La malattia: inquadramento diagnostico

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1 La malattia: inquadramento diagnostico 7 Febbraio 2009 Tiziana Tassinari S.C. Neurologia

25 Spettroscopia a Risonanza Magnetica Definizione fisico-chimica: Analisi delle frequenze ( ω ) dei nuclei Definizione clinica-neuroradiologica: tecnica di studio e di diagnosi complementare all Imaging convenzionale, che offre informazioni sulle caratteristiche istopatologiche cerebrali e sul metabolismo cerebrale.

26 MRS CHEMICAL SHIFT δ = (ω- ω ref ) / ω ref 10 6 (ppm) Nuclei di atomi identici in molecole differenti hanno differenti frequenze di risonanza ANALISI in FREQUENZA del segnale => profilo del metabolismo cerebrale Cho mi NAA Lac

27 Timeline of MR Diffusion Imaging Einstein, 1926: the theory of molecular diffusion Le molecole in un mezzo fluido sono dotate di un continuo movimento erratico, sosteuto dalla loro energia termica. Le molecole di H2O a 37 hanno un movimento erratico variabile tra 17 e 34 µm in 50 msec Stejskal e Tanner, 1965: Spin diffusion measurements: SE in the presence of time-dependent field gradient. J Chem Phys 42: Le Bihan D, Breton E e coll., 1986: MRI of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology 161(2): Moseley ME, Kucharczyk J, Mintorovitch J, 1990: Diffusion-weighted MR Imaging of acute stroke. AJNR 11:423

28 kleenx newspaper d A B cellule fasci assonali Diffusione isotropica (d.d. edema vasogenico e edema citotossico, indice di densità cellulare) Diffusione anisotropica (anatomia e densità dei fasci di fibre della sostanza bianca)

$than in DWI (FA, fraction$

29 Diffusion Tensor Imaging DTI measures only the degree of anisotropy hence, there are much more gradient directions than in DWI (FA, fraction anisotropy)

30 From DTI to Tractography

Diffusion orientation distribution function

31 DIFFUSION SPECTRUM IMAGING DSI (a) Campionamento su 256 dir (b) Estrapolazione a punti (c) Funk Radon transform => Diffusione probability Function PDF => Diffusion orientation distribution function (ODF) (d) Color-coded spherical polar plot of ODF. (e) Min max normalized ODF.

Sclerosi Laterale Amiotrofica ALS tipica PMA

7 x 10-6 mm 2 /s* 707 x 10-6 mm 2 /s 697.

10-6 mm 2 /s 1222 x 10-6 mm 2 /s λ 2 583.

9 x 10-6 mm 2 /s λ 3 395.4 x 10-6 mm 2 /s* 368.

33 Sclerosi Laterale Amiotrofica ALS tipica PMA Controlli FA 0.534* MD x 10-6 mm 2 /s* 707 x 10-6 mm 2 /s x 10-6 mm 2 /s λ x 10-6 mm 2 /s 1219 x 10-6 mm 2 /s 1222 x 10-6 mm 2 /s λ x 10-6 mm 2 /s* x 10-6 mm 2 /s x 10-6 mm 2 /s λ x 10-6 mm 2 /s* x 10-6 mm 2 /s x 10-6 mm 2 /s Cosottini Radiology 2005 (*) p<0.05

34 Amyotrophic Lateral Sclerosis, Volume 10, Issue 1February 2009, pages Detection of motor cortex thinning and corticospinal tract involvement by quantitative MRI in amyotrophic lateral sclerosis. Luca Roccatagliata; Laura Bonzano; Gianluigi Mancardi; Cinzia Canepa; Claudia Caponnetto Department of Neurosciences, Ophthalmology and Genetics, Magnetic Resonance Research Centre on Nervous System Diseases, University of Genoa, Italy

Radiology Section - Magnetic Resonance Spectroscopy Topic: Magnetic Resonance Spectroscopy Date of Origin: 04/1999 Section: Radiology Policy No: 27 Approved Date: 09/07/2004 Effective Date:

39 Radiology Section - Magnetic Resonance Spectroscopy Topic: Magnetic Resonance Spectroscopy Date of Origin: 04/1999 Section: Radiology Policy No: 27 Approved Date: 09/07/2004 Effective Date: 09/07/2004 Next Review Date: 09/ Policy/Criteria Magnetic resonance spectroscopy for any use is considered investigational. Medical Policy MAGNETIC RESONANCE SPECTROSCOPY Section: Radiology Initial Review: 05/03/01 Subsection: General Latest Review: 04/28/05 Publishing Date: 05/17/05 Policy: Magnetic resonance spectroscopy may be considered MEDICALLY NECESSARY for selected patients where differentiation is needed between recurrent or residual brain tumor vs. delayed radiation necrosis or differentiation is needed between brain tumor and other non-tumor diagnoses. Other applications of magnetic resonance spectroscopy are considered INVESTIGATIONAL/NOT MEDICALLY NECESSARY, including but not limited to diagnosis and monitoring patients with multiple sclerosis, dementia (including Alzheimer's disease), Parkinson's disease, cerebrovascular injury, metabolic diseases, degenerative diseases, epilepsy, inflammation and infection.

47 DTI Clinical Application Neurodegenerative disease (ALS, Alzheimer, Parkinson) Brain maturation Brain malformation Brain plasticity Presurgical planning of tumors Brain functional and anatomical connectivity (evaluation of the normal variability and of the psychiatric diseases connectivity)

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