ELÇİN AYDIN, Cenk ERASLAN, Pelin YÜZBAŞ, Nuri ŞENER

Pediatrik olgularda beynin değerlendirilmesinde ve pediatrik beyin hastalıklarının tanısında manyetik transfer MRG'nin yeri

Amaç: Pediatrik grup santral sinir sistemi (SSS) patolojilerinde MT'nin konvansiyonel MRI sekanslarına katkısı, normal olgularda MT bulguları ve yaşa göre gösterdiği değişikliklerin sunulması amaçlandı. Gereç ve Yöntem: Hastanemize değişik nörolojik yakınmalarla başvuran 126 hasta (48 kız, 78 erkek), 28 olgu infant (1 ay-2 yıl), 98 çocuk (2-18 yıl) olmak üzere 2 farklı yaş grubundaydı. Konvansiyonel ve MT MRI incelemeleri yapıldı. Normal gruptaki olgularımızın verilerinin istatistiksel değerlendirilmesinde t-test, korelasyon ve varyans analizi yöntemleri kullanıldı. Bulgular: Altmış altı normal olgunun (36 erkek, 30 kız çocuğu), 18 anatomik lokalizasyonda cinsiyet ile Manyetizasyon Transfer Ratio (MTR) arasında anlamlı istatistiksel fark saptanmadı. Normal gruptaki (28 olgu 0-24 ay, 26'si 24-108 ay, 12'si 109-192 ay) yaş grubunda olgularda MTR değerlerinin ilerleyen yaş ile artışı korelasyon analizine göre yapılan incelemede talamus dışında istatistiksel olarak anlamlı bulundu. Gri cevher yapılarında en yüksek değer globus pallidus, nucleus dentatus ve nucleus ruberde izlenmiştir. Klinik ve konvansiyonel MRG teknikleri ile tanısı konulan nörometabolik ve nörodejeneratif hastalıklarda, SSS enfeksiyonları, beyin tümörleri gibi SSS patolojilerinde aynı yaş grubundaki normal olgularla karşılaştırmalı olarak yapılan değerlendirmede etkilenen alanlarda daha düşük MTR değeri bulundu.

The role of magnetization transfer MRI in the evaluation of brain and in the diagnosis of brain diseases in pediatrics

Aim: It is aimed to evaluate the contribution of Magnetization Transfer (MT) to conventional magnetic resonance imaging in pediatric central nervous system pathologies, and to present the MT findings and the changes in Magnetization Transfer Ratio (MTR) with age in normal pediatric cases. Materials and Methods: A total of 126 pediatric patients (48 girls and 78 boys), who presented to our hospital with various neurological complaints, were divided into two different age groups: 28 infants (1 month-2 years) and 98 children (2-18 years). They underwent conventional and MT MRI examinations. T-test, correlation analysis and variance analysis were used for statistical evaluation of data of the cases in the normal group. Results: No statistically significant difference was found in the MTR of 66 normal cases (36 boys and 30 girls) in 18 anatomical locations between the genders. Correlation analysis performed in normal cases revealed that increased MTR was significantly correlated with increasing age, excluding the MTR of thalamus, in all age groups (28 cases were between 0 and 24 months of age, 26 were between 24 and 108 months of age, and 12 were between 109 and 192 months old). Among grey matter structures, the highest MTR was observed in globus pallidus, dentate nucleus and nucleus ruber. In the comparison of the cases with neurometabolic and neurodegenerative diseases and CNS pathologies such as infections and tumors, diagnosed based on clinical examination and conventional MRI, with agematched normal cases, demonstrated lower MTR in the areas involved. Conclusion: It is thought that MT imaging, which is yet not available in routine practice, is helpful in diagnosis not alone but together with other MRI sequences

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1. Magnetic Resonance - Technology Information Portal. http://www.mr-tip.com
2. Barkovich JA. Concepts of myelin and myelination in Neuroradiology Am J of Neuroradiol 2000;21(6):1099-109.
3. Gupta R. Magnetization transfer MR imaging in central nervous system infections. Indian J Radiol Imaging 2002;12(1):51-8.
4. Hua J, Hurst GC. Analysis of on- and off-resonance magnetization transfer techniques. J Magn Reson Imaging 1995;5(1):113- 20.
5. Edelman RR, Ahn SS, Chien D, et al. Improved time-of-flight MR angiography of the brain with magnetization transfer contrast. Radiology 1992;184(2):395-9.
6. Tanttu JI, Sepponen RE, Lipton MJ, et al. Synergistic enhancement of MRI with Gd-DTPA and magnetization transfer. J Comput Assist Tomogr 1992;16(1):19-24.
7. Ge Y, Grossman RI, Udupa JK, et al. Magnetization transfer ratio histogram analysis of gray matter in relapsing-remitting multiple sclerosis. Am J Neuroradiol 2001;22(3):470-5.
8. Thomas JD. Magnetization transfer in magnetic resonance imaging. Radiol Technol 1996;67(4):297-306.
9. Buchem MA, Steens SCA, Vrooman HA, et al. Global estimation of myelination in the developing brain on the basis of magnetization transfer imaging: A preliminary study Am J Neuroradiol 2001;22(4):762-6.
10. Steen RO, Ogg RJ, Reddick WE, et al. Age related changes in the pediatric brain: Quantitative MR evidence of maturational changes during adolescence. Am J Neuroradiol 1997;18(5):819-28.
11. Buchem MA, Steens SCA, Vrooman HA, et al. Global estimation of myelination in the developing brain on the basis of magnetization transfer imaging: A preliminary study. Am J of Neuroradiol 2001;22(4):762-6.
12. Silver NC, Barker GJ, MacManus DG, et al. Magnetisation transfer ratio of normal brain white matter: a normative database spanning four decades of life. J Neurol Neurosurg Psychiatry 1997;62(3):223-8.
13. Lascola CD, Song AW, Haystead TA, et al. Changes in magnetization transfer MRI correlate with spreading depression-induced astroglial reactivity and increased protein expression in mice. Am J Roentgenol 2004;183(6):1791-7.
14. Price SJ, Tozer DJ, Gillard JH. Methodology of diffusion-weighted, diffusion tensor and magnetisation transfer imaging. BJR 2011;84(2):121-6.
15. Wong AM, Simon EM, Zimmerman RA, et al. Acute necrotizing encephalopathy of childhood: correlation of MR findings and clinical outcome. Am J of Neuroradiol 2006;27(9):1919-23.
16. Ha JS, Kim TK, Eun BL, et al. Maple syrup urine disease encephalopathy: a follow-up study in the acute stage using diffusionweighted MRI. Pediatr Radiol 2004;34(2):163-6.
17. Okumura A, Takenaka K, Nishimura Y, et al. The characterization of human brain tumor using magnetization transfer technique in magnetic resonance imaging. Neurol Res 1999;21(3):250-4.
18. Pui MH. Magnetization transfer analysis of brain tumor, infection, and infarction. J Magn Reson Imaging 2000;12(3):395-9.
19. Zikou A, Ioannidou MC, Tzoufi M, et al. Magnetization transfer ratio measurements of the brain in children with tuberous sclerosis complex. Pediatr Radiol 2005;35(11):1071-4.
20. Gupta RK, Kathuria MK, Pradhan S. Magnetization transfer MR imaging in CNS tuberculosis. Am J Neuroradiol 1999;20(5):867- 75.
21. McGowan JC, Yang JH, Plotkin RC, et al. Magnetization transfer imaging in the detection of injury associated with mild head trauma. Am J of Neuroradiol 2000;21(5):875-80.
22. Sinson G, Bagley LJ, Cecil KM, et al. Magnetization transfer imaging and proton MR spectroscopy in the evaluation of axonal injury: Correlation with clinical outcome after traumatic brain injury. Am J of Neuroradiol 2001;22(1):143-51.