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Dal Zotto, Lara (2015) Analisi di post processing delle risonanze magnetiche cerebrali di bambini con esiti di Shaken Baby Syndrome: studi di DTI del corpo calloso. [Tesi di dottorato]

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Abstract (inglese)

Background. The Shaken Baby Syndrome (SBS) is a leading cause of morbidity and mortality among abused children. Its pathogenesis is characterized by the presence of a mechanical damage responsible of focal lesions, which adds a metabolic damage resulting in widespread damage of the white matter (WM).
Aim. This study used diffusion tensor imaging (DTI) to examine white matter (WM) abnormalities of corpus callosum (CC) in infants with SBS in order to asses how WM microstructure may reflect axonal damage and correlate with clinical outcomes.
Methods. We collect DTI scans from 5 infants (age range: 23 months – 6 years 5 months) after months from the diagnosis of SBS (18 months up to 6 years); the WM of the CC has been analyzed using a probabilistic model.
Clinical variables and conventional imaging findings were analyzed in relation to outcome. Cognitive outcomes were assessed by the administration of the scales of development Griffiths (Griffiths Mental Development Scales-GMDS) or the Wechsler scales for children older than 4 years. Fractional anisotropy ( FA ) , axial diffusivity (AD ) , and radial diffusivity ( RD ) were calculated for each of the seven regions in which it was divided the corpus callosum, according to the Wiltelson model.
Results . The five children studied (3 males and 2 females , mean age = 48 months, average time since diagnosis = 42 months) had normal cognitive development in 3 cases and below normal in 2 cases . The 3T MRI performed during follow-up in the medium-long term showed damage to the white matter only in one case. Reduced FA values were measured in diffuse regions of WM in all children with SBS, with major impairment in children who had a deviation below the norm of cognitive development, but with altered values also in children that at present showed normal development .
Conclusions. Findings support the unique role of new DTI techniques, beyond conventional imaging, in the evaluation of microstructural WM injury of SBS. This preliminary study confirms the important role of DTI tractography for its both therapeutic and prognostic implication, confirming the usefulness of more extensive and sophisticated research in this area

Abstract (italiano)

Introduzione. La Shaken Baby Syndrome (SBS) rappresenta una grave forma di maltrattamento fisico, responsabile di importanti sequele nello sviluppo neurologico. La sua patogenesi si caratterizza per la presenza di un danno meccanico responsabile di lesioni focali, cui si aggiunge un danno metabolico con conseguente diffusa sofferenza della sostanza bianca.
Obiettivo. In questo studio abbiamo applicato lo studio del tensore di diffusione (DTI) per analizzare le alterazioni della sostanza bianca (SB) del corpo calloso (CC) in bambini con SBS al fine di valutare come le alterazioni della microstruttura della SB possano riflettere il danno assonale e si correlino con gli esiti clinici.
Materiali e metodi. Sono stati analizzati i dati delle scansioni DTI di 5 bambini ( di età compresa tra 23 mesi e 6 anni e 5 mesi) a distanza di mesi dalla diagnosi di SBS (da 18 mesi a 6 anni), ed è stata studiata la SB del CC mediante un modello probabilistico. Variabili cliniche e referti radiologici convenzionali sono stati analizzati in relazione al risultato. Gli esiti cognitivi sono stati valutati mediante la somministrazione delle scale di sviluppo Griffiths (GMDS-Griffiths Mental Development Scales) o le scale Wechsler per i bambini di età maggiore di 4 anni. Sono stati calcolati i valori di Anisotropia frazionale (FA), diffusività assiale (AD), e diffusività radiale (RD) per ciascuna delle sette regioni in cui è stato diviso il corpo calloso, secondo il modello di Wiltelson.
Risultati. I 5 bambini studiati (3 maschi e 2 femmine, età media=48 mesi, tempo medio trascorso dalla diagnosi=42 mesi) presentavano uno sviluppo cognitivo nella norma in 3 casi e al di sotto della norma in 2 casi. Le RMN 3T eseguite nel follow-up a medio lungo termine evidenziavano solamente in un caso, un danno alla sostanza bianca. Valori di FA ridotta sono stati misurati in diffuse regioni della SBS in tutti i bambini con esiti di SBS, con compromissione maggiore nei bambini che presentavano una deviazione al di sotto della norma dello sviluppo cognitivo, ma con valori alterati anche nei bambini che allo stato attuale presentavano uno sviluppo nella norma.
Conclusioni. I risultati supportano il ruolo unico delle nuove tecniche di DTI nella valutazione delle lesioni microstrutturali della SB nei bambini vittime di SBS, non identificabili con tecniche di neuroimaging convenzionali. Tale studio preliminare conferma l’importante ruolo delle nuove metodiche di DTI e trattografia per il suo valore prognostico e le conseguenti implicazioni terapeutiche, confermando l’utilità di ricerche in questo ambito più ampie e sofisticate

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Tipo di EPrint:Tesi di dottorato
Relatore:Facchin, Paola
Dottorato (corsi e scuole):Ciclo 27 > scuole 27 > MEDICINA DELLO SVILUPPO E SCIENZE DELLA PROGRAMMAZIONE > SCIENZE DELLA PROGRAMMAZIONE
Data di deposito della tesi:01 Febbraio 2015
Anno di Pubblicazione:01 Febbraio 2015
Parole chiave (italiano / inglese):sindrome del bambino scosso, trattografia, corpo calloso, tensore di diffusione, shaking baby syndrome, fiber tractography, corpus cllosum, DTI
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/38 Pediatria generale e specialistica
Area 06 - Scienze mediche > MED/39 Neuropsichiatria infantile
Struttura di riferimento:Dipartimenti > Dipartimento di Medicina
Codice ID:7889
Depositato il:20 Nov 2015 14:17
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