DIFFUSION TENSOR IMAGING)<\/strong>
\nEste o tehnic\u0103 neuroimagistic\u0103 de m\u0103surare a difuziei anizotrope, care permite vizualizare in vivo a tracturilor de substan\u021b\u0103 alb\u0103. Aduce informa\u021bii importante privind organizarea geometric\u0103 \u0219i microstructural\u0103 a substan\u021bei albe. Este eficient\u0103 \u00een depistarea bolilor care provoac\u0103 deteriorare sau deplasare axonal\u0103.
\nPermite vizualizarea tracturilor de substan\u021b\u0103 alb\u0103 \u0219i localizarea modific\u0103rilor subtile asociate unor maladii precum scleroza multipl\u0103, epilepsie, schizofrenie, boala Alzheimer, AVC.<\/p>\n

Aplica\u021bii clinice ale DTI:<\/strong><\/span>
\n\u00cen tumorile cerebrale:<\/strong>
\n\u2022 permite delimitarea tumorilor \u0219i evaluarea \u021besutului peritumoral (infiltra\u021bia, devierea \u0219i distruc\u021bia tracturilor);
\n\u2022 este util\u0103 \u00een distingerea gliomului de metastazele solitare;
\n\u2022 este util\u0103 \u00een stabilirea protocolului preoperator, a tratamentului radioterapeutic \u0219i \u00een evaluarea r\u0103spunsului la terapie.
\n\u00cen scleroza multipl\u0103:<\/strong>
\n\u2022 detecteaz\u0103 precoce procesele de demielinizare (cre\u0219tere a difuzivit\u0103\u021bii \u0219i descre\u0219tere a valorilor FA);
\n\u2022 serve\u0219te la diagnosticarea \u0219i monitorizarea leziunilor;
\n\u2022 detecteaz\u0103 anomaliile din substan\u021ba alb\u0103 perilezional\u0103.
\n\u00cen epilepsie:<\/strong>
\n\u2022 detecteaz\u0103 anomalii inaparente pe secven\u021bele RM conven\u021bionale;
\n\u2022 detecteaz\u0103 modific\u0103ri structurale subtile precum scleroza mezial\u0103 temporal\u0103 \u0219i malforma\u021bii \u00een dezvoltarea cortical\u0103;
\n\u2022 ajut\u0103 la definirea patologiei \u0219i la optimizarea planurilor preoperative.
\n\u00cen stroke:<\/strong>
\n\u2022 DTI \u0219i DWI sunt esen\u021biale \u00een detectarea \u0219i clasificarea AVC ischemic, \u00een stabilirea \u0219i \u00een monitorizarea tratamentului (\u00een faza acut\u0103, ADC crescut \u0219i FA sc\u0103zut, \u00een faza cronic\u0103: ADC crescut, difuzia anizotrop\u0103 sc\u0103zut\u0103);
\n\u2022 DTI are o senzitivitate superioar\u0103 fa\u021b\u0103 de T2 \u00een detectarea degenerescen\u021bei valeriene;
\n\u2022 poate detecta \u0219i cuantifica degenerarea tracturilor corticospinale (integritatea \u0219i orientarea);
\n\u2022 are poten\u021bial \u00een monitorizarea schimb\u0103rilor structurale datorate infarctului cerebral \u0219i degener\u0103rii asociate.
\n\u2022 aduce informa\u021bii suplimentare \u00een \u00een\u021belegerea pattern-ului evolu\u021biei clinice post-stroke.
\n\u00cen maladiile neurodegenerative:<\/strong>
\nMecanismele neuropatologice aflate la baza modific\u0103rilor de substan\u021b\u0103 alb\u0103 \u00een cazul bolii Alzheimer pot fi evaluate in vivo prin utilizarea tehnicii IRM DTI:
\n\u2022 pacien\u021bii cu Alzheimer prezint\u0103 o cre\u0219tere semnificativ\u0103 a difuzibilit\u0103\u021bii axiale (paralel\u0103 cu fibrele axonale) \u0219i a celei radiale (perpendicular\u0103 pe fibrele axonale);
\n\u2022 \u00een cazul pacien\u021bilor cu boala Alzheimer, s-au raportat cre\u0219terea valorii difuzibilit\u0103\u021bii medii \u00een tracturile cortico-subcortical, limbic, interemisferic \u0219i cortico-spinal \u0219i reducerea anizotropiei frac\u021bionale \u00een tractul parahipocampal, \u00een fornix \u0219i \u00een mici regiuni parietale inferioare
\n\u00cen procese inflamatorii (encefalit\u0103, abces cerebral)<\/strong> \u0219i \u00een malforma\u021biile cerebrale.<\/strong><\/p>\n

Dr. Mircea MEDREA<\/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":"

I. PWI (PERFUSION WEIGHTED IMAGING) Perfuzia IRM (PWI) aduce indicii asupra func\u021biei cerebrale prin m\u0103surarea unor parametri hemodinamici. Este o tehnic\u0103 imagistic\u0103 care permite m\u0103surarea volumului (CBV) \u0219i a debitului […]<\/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-5111","post","type-post","status-publish","format-standard","has-post-thumbnail","category-articole","category-neurologie","tag-medinst"],"yoast_head":"\nInvestiga\u021bii neuroimagistice speciale - aplica\u021bii \u00een patologia neurologic\u0103 - 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\/investigatii-neuroimagistice-speciale-aplicatii-in-patologia-neurologica\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Investiga\u021bii neuroimagistice speciale - aplica\u021bii \u00een patologia neurologic\u0103 - Jurmed - Medici\" \/>\n<meta property=\"og:description\" content=\"I. 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