Quantitative NMR measurements of hippocampal atrophy in Alzheimer's disease

Nuclear magnetic resonance (NMR) imaging was employed to study 10 patients with Alzheimer's disease (AD) and seven healthy elderly control subjects. Coronal sections were used to make volumetric measurements of the hippocampus, ventricles, subarachnoid space, and brain parenchyma. The hippocampal volume (normalized relative to the size of the lenticular nucleus) was reduced by 40% in the AD group compared to the controls, with no overlap between the two groups. Overall measures of brain atrophy and ventricular and sulcal enlargement also showed significantly different group means, although with overlap between the two groups. Hippocampal atrophy did not correlate with either overall brain atrophy or dementia severity, although the degree of brain atrophy was correlated with dementia severity. These results show that NMR is capable of providing in vivo quantification of diminished hippocampal size in AD which is not correlated with overall brain atrophy and which may differentiate AD from normal aging.     

Infraspinatus muscle atrophy: implications?

PURPOSE: To evaluate associated findings in patients who exhibited atrophy of infraspinatus muscle at magnetic resonance (MR) examination of their shoulders to clarify implications of this abnormality. MATERIALS AND METHODS: With an electronic database search, cases of advanced infraspinatus muscle atrophy in patients who underwent MR imaging during a 1-year period for evaluation of shoulder pain or dysfunction were identified. The analysis was restricted to cases interpreted by one reader who applied a standardized method of reporting. Associated MR imaging findings in these cases were tabulated. RESULTS: Advanced infraspinatus muscle atrophy was encountered in 51 (4.3%) of 1,191 MR examinations of the shoulder. Tears of the infraspinatus tendon were present in only 27 (53%) of 51 cases. In 46 (90%) of 51 cases, a full-thickness tear was present in the anterior portion of the rotator cuff. In 10 (20%) of 51 cases with infraspinatus muscle atrophy, cuff muscle atrophy was confined to the infraspinatus muscle. Cuff muscle atrophy was isolated to the infraspinatus muscle in four (17%) of 24 cases in which atrophy of the infraspinatus muscle was present despite an intact tendon. In none of the 51 cases was there a mass in the suprascapular or sphenoglenoid notch. CONCLUSION: Infraspinatus muscle atrophy typically occurs with tendon tears in the anterior aspect of the rotator cuff. Concomitant atrophy in the supraspinatus muscle often is present, but infraspinatus muscle atrophy can occur in isolation, and this finding does not imply that the infraspinatus tendon is ruptured.     

CT and MRI in iatrogenic and sporadic Creutzfeldt-Jakob disease: as far as imaging perceives

Creutzfeldt-Jakob Disease (CJD), an invariably fatal dementing illness, affects patients in middle and old age (sporadic form). However, the association of CJD with certain treatments (iatrogenic form) has been described in younger patients. The clinical onset of the two forms seems to differ; in the iatrogenic form a high frequency of the ataxic CJD variant has been reported. Nowadays, a definitive diagnosis of CJD is exclusively histological. We present five cases of CJD, one sporadic and the others iatrogenic, following dura mater grafts and analyse their CT and MRI features. CT typically demonstrates brain atrophy, generally progressive, but in sporadic CJD midfield MRI also showed abnormal signal, with predominant deep grey matter involvement. The use of narrow windows with proton-density sequences may reveal subtle cortical signal abnormalities not clearly visible with conventional windows. The early demonstration of these changes, in the appropriate clinical context, may suggest CJD and this supports the use of mid- or high magnetic fields in the diagnosis of CJD and other forms of dementia. In our cases of iatrogenic CJD, low-field MRI did not reveal more than the progressive atrophy displayed by CT, and raises the question on the one hand of possible differences, based on imaging, from the sporadic form, and on the other of the lack of sensitivity of low-field magnets to signal changes in CJD.Presented in part at the 6th annual meeting of the Sociedad Ibero-Latinoamericana de Neuroradiología Diagnóstica y Terapéutica (SILAN) Madrid, June 1994     

Regrowth of skeletal muscle atrophied from inactivity

The current state of knowledge regarding regrowth of skeletal muscle after inactivity-induced atrophy is reviewed. Muscle regrowth is incomplete after hindlimb suspension in juvenile rats and after limb immobilization in old animals. The process of regrowth from immobilization-induced atrophy likely involves the reversal of directional changes in molecules producing muscle loss while initiating anabolic processes for regrowth of muscle mass. Unfortunately, the molecular mechanisms responsible for successful, or failed, muscle regrowth are not well understood. The purpose of the review is to provide current knowledge about the biology of muscle regrowth from inactivity-induced atrophy.     

Cerebrotendinous xanthomatosis (van Bogaert-Scherer-Epstein disease): CT and MR findings.

PURPOSETo describe the CT and MR findings in the brain and spinal cord of patients with cerebrotendinous xanthomatosis and to seek possible correlations between clinical, biochemical (cholestanol levels), and neuroimaging findings.METHODSTen patients with well-defined clinical and biochemical diagnoses of cerebrotendinous xanthomatosis were examined. Brain CT was performed in eight cases. In all patients MR was obtained using spin-echo and gradient-echo sequences. In eight patients spine MR was also performed.RESULTSNeuroradiologic findings included diffuse cerebral and cerebellar atrophy. In half the cases, atrophy of the brain stem and corpus callosum was also found. In the majority of patients cerebellar bilateral focal lesions and mild white matter signal alterations were present. Spinal cord MR did not show signal abnormalities or atrophy.CONCLUSIONSWe found cranial alterations in patients with severe neurologic impairment, but there was no correlation with cholestanol plasma levels. No spinal cord abnormalities were present.     

Anti-NMDA receptor encephalitis and brain atrophy in children and adults: A quantitative study

PurposeTo determine whether brain atrophy was present in patients with anti-N-methyl-d-aspartate receptor encephalitis (anti-NMDARE) using qualitative and quantitative analyses of brain magnetic resonance imaging (MRI) and to explore clinical differences in patients with anti-NMDARE with or without brain atrophy.MethodsA retrospective observational study encompassing the serologic, cerebrospinal fluid, and brain MRI data of 23 patients with anti-NMDARE was conducted. Median patient age was 14 years (interquartile range [IQR], 12 years). The cohort included 15 children (<18 years old) and 8 adults (≥18 years old). There were 6 male and 17 female patients. Imaging analysis involved 2 expert readers' observations of MRIs and automated volumetric quantification using NeuroQuant (CorTechs Labs, Inc.) software.ResultsOf 23 pediatric and adult patients, 11 patients had 14 brain MRIs that were quantitatively analyzed. Quantitative NeuroQuant volumetric analysis showed atrophy in 9 of 14 MRIs for 7 of 11 patients compared to age-controlled normative data. In these 9 MRIs, atrophy was present in the temporal lobes (n = 9), cerebral cortex (n = 3), and cerebellum (n = 3). Qualitative analysis of 59 MRIs (23 patients) revealed volume loss in 6 patients: 5 with global cerebral and temporal lobe volume loss and 1 with temporal lobe volume loss. No patient showed cerebellar volume loss on qualitative analysis. Mean length of stay in the intensive care unit was not significantly different for patients with or without quantitative volume loss (3.5 [5.2] vs 27.4 [23.4] days; p = 0.08).ConclusionsIn this cohort of patients with anti-NMDARE, quantitative volumetric analysis showed brain atrophy, particularly affecting the temporal lobes, in 64% (7/11) of the patients. Qualitative analysis showed brain atrophy in 26% (6/23). These findings highlight the increased sensitivity of quantitative methods for volume loss detection. Larger studies are needed.     

Ataxia-telangiectasia: the pattern of cerebellar atrophy on MRI

We describe MRI of the brain in 19 patients with ataxia-telangiectasia (AT) and correlate the appearances with the degree of neurologic deficit. We examined 10 male and nine female patients; 17 were aged between 2 and 12 years (mean 8 years) but a woman and her brother were 35 and 38 years old, and had a variant of AT. Ataxia was the first recognized sign of the disease in every patient. We detected the following patterns of cerebellar atrophy: in the youngest patient, aged 2 years, the study was normal; in the five next youngest patients 3-7 years of age, the lateral cerebellum and superior vermis showed the earliest changes of atrophy; and all but one of the other patients had moderate to marked diffuse atrophy of vermis and cerebellar hemispheres. There were 12 patients aged 9 years and above; one, who was normal, was 9 years old. The five patients who at the time of examination were unable to walk all had diffuse atrophy involving both vermis and cerebellar hemispheres.     

Increased myocardial uptake of iodine-123 metaiodobenzylguanidine on delayed images, compared with early images, in patients with multiple system atrophy

We present 2 interesting cases of multiple system atrophy in which increased myocardial iodine-123 metaiodobenzylguanidine uptake was observed on delayed images (3 hours after injection) compared with early images (15 minutes after injection). These findings have not been previously described. The duration of symptoms was less than 1 year in both these patients. The mechanism responsible for these findings is not clearly understood, but could be related to the pathophysiological changes in the early stage of multiple systemic atrophy.     

Paradoxic hypertrophy of the sciatic nerve in adult patients after above-knee amputation

Paradoxic hypertrophy of nerve tissue at an amputation stump without neuroma formation rarely develops in young patients, in contrast to atrophy of the nerve in older patients. Herein, we present the magnetic resonance imaging (MRI) findings of adult patients (older than 20 years old) who underwent above-knee amputation, one of whom had a palpable mass suggesting a recurrent lesion. MRI ruled out the recurrent lesion and demonstrated paradoxic hypertrophy of the sciatic nerve in all patients.     

Leukoaraiosis: correlation of MR and CT findings with blood flow, atrophy, and cognition

Hypodense periventricular white-matter lesions detected by CT (leukoaraiosis) and high-intensity T2 signals detected by MR imaging were correlated with measurements of local cerebral blood flow (LCBF), cerebral atrophy, and cognitive performance. Subjects studied included elderly volunteers who were neurologically normal (n = 6), patients with chronic cerebral infarctions and intact cognition (n = 2), patients with multiinfarct dementia (n = 14), and patients with Alzheimer dementia (n = 9). Leukoaraiosis correlated with periventricular high-intensity lesions detected by MR, LCBF reductions, cognitive impairments, and cerebral atrophy. Moderate to severe leukoaraiosis was associated with LCBF reductions in the cortex, basal ganglia, and frontal white matter. Periventricular MR lesions correlated with cerebral atrophy but not with cognitive impairments or reductions in LCBF. The exquisite sensitivity of MR revealed small lesions that did not correlate with LCBF reductions and cognitive impairments. Remote subcortical white-matter lesions detected by MR did not correlate with periventricular MR lesions, leukoaraiosis, LCBF, cerebral atrophy, or cognitive performance, indicating little clinical relevance. We concluded that diffuse cerebral hypoperfusion, particularly in combination with the poor collateral circulation of white matter surrounding the lateral ventricles, is responsible for leukoaraiosis.     

Comparison study of positron emission tomography, X-ray CT and MRI in parkinsonism with dementia

In cases of Parkinson's disease, a high incidence of dementia and simultaneous pathologic changes of Alzheimer's type have been reported. X-ray CT and MRI have such good spatial resolution that they can be expected to be useful for evaluation of brain atrophy. Positron emission tomography (PET) used with 18F-2-deoxy-2-fluoro-D-glucose is considered to reflect regional function. By these techniques, brain atrophy and local cerebral metabolic rate of glucose (LCMR-glc) in patients with Parkinsonism with dementia was studied, and also compared with age-matched normal controls and senile dementia of Alzheimer type. In seven cases of Parkinson's disease with dementia, LCMRs-glc were statistically decreased in all regions in comparison with ten normal controls. LCMRs-glc in six Parkinson's disease without dementia were higher than those of demented Parkinson's disease, but significantly lower than normal controls in all regions except basal ganglia. Some aged normal controls presented cortical atrophy and a significant difference could not be seen in evaluation by MRI among these three groups. There was also no correlation between LCMR-glc and cortical atrophy. There was no significant difference of LCMR-glc between six Guamnian cases of Parkinsonism-Dementia complex (PD complex) without ALS and four cases of PD complex with ALS, and these values were significantly lower than five Guamanian and ten Caucasian normal controls. In PD complex with and without ALS, remarkable cortical atrophy and ventricular dilatation were recorded in comparison with normal controls, and correlation between decrement of LCMR-glc and cortical atrophy was indicated in frontal, parietal and temporal lobe. In Parkinson's disease with dementia and PD complex in Guam, LCMRs-glc in all regions of brain were generally lower than normal controls. These findings were different from Alzheimer's disease in which LCMR-glc have been reported to be low especially in cerebral cortex. On the other hand, cortical atrophy and ventricular dilatation evaluated by MRI and CT was apparent in PD complex, but these changes were not remarkable in Parkinson's disease. Cortical atrophy did not always correlate with the decrease of LCMR-glc and changes of LCMR-glc could reflect clinical signs such as Parkinsonism and dementia. Both PET as a functional imaging method and MRI, CT as an anatomical imaging method are useful to access the study of these diseases.     

Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome

BACKGROUND: The role of degenerative changes in rotator cuff musculature with respect to the functional outcomes of rotator cuff repair have only recently been recognized and are still not well understood. In addition, the reversibility of these changes with repair of the tendons is questionable. HYPOTHESIS: Poorer preoperative muscle quality negatively affects outcome, and a successful outcome (in terms of a healed repair) might demonstrate improvements in fatty infiltration and muscle atrophy. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Thirty-eight patients (mean age, 62 years) were prospectively evaluated with preoperative and 1-year postoperative clinical examination and appropriate magnetic resonance image sequencing to determine grades of muscle atrophy and fatty infiltration of the supraspinatus and infraspinatus muscles. American Shoulder and Elbow Society (ASES), Constant, and pain scores were determined as well as strength measurements. The retear rate and progression of muscle degeneration were also evaluated. Independent predictors of outcome measurements and cuff integrity were determined. RESULTS: The overall clinical outcome, including ASES, Constant, and pain scores, improved significantly (P < .0001). Strength in forward elevation improved significantly (P < .006), while external rotation strength did not. There was a strongly negative correlation between muscle quality and outcome results in most cases. When the results were adjusted for multivariate effect, muscle atrophy and fatty infiltration of the infraspinatus muscle were the only independent predictors of ASES and Constant scores (P < .03). Tear size and rotator cuff healing did not play an independent role. Tear size, however, was the only independent predictor of ultimate cuff integrity (P = .002). Both atrophy and fatty infiltration progressed significantly over the course of the study. In cases in which the tendon had re-torn, the progression was found to be more significant than when the repair proved successful (P < .003). CONCLUSION: Muscle atrophy and fatty infiltration of the rotator cuff muscles, particularly of the infraspinatus, play a significant role in determining functional outcome after cuff repair. Tear size appears to have the most influential effect on repair integrity. A successful repair did not lead to improvement or reversal of muscle degeneration and a failed repair resulted in significantly more progression. In general, healed repairs demonstrated minimal progression. These findings suggest that repairs should be performed, if possible, before more significant deterioration in the cuff musculature in order to optimize outcomes, and that understanding the degree of muscle atrophy and fatty infiltration before surgery can help guide patient expectations.     

The spectrum of brain MR abnormalities in sickle-cell disease: a report from the Cooperative Study of Sickle Cell Disease.

PURPOSETo define the spectrum of abnormalities in sickle-cell disease, including infarction, atrophy, and hemorrhage, that are identified by brain MR imaging.METHODSAll MR studies included T1, T2, and intermediate pulse sequences. Images were interpreted without knowledge of the clinical history or neurologic examination findings. Brain MR imaging was performed in 312 children with sickle-cell disease.RESULTSSeventy patients (22%) had infarction/ischemia and/or atrophy, infarction/ischemia was noted in 39 children (13%) who had no history of a stroke (the "silent" group). The prevalence rates for silent lesions were 17% for sickle-cell anemia and 3% for hemoglobin sickle-cell disease. For patients with sickle-cell anemia and a history of cerebrovascular accident, infarction/ischemia lesions typically involved both cortex and deep white matter, while silent lesions usually were confined to deep white matter. Within the age range studied, the prevalence of infarction/ischemia did not increase significantly with age, although older patients with lesions had more lesions than did younger patients with lesions.CONCLUSIONSBrain MR imaging showed infarction/ischemia in the absence of a recognized cerebrovascular accident in 13% of patients. The prevalence of these lesions did not increase significantly between the ages of 6 and 14 years, suggesting that lesions are present by age 6. However, the increase in the average number of lesions per patient with age may indicate progressive brain injury.     

Computed tomography of spinal cord atrophy

Summary Spinal cord atrophy takes on several different forms which correlate closely with specific clinical features. The majority of them, however, can be categorized into three distinct patterns, diffuse (transverse myelopathy), hemi-(Brown-Sequard syndrome), or anterior (anterior spinal artery syndrome) atrophy. Until recently, the differential diagnosis had been made solely on the neurological examination. We present three cases of spinal cord atrophy, one in each category. Spinal computed tomography with metrizamide appears to be a reliable supporting diagnostic method for spinal cord atrophy.     

Lumbosacral ventral spinal nerve root atrophy identified on MRI in a case of spinal muscular atrophy type II

Spinal muscular atrophies are rare genetic disorders most often caused by homozygous deletion mutations in SMN1 that lead to progressive neurodegeneration of anterior horn cells. Ventral spinal root atrophy is a consistent pathological finding in post-mortem examinations of patients who suffered from various subtypes of spinal muscular atrophy; however, corresponding radiographic findings have not been previously reported. We present a patient with hypotonia and weakness who was found to have ventral spinal root atrophy in the lumbosacral region on MRI and was subsequently diagnosed with spinal muscular atrophy. More systematic analyses of imaging studies in spinal muscular atrophy will help determine whether such findings have the potential to serve as reliable diagnostic markers for clinical evaluations or as outcome measure for clinical trials.     

Aerobic exercise as a countermeasure for microgravity-induced bone loss and muscle atrophy in a rat hindlimb suspension model

BACKGROUND: Loss of bone and skeletal muscle atrophy resulting from non-weight-bearing are major concerns associated with microgravity environment and spaceflight deconditioning. The objective of this research was to address the fundamental issue of whether bone loss and muscle atrophy could be attenuated using weight-bearing aerobic exercise on a treadmill as a countermeasure in rats subjected to simulated weightlessness by hindlimb suspension. METHOD: Bone and muscle from control and hindlimb-suspended groups with and without exercise were evaluated by bone mineral density (BMD), mechanical tests, bone histomorphometry and muscle mass. RESULTS: Femoral BMD of hindlimb-suspended (HS) rats subjected to treadmill exercise was significantly greater than femoral BMD of HS rats without exercise and also was equivalent to that of weight-bearing controls. Muscle mass from HS rats exercised on a treadmill was significantly greater than muscle mass from HS rats that did not exercise. Exercise did not result in muscle mass equal to that of controls, however. In addition, histomorphometric analysis of the metaphysis of the proximal tibia revealed that HS rats that exercised did not maintain bone formation equivalent to controls. No other bone parameters were found to vary significantly between groups. CONCLUSIONS: It was concluded that moderate aerobic exercise on a treadmill did attenuate bone loss and muscle atrophy due to simulated weightlessness by hindlimb suspension, however its effectiveness differed by tissue, anatomical site and parameter investigated.     

Influence of diabetes mellitus on regional cerebral glucose metabolism and regional cerebral blood flow

Previous studies have shown both increased and decreased regional cerebral glucose metabolism-blood flow (rMRGlu-rCBF) values in diabetes. We sought to elucidate the influence of diabetes on rMRGlu-rCBF in 57 patients with pure cerebral microangiopathy. Sixteen of 57 patients had diabetes requiring therapy (11 NIDDM, 5 IDDM). Using a special head-holder for exact repositioning, rMRGlu (PET) and rCBF (SPET) were imaged and measured in slices, followed by MRI. White matter and cortex were defined within regions of interest taken topographically from MRI (overlay). Diabetic and non-diabetic microangiopathy patients were compared to 19 age-matched controls. The diabetic patients showed significantly lower rMRGlu-rCBF values in all regions than controls, whereas non-diabetic patients did not. There were no significant NIDDM-IDDM differences. rMRGlu-rCBF did not depend on venous blood glucose levels at the time of the PET examination. However, analysis of variance with the factors diabetes, atrophy and morphological severity of microangiopathy showed that lowered rMRGlu-rCBF in the diabetic group was due to concomitant atrophy only (P < 0.005), while neither diabetes nor microangiopathy had any influence on rMRGlu-rCBF (all P > 0.2). These results were confirmed by multivariate factor analysis. It can thus be concluded that a supposed decrease in rMRGlu-rCBF in diabetes mellitus is in fact only an artefact produced by the concomitant atrophy. All previous studies failed to correct for atrophy, and a critical reappraisal is required.     

Temporal lobe morphology in normal aging and traumatic brain injury

BACKGROUND AND PURPOSE: Little is known regarding changes in the temporal lobe associated with traumatic brain injury (TBI) in early-to-mid adulthood. We report on two quantitative MR studies: study 1 addressed age-related changes of the temporal lobe in subjects aged 16-72 years; information obtained in this study provided a normative database for comparison with findings in 118 patients with TBI who were included in study 2. We expected stable morphology in healthy subjects and trauma-related atrophy in patients with TBI. METHODS: MR multispectral tissue segmentation was used to calculate bilateral temporal lobe gyrus and sulcus, sylvian fissure CSF, hippocampus, and temporal horn volumes and to measure the white matter (WM) temporal stem. RESULTS: With normal aging, gyral volume remained stable, decreasing approximately 0.26% per year (total, approximately 11%). Sulcal CSF volume doubled. Hippocampal volume decreased (minimally, significantly); temporal horn volume increased (not significantly) and was minimally related to hippocampal volume. WM measurements were constant. Trauma changed morphology; WM measures decreased. Gyral volumes were not different between the groups. In TBI, CSF volume increased significantly, was most related to reduced WM measurements, and was relatively independent of gyral volume. Temporal horn dilatation was related more to WM atrophy than to hippocampal atrophy. In TBI, subarachnoid sulcal and temporal horn CSF volumes were most related to WM atrophy, which was relatively independent of gyral volume; gyral and hippocampal volumes and WM measures were related to memory performance. CONCLUSION: Age-related changes cause minimal temporal lobe gyral, hippocampal, temporal horn, and WM atrophy. Only subarachnoid sulcal CSF volume changed robustly. Trauma produced disproportionate WM loss associated with increased temporal horn and sulcal CSF volumes; it caused substantial hippocampal atrophy, which was related to memory impairment. Gyral volume did not decrease, although it was related to memory performance.     

Spinal cord atrophy in injured rodents: high-resolution MRI.

Longitudinal magnetic resonance imaging (MRI) was performed in normal and spinal cord (SC)-injured rodents. A fast technique based on polar B-spline snake was developed to extract the SC contour from the MR images in order to estimate the cord atrophy. Based on pooled data from all of the imaging studies, the extracted contours correlated well with manually defined contours. Results from the injured group showed cord atrophy shortly after the contusion injury. The maximum amount of atrophy (9.7% +/- 3.5% decrease in the cross-sectional area (CSA)) occurred mainly at the epicenter around 14 days postinjury. The caudal and rostral segments in the injured group did not exhibit significant atrophy compared to the normal controls. The MRI-based atrophy measurements obtained in injured cords are consistent with previous histological findings.     

CT scanning in meningitis

Twelve paediatric cases of acute meningitis were reviewed retrospectively. Findings on CT scan were compared with the clinical course and resulting neurological sequelae. Complications detected by CT scanning include subdural effusion, empyema, hydrocephalus, cerebral atrophy, oedema and infarction. The CT scan results adequately correlated with neurological signs in most cases. Infarction was a reliable indicator of neurological sequelae. Cerebral atrophy alone, however, did not correlate well with the clinical sequelae.