Environnement lumineux et anxiété des patients en service d’IRM

BackgroundMagnetic Resonance Imaging (MRI) is a medical imagery exam, which is considered stressful/worrying for patients. This anxiety is related to several factors: negative beliefs linked to the lack of knowledge about the procedure of the exam, duration, noise of the MRI, etc. Several interventions, before and during the MRI were proposed and evaluated with the aim of reducing anxiety for patients (information given to patients, psychological preparation before the exam and hypnosis, aromatherapy, sedation, environment and positioning of the patient). While the health service is more and more centered on cost-efficiency and pressure for greater patient throughput, it is important to find appropriate interventions to improve patient tolerance of MRIs.ObjectiveThe objective of this study was to compare anxiety of patients based on the MRI luminous environment.Methods208 patients aged 18–70 years participated in the study. Four subgroups were created according to the presence or absence of luminous environment, screen and music: G1 (60 participants, with luminous environment, without screen, music with fast tempo); G2 (60 participants, with luminous environment, with screen, music with slow tempo); G3 (27 participants, without luminous environment, without music); G4 (61 participants, without luminous environment, music with fast tempo). All participants completed a questionnaire to evaluate their anxiety regarding the exam (anxiety-state, AE) and in everyday life (anxiety-trait, AT): STAI-Y. Open questions were also asked to participants in order to gain an understanding of their experience of the exam (positive points and suggestions for improvements).ResultsThe results showed a significant difference between the groups of the AE: patients of group G1 showed more AE than patients in group G2 (p = 0.037), patients of group G2 showed less AE than those of group G3 (p = 0.001), and patients of group G3 showed more AE than patients in group G4 (p = 0.019). No significative difference was found between the 3 groups in the AT. The participants who underwent exams in a room with a luminous environment equipped with a screen with slow tempo music reported more satisfaction and offered fewer suggestions for improvement compared with the two other groups.ConclusionThis study has revealed that the environment in which patients undergo their exam affects their level of anxiety during the exam. A luminous environment equipped with a screen led to a considerable decrease in patient anxiety during the MRI exam. Technological innovations are allowing the patient to be the center of radiographers focus more and more. Trying to priorities improvement of patient well-being consequently facilitates their work. Taking into account the cost and increasing number of medical imagery exams, prevention of anxiety and its undesirable side-effects is not only important for patients, but also avoids wastage of staff and of time. The results of this study should encourage health centers to invest in these new installations, keeping in mind that new technologies can never replace information and support offered before the exam by radiologists and radiographers.     

Pharmacologic Treatment of Attention-Deficit/Hyperactivity Disorder: Efficacy,Safety and Mechanisms of Action

Studies examining the efficacy, safety and mechanisms of action of agents for the treatment of attention-deficit/hyperactivity disorder (ADHD) are reviewed, with an emphasis on newer agents such as the long acting stimulants and atomoxetine. Recent studies of medications are characterized by large, rigorously diagnosed samples of children, adolescents and adults with ADHD, use of standardized rating scales and extensive safety data. These studies confirm a robust treatment effect for the Food and Drug Administration approved agents ranging from 0.7 to 1.5. The most common short term side effects to the most commonly used agents include insomnia, loss of appetite, and headaches. Despite public controversy and labeling changes to warn of extremely rare cardiovascular and psychiatric side effects, the evidence does not support the hypothesis that medication for ADHD increases risk for sudden death, mania or psychosis. A wide variety of neuroimaging techniques including electrocephalogram (EEG) power, event related potentials (ERP), functional magnetic resonance imaging (fMRI), and positron emission tomography (PET) are beginning to examine the mechanisms of action of medications for ADHD, and implicating the catecholamines and prefrontal and anterior cingulate cortices as prime sites of actions for these agents.     

The Contribution of Neuroimaging to the Study of Language and Aphasia

New structural and functional imaging methods continue to be developed at a rapid pace. In the last 25 years, advanced imaging techniques have provided insights into how language is represented and processed in the brain and how it can be disrupted by damage to, or dysfunction of, various parts of the brain. Imaging studies have also yielded new information regarding how individuals recover language after stroke. We briefly review the strengths and weaknesses of the various radiological methods currently used to study language and aphasia.     

Sex differences in the adolescent brain

Adolescence is a time of increased divergence between males and females in physical characteristics, behavior, and risk for psychopathology. Here we will review data regarding sex differences in brain structure and function during this period of the lifespan. The most consistent sex difference in brain morphometry is the 9–12% larger brain size that has been reported in males. Individual brain regions that have most consistently been reported as different in males and females include the basal ganglia, hippocampus, and amygdala. Diffusion tensor imaging and magnetization transfer imaging studies have also shown sex differences in white matter development during adolescence. Functional imaging studies have shown different patterns of activation without differences in performance, suggesting male and female brains may use slightly different strategies for achieving similar cognitive abilities. Longitudinal studies have shown sex differences in the trajectory of brain development, with females reaching peak values of brain volumes earlier than males. Although compelling, these sex differences are present as group averages and should not be taken as indicative of relative capacities of males or females.     

Hippocampal region-specific contributions to memory performance in normal elderly

To investigate the relationship between regional hippocampal volume and memory in healthy elderly, 147 community-based volunteers, aged 55–83 years, were evaluated using magnetic resonance imaging, the Groton Maze Learning Test, Visual Reproduction and the Rey Auditory Verbal Learning Test. Hippocampal volumes were determined by interactive volumetry. We found greater age-related reduction in the volume of the hippocampal head relative to the tail. Right hippocampal tail volume correlated with spatial memory on the Groton Maze Learning Test while left hippocampal body volume was associated with delayed verbal memory. These associations were independent of age, sex, education and speed of processing and support the notion of functional differentiation along the long axis of the hippocampus.     

Functional imaging of working memory and peripheral endothelial function in middle-aged adults

The current study examined the relationship between a prognostic indicator of vascular health, flow-mediated dilation (FMD), and working memory-related brain activation in healthy middle-aged adults. Forty-two participants underwent functional magnetic resonance imaging while completing a 2-Back working memory task. Brachial artery endothelial-dependent flow-mediated dilation (FMD) was assessed using B-mode ultrasound. The relationship between FMD and task-related brain activation in a priori regions of interest was modeled using hierarchical linear regression. Brachial FMD, was significantly related to reduced working memory-related activation in the right superior parietal lobule (β = 0.338, p = 0.027), independent of age, sex, systolic blood pressure, and full scale IQ (F(5, 36) = 2.66, p = 0.038). These data provide preliminary support for the association between a preclinical marker of endothelial dysfunction and cerebral hemodynamic alterations in healthy middle-aged adults. Considering the modifiable nature of endothelial function, additional investigations on the prognostic significance of FMD on future cognitive impairment are warranted.     

Motor asymmetry and substantia nigra volume are related to spatial delayed response performance in Parkinson disease

Studies suggest motor deficit asymmetry may help predict the pattern of cognitive impairment in individuals with Parkinson disease (PD). We tested this hypothesis using a highly validated and sensitive spatial memory task, spatial delayed response (SDR), and clinical and neuroimaging measures of PD asymmetry. We predicted SDR performance would be more impaired by PD-related changes in the right side of the brain than in the left. PD (n = 35) and control (n = 28) participants performed the SDR task. PD participants either had worse motor deficits on the right (RPD) or left (LPD) side of the body. Some participants also had magnetic resonance imaging for measurement of their substantia nigra (SN) volumes. The LPD group performed worse on the SDR task than the RPD and control groups. Right SN volume accounted for a unique and significant portion of the variance in SDR error, with smaller volume predicting poorer performance. In conclusion, left motor dysfunction and smaller right SN volume are associated with poorer spatial memory.     

The effect of severe carotid occlusive disease and its surgical treatment on cognitive functions of the brain

Surgery of a high-grade carotid stenosis is evidence-based stroke prevention. Also cognitive effects are reported after carotid endarterectomy (CEA): both deterioration and improvement, the former attributed to perioperative complications and the latter often to learning effect. By imaging, brain perfusion and diffusion changes were shown in subjects with a high-grade stenosis undergoing CEA. We wanted to find out if the cognition of patients undergoing CEA display postoperative worsening or true improvement in association with findings in serial MR imaging. The patients had a poorer overall cognition than healthy matched controls. The cerebral hemisphere ipsilateral to the stenosis had higher diffusion and more sluggish perfusion leading to perfusion deficits. These asymmetries were abolished by CEA. Postoperatively, the patients showed a trend for cognitive worsening, most often attentional, but over months, the group performance improved similarly to the controls. Still, lower baseline perfusion was associated with a greater cognitive improvement, most clearly in executive functions. Consequently, despite the risk for transient decline, true cognitive benefit by CEA seems possible.     

Myelin breakdown mediates age-related slowing in cognitive processing speed in healthy elderly men

Background

To assess the hypothesis that in a sample of very healthy elderly men selected to minimize risk for Alzheimer’s disease (AD) and cerebrovascular disease, myelin breakdown in late-myelinating regions mediates age-related slowing in cognitive processing speed (CPS).

Materials and methods

The prefrontal lobe white matter and the genu of the corpus callosum myelinate later in brain development (late-myelinating white matter; LMWM) and are more vulnerable to breakdown due to the effects of normal aging. An in vivo MRI biomarker of myelin integrity (transverse relaxation rates; R₂) of LMWM was obtained for 38 very healthy elderly adult men (mean age = 66.3 years; SD = 6.0; range = 55–76). To evaluate regional specificity, we also assessed a contrasting early-myelinating region (splenium of the corpus callosum; SWM), which primarily contains axons involved in visual processing. CPS was assessed using the Trail Making Test.

Results

LMWM R₂ and CPS measures were significantly correlated (r = .515, p = .0009), but no significant association between R₂ and CPS was detected in the splenium (p = .409). LMWM R₂, but not SWM R₂, was a significant mediator of the relationship between age and CPS (p = .037).

Conclusions

In this very healthy elderly sample, age-related slowing in CPS is mediated by myelin breakdown in highly vulnerable late-myelinating regions but not in the splenium.     

Variability in subcortical aphasia is due to variable sites of cortical hypoperfusion

A variety of fluent and nonfluent aphasias have been reported after left basal ganglia stroke. It has been speculated that this heterogeneity may reflect variations in cortical hypoperfusion resulting from large vessel stenosis. To test this hypothesis, a consecutive series of 24 patients with left caudate infarct identified with diffusion-weighted imaging underwent language testing and perfusion-weighted imaging < 24h from onset of symptoms. Specific regions in perisylvian cortex were rated for the percentage of the region that was hypoperfused. Aphasia type was determined on the basis of speech fluency, comprehension, and repetition performance on the language tests. Association between aphasia type/language impairment and regions of hypoperfusion were identified with Fisher's exact tests. Results demonstrated that in patients with acute left caudate infarct, the presence and type of aphasia reflected regions of hypoperfusion, and generally followed predictions based on chronic lesion studies, regarding anatomical lesions associated with classic aphasia types.     

Correlation between gray/white matter volume and cognition in healthy elderly people

This study applied volumetric analysis and voxel-based morphometry (VBM) of brain magnetic resonance (MR) images to assess whether correlations exist between global and regional gray/white matter volume and the cognitive functions of semantic memory and short-term memory, which are relatively well preserved with aging, using MR image data from 109 community-dwelling healthy elderly individuals. We used the Information and Digit Span subtests of the Wechsler Adult Intelligent Scale-Revised as measures of semantic memory and short-term memory, respectively. We found significant positive correlations between the gray matter ratio, the percentage of gray matter volume in the intracranial volume, and performance on the Digit Span subtest, and between the regional gray matter volumes of the bilateral anterior temporal lobes and performance on the Information subtest. No significant correlations between performance on the cognitive tests and white matter volume were found. Our results suggest that individual variability in specific cognitive functions that are relatively well preserved with aging is accounted for by the variability of gray matter volume in healthy elderly subjects.     

盆底结构MRI研究进展及思考

盆底结构精细复杂,传统的解剖学以尸检为依据,现代影像学则提供了活体观察功能形态的有效方法。盆底结构核磁共振成像研究的新进展,体现了医学技术创新的稳健性、后发性、综合性,其发展取决于现代科学技术的进步。因此影像医学工作者作为医学科技主体,只有具备综合型知识结构,才能更好地进行医学技术创新。     

Prototype-distortion category learning: a two-phase learning process across a distributed network

This paper reviews a body of work conducted in our laboratory that applies functional magnetic resonance imaging (fMRI) to better understand the biological response and change that occurs during prototype-distortion learning. We review results from two experiments (Little, Klein, Shobat, McClure, & Thulborn, 2004; Little & Thulborn, 2005) that provide support for increasing neuronal efficiency by way of a two-stage model that includes an initial period of recruitment of tissue across a distributed network that is followed by a period of increasing specialization with decreasing volume across the same network. Across the two studies, participants learned to classify patterns of random-dot distortions (Posner & Keele, 1968) into categories. At four points across this learning process subjects underwent examination by fMRI using a category-matching task. A large-scale network, altered across the protocol, was identified to include the frontal eye fields, both inferior and superior parietal lobules, and visual cortex. As behavioral performance increased, the volume of activation within these regions first increased and later in the protocol decreased. Based on our review of this work we propose that: (i) category learning is reflected as specialization of the same network initially implicated to complete the novel task, and (ii) this network encompasses regions not previously reported to be affected by prototype-distortion learning.     

抑郁症的脑功能异常:来自静息态功能磁共振成像的证据

静息态功能磁共振成像是指在静息状态下测量的BOLD信号,即受试者安静地躺在扫描仪中,不给受试者任何特定的任务,受试者也不用做任何反应,此时受试者的大脑活动处于自发状态。通过使用该技术可以为抑郁症发作的临床现象提供神经影像学依据,以期为将来抑郁症的治疗提供生物标记。因此,本文综述了大量抑郁症患者在静息态脑功能方面的差异研究,发现了单、双相抑郁症,首、复发抑郁症,早发性、晚发性抑郁症,难治、非难治性抑郁症等不同类型的抑郁症在包括局部一致性(Re Ho)和低频振幅(ALFF)在内的功能分化以及包括功能连接密度(FCD)、功能同伦(VMHC)、复杂网络(Complex Network)和ROI功能连接在内的功能整合两大指标的改变。     

青老年组不同难度下心算活动的脑功能磁共振成像研究

应用功能磁共振成像技术研究不同心算难度下脑区的活动以及年龄的影响。14名志愿者（20～29岁青年和60～69岁老年被试各7名）参加了该实验。实验任务为2个难度水平的连续减法心算,分别为1000—3和1000—17。结果表明：（1）心算加工激活了额叶和顶叶的许多脑区;（2）大脑左半球是心算加工的优势半球,但随着心算难度加大,大脑一侧化程度下降,而年老加剧了这一趋势;（3）青年组进行简单心算（1000—3）时,额中回未见明显激活,而老年组进行简单心算时,该脑区被明显激活。总体上,额叶和顶叶在心算活动中起着重要作用,而任务难度和年龄对心算加工时脑活动的影响以额中回区最为明显。     

2003年诺贝尔医学奖给科学界的多重启示(上)

2003年诺贝尔医学奖授予了两位美英物理学家,劳特布尔和曼斯菲尔德,表彰他们在磁共振成像方面的发现.这些发现导致现代磁共振技术的开发,这一技术标志着医学诊断学和科学研究中的一项突破.该项发现建筑在核磁和核磁共振现象被发现的基础之上.核磁现象的发现及其应用导致了1943、1944和1952年诺贝尔物理学奖的获得.核磁共振现象的发现及其应用导致了1991年和2002年诺贝尔化学奖的获得.这意味着,2003年诺贝尔医学奖是该系列发现中第六个诺贝尔科学奖.