Efrosini Papadaki

White matter and deep gray matter hemodynamic changes in multiple sclerosis patients with clinically isolated syndrome

The dynamic susceptibility contrast magnetic resonance imaging perfusion technique was used to investigate possible hemodynamic changes in normal appearing white matter and deep gray matter (DGM) of 30 patients with clinically isolated syndrome (CIS) and 30 patients with relapsing–remitting multiple sclerosis. Thirty normal volunteers were studied as controls. Cerebral blood volume, cerebral blood flow (CBF), and mean transit time values were estimated. Normalization was achieved for each subject with respect to average values of CBF and mean transit time of the hippocampis dentate gyrus. Measurements concerned three regions of normal white matter of normal volunteers, normal appearing white matter of CIS and patients with relapsing–remitting multiple sclerosis, and DGM regions, bilaterally. All measured normal appearing white matter and DGM regions of the patients with CIS had significantly higher cerebral blood volume and mean transit time values, while averaged DGM regions had significantly lower CBF values, compared to those of normal volunteers (P < 0.001). Regarding patients with relapsing–remitting multiple sclerosis, all measured normal appearing white matter and DGM regions showed lower CBF values than those of normal volunteers and lower cerebral blood volume and CBF values compared to patients with CIS (P < 0.001). These data provide strong evidence that hemodynamic changes—affecting both white and DGM—may occur even at the earliest stage of multiple sclerosis, with CIS patients being significantly different than relapsing–remitting multiple sclerosis patients. Magn Reson Med, 2012.

Watery eye following patent external DCR: an MR dacryocystography study.

Purpose: To examine patients with persistent watery epiphora following patent external dacryocystorhinostomy (DCR) with magnetic resonance imaging dacryocystography (MR-DCG). Methods: Patients with unobstructed nasolacrimal irrigation following external DCR were included. Five patients with watery epiphora constituted the study group (SG). Five patients without epiphora constituted the control group (CG). All patients underwent MR-DCG following the instillation of artificial tears in the conjunctival fornix. The osteotomy site was identified in T1-weighted coronal images. Lacrimal flow was assessed with modified T2-weighted (True Fast Imaging Steady State Pulse, “TrueFISP”) coronal images before and 10 min after repeated blinking. Signal intensities at three regions of interest (ROIs), corresponding to the eyeball (ROI-1), conjunctival sac (ROI-2), and anastomotic site (ROI-3) were measured. Results: Differences in the diameter of both osseous and soft tissue ostia between SG and CG were statistically not significant. A post-blink increase in signal intensity at ROI-3 was noted in both groups, whereas differences in signal intensity for ROI-1 and ROI-2 were statistically not significant. The post-blink signal intensity increase in ROI-3 was significantly more pronounced in the CG, compared with the SG. Conclusions: The fact that signal intensity increase at ROI-3 was less pronounced in the SG, compared with CG, implies a compromised “lacrimal pump” mechanism in the former group. The methodology presented may be used for the evaluation of post-DCR epiphora.

MRI Evaluation of Lacrimal Drainage After External and Endonasal Dacryocystorhinostomy

Purpose: External and endonasal dacryocystorhinostomy (EX-DCR and EN-DCR, respectively) affect the tear drainage mechanism. This study evaluates the preservation of “lacrimal pump” function in both procedures. Methods: Cases of successful EN-DCR (4 patients) and EX-DCR (4 patients) were included. All patients underwent MRI of the rhinostomy areas, at least 6 months postoperatively. The vertical diameter of rhinostomy (both osseous and soft-tissue apertures) was measured in T1-oriented images, whereas the signal intensity levels were examined for 3 regions of interest (ROIs) in T2-oriented (true fast imaging steady state pulse) images with instillation of normal saline to the conjunctival fornices, both before and after blinking (activation of the “lacrimal pump”). ROI 1 corresponded to the globe (control), ROI 2 corresponded to the inferior conjunctival fornix, and ROI 3 corresponded to the rhinostomy site. Results: Signal intensity in ROI 3 (rhinostomy) was significantly increased after blinking in both EX-DCR and EN-DCR cases. The increase was significantly higher in the latter. Signal intensity changes in ROI 3 were significantly correlated with rhinostomy size in both groups, whereas the respective correlations with the postoperative interval were not statistically significant. Conclusions: Findings imply that the “lacrimal pump” is active following DCR and may be better preserved in the EN-DCR than in the EX-DCR group. Persistent epiphora after patent DCR may thus be attributed to a defective “pump” function and treated accordingly.

Coexistence of systemic lupus erythematosus and multiple sclerosis: prevalence, clinical characteristics, and natural history.

OBJECTIVES The coexistence of systemic lupus erythematosus (SLE) and multiple sclerosis (MS) in the same individual has rarely been described. Our objective was to report on the prevalence, clinical characteristics, and prognosis of cases fulfilling the criteria for both SLE and MS. METHODS We utilized existing patient cohorts from the Departments of Rheumatology and Neurology, University of Crete, and screened patients diagnosed with either SLE (n = 728) or MS (n = 819) for features of both diseases. The clinical, laboratory, and neuroimaging findings were assessed. RESULTS We identified nine patients who fulfilled the diagnostic criteria for both SLE and MS, corresponding to a prevalence rate of 1.0-1.2% in each cohort. All patients were women, with an average age at SLE diagnosis of 42.1 years (range: 34-56 years). The diagnosis of SLE preceded the development of MS in five patients, with a time lag ≤ 5 years in four of them. Initial presentation of MS included spinal symptoms in seven patients. All patients had features of mild SLE with predominantly cutaneous, mucosal, and musculoskeletal manifestations. Accordingly, therapeutic decisions were mainly guided by the severity of the neurological syndrome. During the median follow-up of 4 years (range: 1-10 years), three patients remained stable and the remaining experienced gradual deterioration in their neurological status. SLE remained quiescent in all patients while on standard immunomodulatory MS therapy. CONCLUSIONS Occurrence of both diseases in the same individual is rare, corroborating data that suggest distinct molecular signatures. SLE and MS coexistence was not associated with a severe phenotype for either entity.

Effective Orbital Volume and Eyeball Position: An MRI Study

Purpose: Previous studies have examined factors affecting the position of the eyeball to the orbit. This study examined the role of effective orbital volume (EOV), defined as the difference between orbital and eyeball volume, as a determinant of eyeball position, using MRI scans. Methods: Forty-six patients were recruited from the Department of Ophthalmology of the University Hospital of Heraklion, Crete Greece. Patients with a history of orbital disease were excluded. Distances between eyeball poles and orbital landmarks were measured in T1 weighted transverse, sagittal and coronal orbital images. The protrusion of the eyeball in the sagittal and transverse planes was recorded. The volume of the eyeball and bony orbit, the EOV, the volume of the extraocular muscles as well as clinical information (age, gender, Hertel exophthalmometry) were also recorded. Results: EOV was significantly associated with orbital volume but not with eyeball volume. EOV was also significantly associated with transverse and sagittal globe ptotrusions. Females displayed significantly lower orbital and eyeball volumes as well as EOV than males but higher transverse globe protrusion than males. Conclusions: Variations in EOV are associated with orbital volume rather than with eyeball volume. EOV is associated with globe protrusion and may be taken into account in the planning of various procedures, including orbital decompression, treatment of enophthalmos or the size of orbital implants following enucleation.

Hemodynamic evidence linking cognitive deficits in clinically isolated syndrome to regional brain inflammation

To investigate the relation between hemodynamic measurements and memory function in patients with clinically isolated syndrome (CIS).

Regional MRI Perfusion Measures Predict Motor/Executive Function in Patients with Clinically Isolated Syndrome

Background. Patients with clinically isolated syndrome (CIS) demonstrate brain hemodynamic changes and also suffer from difficulties in processing speed, memory, and executive functions. Objective. To explore whether brain hemodynamic disturbances in CIS patients correlate with executive functions. Methods. Thirty CIS patients and forty-three healthy subjects, matched for age, gender, education level, and FSIQ, were administered tests of visuomotor learning and set shifting ability. Cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) values were estimated in normal-appearing white matter (NAWM) and normal-appearing deep gray Matter (NADGM) structures, using a perfusion MRI technique. Results. CIS patients showed significantly elevated reaction time (RT) on both tasks, while their CBV and MTT values were globally increased, probably due to inflammatory vasodilation. Significantly, positive correlation coefficients were found between error rates on the inhibition condition of the visuomotor learning task and CBV values in occipital, periventricular NAWM and both thalami. On the set shifting condition of the respective task significant, positive associations were found between error rates and CBV values in the semioval center and periventricular NAWM bilaterally. Conclusion. Impaired executive function in CIS patients correlated positively with elevated regional CBV values thought to reflect inflammatory processes.

Evaluation of the position and function of aqueous drainage implants with magnetic resonance imaging.

PurposeTo evaluate position and function of antiglaucomatous Ahmed and Molteno shunts using magnetic resonance imaging with head and surface coils. MethodsEight patients (5 males) with shunt implants were included, 4 with Ahmed (FP-7) and 4 with Molteno (s1, single plated). All patients were operated at least 6 months before imaging. In 3 cases (2 with Molteno and 1 with Ahmed shunt), the intraocular pressure (IOP) was above 21 mm Hg, despite maximal medical treatment. The shunt endplate, tube and filtering blebs were identified in T1-weighted and T2-weighted images with both head and surface coils. Volumetric measurements of the orbits, eyeball, and filtering bleb and calculation of the endplate position along sagittal, transverse, and vertical axes were performed in T1-weighted and T2-weighted images using head coils. ResultsThe shunt endplate was identified in T1-weighted and T2-weighted images (head coils) as a low intensity (dark) circumlinear band at the superotemporal aspect of the eyeball, surrounded by a pocket of water density, corresponding to the filtering bleb. The anterior position of the endplate, and smaller volume of the orbital cavity (less available orbital space) were associated with higher IOP. Filtering bleb volume was inversely correlated with IOP. In the unsuccessful cases, filtering bleb was absent. ConclusionsMagnetic resonance imaging provides insights into the mechanism of aqueous outflow and causes of failure of shunts. A lower orbital volume is associated with anterior position of the shunt endplate and poor shunt performance.

Evaluation of globe position within the orbit: clinical and imaging correlations

Significant variations have been reported concerning the size of the orbit and eyeball, and the position of the latter in the former.1 Hertel exophthalmometry has inherent deficiencies, including the fact that the lateral orbital rim (on which it relies as a reference point) varies among individuals.2 Previous studies have evaluated the position of the globe within the orbit and its correlations with MRI.3 We have also used a 1.5 T MRI scanner in a series of 32 adult patients (19 males, 59.3%) aged 56.22 (SD 13.80) (36 to 80) years, without any previous history of orbital disease, to measure the volumes of ocular and orbital structures and the distance of the eyeball poles from respective orbital landmarks. We aimed to examine whether intraorbital globe position is affected by orbital or …

Neuropsychiatric lupus or not? Cerebral hypoperfusion by perfusion-weighted MRI in normal-appearing white matter in primary neuropsychiatric lupus erythematosus

Objectives Cerebral perfusion abnormalities have been reported in systemic lupus erythematosus (SLE) but their value in distinguishing lupus from non-lupus-related neuropsychiatric events remains elusive. We examined whether dynamic susceptibility contrast-enhanced perfusion MRI (DSC-MRI), a minimally invasive and widely available method of cerebral perfusion assessment, may assist neuropsychiatric SLE (NPSLE) diagnosis. Methods In total, 76patients with SLE (37 primary NPSLE, 16 secondary NPSLE, 23 non-NPSLE) and 31 healthy controls underwent conventional MRI (cMRI) and DSC-MRI. Attribution of NPSLE to lupus or not was based on multidisciplinary assessment including cMRI results and response to treatment. Cerebral blood volume and flow were estimated in 18 normal-appearing white and deep grey matter areas. Results The most common manifestations were mood disorder, cognitive disorder and headache. Patients with primary NPSLE had lower cerebral blood flow and volume in several normal-appearing white matter areas compared with controls (P<0.0001) and lower cerebral blood flow in the semioval centre bilaterally, compared with non-NPSLE and patients with secondary NPSLE (P<0.001). A cut-off for cerebral blood flow of 0.77 in the left semioval centre discriminated primary NPSLE from non-NPSLE/secondary NPSLE with 80% sensitivity and 67%–69% specificity. Blood flow values in the left semioval centre showed substantially higher sensitivity than cMRI (81% vs 19%–24%) for diagnosing primary NPSLE with the combination of the two modalities yielding 94%–100% specificity in discriminating primary from secondary NPSLE. Conclusion Primary NPSLE is characterised by significant hypoperfusion in cerebral white matter that appears normal on cMRI. The combination of DSC-MRI-measured blood flow in the brain semioval centre with conventional MRI may improve NPSLE diagnosis.