Perifocal Changes Research Articles

Magnetic resonance imaging in assessing the staging of intracerebral hemorrhages in children

The purpose of the study was to evaluate the possibilities of MRI in determining the stage of hemorrhagic stroke (HS) depending on structural and perifocal changes in children.Materials and methods. The study included 46 patients (including 19 boys and 27 girls) aged from the 29th day of life to 18 years, with a clinical picture of cerebrovascular accident and the presence of HS in the brain substance (BS) during an MRI study. For statistical analysis, patients were divided into two groups: group 1 – patients examined in the first 48 hours from the onset of neurological symptoms (21 people), group 2 – after 48 hours (26 people). Comparison in two groups was carried out according to MR signs: the presence of perifocal cytotoxic edema, the presence of perifocal hemorrhagic impregnation, the presence of a cytoplasmic rim. Intergroup comparisons on a qualitative basis were carried out using Fisher's exact test.Results. As a result of the study, differential diagnostic criteria for the stages of HS in children were determined by analyzing the MRI semiotics of hematoma in combination with the symptom complex of perifocal changes (CPC) in the form of perifocal cytotoxic edema, perifocal hemorrhagic impregnation and cytoplasmic rim. Statistically significant differences in the frequency of occurrence of signs of perifocal cytotoxic edema and perifocal hemorrhagic impregnation in the groups were found. The presence of perifocal cytotoxic edema was statistically significant (p = 0.027) more common in group 1 (47% (n = 10), 95% CI 26–69) than in group 2 (16% (n = 4), 95% CI 5–36). The presence of perifocal hemorrhagic soaking was statistically significantly (p = 0.003) more common in group 1 (81% (n = 17), 95% CI 57–93) than in group 2 (36% (n = 9), 95% CI 18–57). In addition, a statistically significant (p = 0.005) difference was found in the incidence of CPC, which was observed in group 1 (28% (n = 6), CI 12–52) and was not observed in group 2 (0%, (n = 0), 95% CI 0–17).Conclusions. The use of T2, T1, FLAIR, SWI and DWI modes (b = 1000) in combination with ADC in the protocol of MRI examination of children is mandatory, and only a comparison of the characteristics of the MR signal from a hematoma in combination with an analysis of perifocal changes allows us to differentiate the stage of hemorrhage. HS in the acute and early subacute stages has a similar MRI semiotics, therefore, it is necessary to assess the complex of perifocal changes, which allows to differentiate these stages, as it is determined in patients examined in the first 48 hours (p < 0.05) and is not observed after two days. SWI analysis makes it possible to differentiate the late subacute stage of hematoma from chronic due to different characteristics of the MR signal, and also allows you to establish the presence of perifocal hemorrhagic impregnation, which contributes to the differential diagnosis of hemorrhage in the early stages of the pathological process.

Новые биосинтетические имплантаты для хирургического лечения туберкулеза легких

Experimental testing of biocompatible biodegradable highly porous pleural implants for the surgical treatment of destructive pulmonary tuberculosis. Laboratory animals were implanted with a highly porous biorsorbable material based on polylactide and polycaprolactone. The morphological picture in implants and in local tissues was studied after intrapleural implantation at 7, 21, 54, 66 and 78 weeks, the animals were removed from the experiment by overdosing of drugs for anesthesia. As experimental animals, rabbits were used- mature females of the Chinchilla breed, age 1–1.5 years, body weight 3500–4300 g. When studying the morphological picture in the implants, good biocompatibility was observed during a long experiment, which was manifested by the absence of necrosis in the implants and surrounding tissues. In implants, a capsule is formed over time, starting from week 7, the processes of implant vascularization occur, which begin with the surface sections with the development of small capillary-type vessels, followed by the ingrowth of vessels into the thickness of implants and the formation of larger thin-walled sinusoidal vessels, as well as larger vessels (arteries and veins), in addition to capillaries. In the adjacent soft tissues (lung, pleura, soft tissues of the chest wall) in the first and second implantation periods, reactive changes are minimal. They manifest as focal fibrosis of muscle fibers, focal mononuclear infiltration in fibrous tissue in the first implantation period (7 weeks). And in the form of weakly expressed cellular infiltration in separate fields of vision in adjacent soft tissues in the second period. Upon further examination, no perifocal changes were observed in the third, fourth and fifth transplantation periods. Morphological changes were studied in the implant and adjacent tissues of the chest wall. It is proved that a highly porous pleural implant based on polylactide and polycaprolactone has good biocompatibility and bio-safety, is a promising material for general thoracic surgery and surgical treatment of destructive widespread pulmonary tuberculosis.

Assessment of denosumab treatment efficiency in patients with giant cell tumor of bone using CT and MRI (own results and literature review)

Relevance. Giant cell tumor of the bone is most common in people of working age, which determines the high social significance of successful treatment of this category of patients. The main method of treatment is surgical. Currently, the targeted drug denosumab has appeared, the criteria for evaluating the effectiveness of therapy for which, according to the data of radiation methods, are not clearly defined.Target. To analyze and compare the possibilities of CT and MRI in evaluating the effectiveness of denosumab therapy for giant cell tumors.Materials and methods. The data of CT and MRI of 19 patients with giant cell tumor of tubular bones on the background of denosumab therapy were analyzed.Results. Before treatment, the extraosseous component was determined in 57.9 % (n = 11), after – 31.6 % (n = 6). The decrease occurred in 100 %, the disappearance – in 45 % (n = 11) of cases. The thickness of the extraosseous component before treatment ranged from 4 to 43 mm (Me = 15 mm), after treatment it ranged from 0 to 30 mm (Me = 8 mm). The decrease occurred in the range from 4 to 14 mm (M ± SD = 7 ± 4 mm). In 100 % of cases, a sclerotic rim appeared, the thickness of which after treatment ranged from 1 to 5 mm (Me = 3 mm). In the structure of the tumor, fibrosis occurred in 95 % (n = 18), a decrease in the cystic component occurred in 82 % (n = 9) of cases. Perifocal changes decreased in 100 % of cases. In 100 %, the average tumor density increased. The mean tumor density before treatment ranged from 27 to 65 HU (M ± SD = 42 ± 11 HU), after treatment it ranged from 69 to 500 HU (Me = 150 HU). The increase in density occurred in the range from 41 to 454 HU (Me = 101 HU). All differences are statistically significant (p < 0.05).Conclusions. Evaluation of effectiveness with the definition of quantitative and qualitative indicators is possible according to the data of both CT and MRI; with CT, changes are recorded longer, and more indicators available for quantitative measurement are determined.

Use of magnetic resonance imaging features as radiomic markers in pre-operative evaluation of extra-axial tumor grade

BACKGROUND: Extra-axial tumors are one of the tumor groups with difficult primary differential diagnostics. Detection and standardization of radiomic markers are one of the main problems of our time.
 AIM: To detect radiomic markers for preoperative assessment of extra-axial tumor grade.
 MATERIALS AND METHODS: This study retrospective analyzed the magnetic resonance imaging (1.5 T) data of 156 patients with extra-axial tumors. Patients were divided into 2 groups: Group 1 (n=106) with perifocal changes and Group 2 (n=50) with extra-axial tumors without perifocal changes. Diffusion and perfusion sequences were included in the scanning protocol. The areas of interest include (1) the lesion and (2) the area of perifocal changes. Measurements were made from the lesion and the area of perifocal changes on ACD and DSС maps, DCE was analyzed.
 RESULTS: The maximum lesion size in Group 1 was 2.2 cm (1.4; 4.3), whereas in 1.2 cm in Group 2 (0.9; 3.5). In Group 1, the diffusion restriction from the lesion was detected in 42 patients (39.6%), whereas 7 (14%) in Group 2. The maximum size of perifocal changes in Group 1 was 2.85 cm (1.5; 4.7). Diffusion restriction was detected in 52 (49.1%) cases. In Group 1, patients with verified meningioma multivariable linear regression analysis showed 3.3-times increase of rCBF of the maximum size of the lesion from the area of perifocal changes (coef. 3.3, CI: 1.27; 5.28), p=0.003; however, it demonstrated a 4-time decrease of rCBF (coef. 4 CI: -7.46; -0.71), p=0.02.
 CONCLUSIONS: Perfusion and diffusion methods combined with anatomical sequences show potential use as radiomic markers for diagnostic assessment and treatment of extra-axial tumors. Further detection of radiomic functional markers from the area of perifocal changes has potential.

Magnetic resonance imaging prospects of prognostic value in women pelvic pathology

Aim of the study was to estimate the prognostic value of perfusion and diffusion magnetic resonance imaging (MRI) methods in systemic evaluation of perifocal changes of malignant masses in women’s pelvis. Material and methods. A retrospective analysis of MRI of the pelvic organs in women was performed on MRI scanners with a magnetic field of 1.5 T (Philips Achieva, Netherlands). The retrospective study included 1,5 T MRI of 530 women with pelvis pathology. It consists of 50 % (265 cases) of malignant pelvic mass and 50 % (265 cases) of non tumor pathologies. The most common malignant pathologies were regarded: rectum cancer (n=61), ovarian cancer (n=62), uterine cancer (n=65), cervical cancer (n=77). Group with non-tumor pathology was taken as comparison group and included inflammation (abscess), adhesions and other non-tumor pelvic pathologies (pseudocyst of peritoneum, hemorrhagic cyst, endometriosis). In all cases a body coil was used on pelvic region. MRI protocols included T2-, T1 – weighted imaging, diffusion weighted imaging, postcontrast T1 - weighted imaging. apparent diffusion coefficient value and perfusion value were estimated. Results and discussion. In intergroup comparison with systemic evaluation of MRI with ANOVA we revealed that the diffusion restriction and the apparent diffusion coefficient bear potential value for disease prognosis. Conclusions. MRI can be of value not only for evaluation of local spread, as well as providing wide opportunities for differential diagnosis and use of MRI as biomarker in some diseases. Such indications as restricted diffusion, apparent diffusion coefficient value and type of dynamic curve from perifocal lesion can benefit disease prognosis.

Effect of the dynamic curve type from the perifocal infiltration zone obtained by magnetic resonance imaging on prognosis in pelvic pathologies in women

The aim of the study is to evaluate the role and prognostic significance of magnetic resonance imaging (MRI) perfusion methods in prognosis of disease course and outcome based on evaluation of the perifocal infiltration zone in pelvic disorders in women.Materials and methods. Retrospective analysis of pelvic MRI data obtained using MRI system with induced magnetic field of 1.5 T was performed. The study included 530 protocols of pelvic scans in women. Two equal groups (n = 265) of patients with oncological and nononcological pathologies of pelvic organs were formed; after application of propensity score matching, each group contained 165 patients. All examination protocols included dynamic contrast enhancement. The obtained data were statistically analyzed using the Stata 13 software.Results. In the study, types of dynamic curves obtained using dynamic contrast enhancement from the perifocal infiltration zone were analyzed. There was no data showing a correlation between the type of dynamic curve from the zone of perifocal changes and disease prognosis or possibility of differential diagnosis.Conclusions. Evaluation of the perifocal infiltration zone per MRI results with intravenous contrast does not affect prognostic accuracy of the method (p >0.05); contrast can be used only for differential diagnosis or evaluation of local advancement of the process.

A comparative experimental-morphological study of the methods of chemodestruction, cryodestruction and laser destruction of the peripheral nerve trunk

An experimental morphological study of the methods of chemodestruction, cryodestruction and laser destruction as those of medical denervation in pharmacoresistant forms of prosopalgia was carried out. The obtained data testify to the presence of evident destructive macro- and microscopic changes both in the nerve trunk and its surrounding tissues when using alcoholic chemodestruction. A lesser degree of morphological changes was observed in phenol chemodestruction. Cryodestruction was characterized by morphological signs of persistent denervation with a minimal manifestation of perifocal changes in the surrounding tissues. The laser method of denervation resulted in replacement of destruction by regeneration in the early period. Perifocal changes were minimal.

CLINICAL CLASSIFICATION OF TUBERCULOSIS WHEN ASSESSING THE PREVALENCE OF CAVERNOUS FORMS OF THE DISEASE

Cavernous form of tuberculosis being important in its clinical aspects is presented with the reference to pathogenesis, morphogenesis, structure of cavitary wall as acute pneumoniogenic cavity, bronchogenic cavity, cavity from the focus with pre-existing capsule, without expressed fibrosis, with perifocal changes and without them, with semination foci and without them. The statement of the long-lasting impropriety of official statistic rates received through current clinical classification of tuberculosis (ICD-10) explains the increase oftuberculosis prevalence and raises the need to review the classification oftuberculosis and points atthe urgency oftuberculosis control actions adequate for current unfavorable epidemic situation.

Prediction of radiation-induced changes in the lung after stereotactic body radiation therapy of non–small-cell lung cancer

To estimate the risk of radiation-induced changes in the lung before single-dose treatment (stereotactic body radiation therapy [SBRT]) of lung cancer, the quantitative dose-response and volume-response relations must be known. A total of 64 patients treated for non-small-cell lung cancer with single doses of 20-30 Gy were classified according to the occurrence or nonoccurrence of perifocal changes in the lung detected by CT. Patients without toxic events in the lung were required to have >or=6 months of follow-up. The mean dose (D(mean)) in the ipsilateral lung and the volume receiving >7 or 10 Gy (V7 and V10, respectively) were used to calculate the dose-response and volume-response curves. The predictive value of additional variables was also investigated. Of the 64 patients, 83% exhibited the selected endpoint. The tolerance values at a 50% probability of toxic events were 1.2 +/- 0.7 Gy for the D(mean) and 5.8 +/- 3.0% and 3.1 +/- 2.0% for V7 and V10, respectively. A nonsignificant shift to higher doses was seen for the dose-response curve for the upper compared with the lower part of the lung. The D(mean), V7, and V10 can be used to predict the risk of lung toxicity after SBRT treatment of non-small-cell lung cancer. Because of the lack of patients with low prescribed doses, however, the related uncertainty of this prediction is still relatively large. The D(mean), V7, and V10 are equally well suited. The additional investigated variables did not provide significant advantages. The lower part of the lung appears to be more radiosensitive than the upper.

Chapter 22 The opioid receptor antagonist naloxone influences the pathophysiology of spinal cord injury

Publisher Summary This chapter discusses the opioid receptor antagonist naloxone that influences the pathophysiology of spinal cord injury. A focal trauma to the spinal cord, for instance, induced by a traffic accident, may lead to various degrees of functional disturbances. The degree of permanent disability is influenced by several factors such as the extent and type of the initial physical injury, secondary or perifocal changes around the site of the initial injury and the efficiency of medical treatment and rehabilitation. Methylprednisolone is the only compound that has gained widespread acceptance in the treatment of traumatic injuries of the human spinal cord. The significance of factors that mare formed or released because of the initial physical injury have attracted a great deal of attention. Such injury factors include eicosanoids, plateletactivating factors, free radicals, neuropeptides, monoamines, and cations. Experimental studies can be performed by using opioid peptide antagonists. This chapter discusses the influence of the important opioid peptide antagonist and naloxone in spinal cord injury. Naloxone is a competitive antagonist of μ, δ and ĸ opioid receptors.

Focal and Perifocal Changes in Tissue Energy State during Middle Cerebral Artery Occlusion in Normo- and Hyperglycemic Rats

The objective of the present study was to assess changes in cellular energy metabolism in focal and perifocal areas of a stroke lesion and to explore how these changes are modulated by preischemic hyperglycemia. A model for reversible occlusion of the middle cerebral artery (MCA) in rats was used to study changes in energy metabolism. Following MCA occlusion for 5, 15, or 30 min in normoglycemic rats, the tissue was frozen in situ, and samples from the lateral caudoputamen and from two neocortical areas were collected for metabolite analyses, together with a control sample from the contralateral, nonischemic hemisphere. Two other groups, subjected to 30 min of MCA occlusion, were made hyperglycemic by acute glucose infusion or by prior injection of streptozotocin. Enzymatic techniques were used for measurements of phosphocreatine, creatine, ATP, ADP, AMP, glycogen, glucose, pyruvate, and lactate. The neocortex of the contralateral, nonischemic hemisphere had labile metabolites that were similar to those measured in control animals. Ipsilateral neocortex bordering the focus, and thus constituting the "penumbra," showed mild to moderate ischemic changes. In the "focus" (lateral caudoputamen plus the overlying neocortex), deterioration of energy state was rapid and relatively extensive (ATP content 20-40% of control). After 5 min of occlusion, no further deterioration of metabolic parameters was observed. Substrate levels were markedly reduced, and lactate content rose to approximately 10 mM kg-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Chapter 28: Release of endogenous neurochemicals may increase vascular permeability, induce edema and influence cell changes in trauma to the spinal cord

Trauma to the spinal cord induces a series of electrophysiological, immunological and biochemical events, but it is still unclear how such reactions are initiated and maintained. Most likely release of neurochemicals, breakdown of microvascular permeability and the formation of vasogenic edema play important roles in the pathophysiology of spinal cord trauma. In an animal model we have focused the attention to the possible involvement of endogenous serotonin, prostaglandins and opioid peptides in the formation of edema and associated disturbances of vascular permeability. The trauma was produced in anesthetized rats by making a focal lesion in the right dorsal horn at the T10-11 segments. This injury resulted in a profound increase in the microvascular permeability to 131I-sodium and an elevation of water content in the rostral T9 and caudal T12 segments as measured 5 h after the onset of the injury. Light microscopy of the perifocal changes in the T9-T12 segments using Nissl stain and immunohistochemistry to glial fibrillary acidic protein (GFAP) and myelin basic protein (MBP) showed profound cellular changes which were most severe in the ipsilateral ventral horn. Many nerve cell bodies were shrunken and the tissue had a spongy edematous appearance. There was a marked increase of GFAP immunoreactivity as well as a significant diminution of MBP staining. Pre-treatment with p-chlorophenylalanine (p-CPA, an endogenous serotonin depletor and synthesis inhibitor) or indomethacin (an endogenous prostaglandin synthesis inhibitor) or naloxone (an opioid receptor antagonist) significantly reduced the permeability changes and the edema formation.(ABSTRACT TRUNCATED AT 250 WORDS)