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Master's Dissertation
DOI
10.11606/D.17.2005.tde-02102006-130052
Document
Author
Full name
Augusto Elias Mamere
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2005
Supervisor
Committee
Santos, Antonio Carlos dos (President)
Muglia, Valdair Francisco
Yamashita, Helio Kiitiro
Title in Portuguese
"Avaliação do dano neuronal e axonal tardio, secundário ao traumatismo craniencefálico moderado e grave, por técnicas quantitativas em ressonância magnética"
Keywords in Portuguese
lesão axonal difusa
ressonância magnética
trauma craniocerebral
Abstract in Portuguese
O traumatismo craniencefálico (TCE) fechado é, classicamente, um modelo de lesão neuronal e axonal monofásica, onde a destruição do parênquima, incluindo neurônios e células gliais, ocorre principalmente no momento do trauma, seguida pela degeneração Walleriana anterógrada e retrógrada nos dias subseqüentes. Há evidências de progressão da perda neuronal e axonal na fase tardia após o trauma, observada principalmente pela evolução da atrofia cerebral, secundária a vários fatores, incluindo a apoptose neuronal. Com o objetivo de testar a hipótese de que as técnicas quantitativas em ressonância magnética (RM) permitem identificar, de modo não invasivo, as variáveis biológicas que estimam a perda neuronal e axonal no cérebro relacionadas ao TCE moderado e grave e à lesão axonal difusa, na fase tardia, foram avaliados 9 pacientes, sendo 5 do sexo masculino e 4 do sexo feminino, com idades variando de 11 a 28 anos (média de 21,1 anos), que foram vítimas de TCE moderado ou grave (Escala de Coma de Glasgow menor que 12 na admissão hospitalar após o TCE) e que tiveram boa recuperação. O tempo médio entre o trauma e o exame de ressonância magnética foi de 3,1 anos (± 0,5 anos). Foram utilizados os índices ventrículo-cerebrais bifrontal (IVCF) e bicaudado (IVCC), a medida do tempo de relaxação T2, o índice de transferência de magnetização (MTR), o coeficiente de difusão aparente (ADC) e a espectroscopia de prótons multi-voxel, com o cálculo dos índices metabólicos N-acetilaspartato/creatina (NAA/Cre) e colina/creatina (Cho/Cre). Foram estudados a substância branca (SB) frontal e parietal bilateralmente, o joelho e o esplênio do corpo caloso (CC) e a substância cinzenta (SC). As médias dos valores medidos foram comparadas às de um grupo controle formado por 9 pessoas sadias, pareadas pela idade e sexo. Observou-se aumento estatisticamente significativo (p ≤ 0,05) do IVCF e do IVCC nos pacientes, devido ao aumento ventricular secundário à atrofia subcortical; aumento no tempo de relaxação T2 na SB e no CC, que reflete o aumento da concentração de água por provável perda axonal e gliose; aumento do ADC e redução do MTR na SB e no CC, que demonstram lesão das fibras axonais mielinizadas, e redução do índice NAA/Cre no CC, indicando perda axonal. Não houve diferença estatisticamente significativa nas medidas realizadas na SC e nem no índice Cho/Cre (p › 0,05). Os resultados encontrados mostram que as técnicas quantitativas em RM foram capazes de detectar, de modo não invasivo, o dano neuronal e axonal na substância branca e no corpo caloso de cérebros humanos, secundário ao TCE moderado e grave.
Title in English
Evaluation of delayed neuronal and axonal damage, secondary to moderate and severe traumatic brain injury, using quantitative magnetic resonance techniques.
Keywords in English
craniocerebral trauma
diffuse axonal injury
magnetic resonance
Abstract in English
Closed traumatic brain injury (TBI) is a classic model of monophasic neuronal and axonal injury, where tissue damage mainly occurs at the moment of trauma, followed by anterograde and retrograde Wallerian degeneration in the subsequent days. There are some evidences of delayed progression of the neuronal and axonal loss after TBI, mainly shown by gradual development of cerebral atrophy, due to many factors, including neuronal apoptosis. For the purpose of testing the hypothesis that quantitative magnetic resonance techniques are able to assess the biological variables which estimate neuronal and axonal loss in brain, related to moderate or severe TBI and diffuse axonal injury, nine patients (age range 11 – 28 years; mean age 21,1 years; 5 male and 4 female), who sustained a moderate or severe TBI (initial Glasgow Coma Scale less than 12), with good recovery, were evaluated in a mean of 3,1 years after trauma (± 0,5 year). The following techniques were applied: bicaudate (CVIC) and bifrontal (CVIF) cerebroventricular indexes; T2 relaxation time measurement (T2 relaxometry); magnetization transfer ratio (MTR); apparent diffusion coefficient (ADC); multivoxel proton magnetic resonance spectroscopy, using N-acetylaspartate/creatine (NAA/Cre) and choline/creatine (Cho/Cre) ratios; measured in the frontal and parietal white matter (WM) of both cerebral hemispheres, in the genu and splenium of the corpus callosum (CC) and in the gray matter (GM). The results were compared with those of a control group constituted by 9 healthy volunteers with a matched age and sex distribution. The CVIC and CVIF mean values were significantly increased (p ≤ 0,05) in patients due to ventricular enlargement secondary to subcortical atrophy; an increase in T2 relaxation time was observed in the WM and CC, reflecting an enhancement in water concentration, probably secondary to axonal loss and gliosis; increased ADC mean values and reduced MTR mean values were found in the WM and CC, showing damage in the myelinated axonal fibers; and decreased NAA/Cre ratio mean values in the CC, indicating axonal loss. No significant differences were observed in the mean values measured at the GM or in the Cho/Cre ratio mean values (p › 0,05). These quantitative magnetic resonance techniques were able to non-invasively demonstrate the neuronal and axonal damage in the WM and CC of human brains, secondary to moderate or severe TBI.
 
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Publishing Date
2006-10-09
 
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