Biomedical subjects

Cristina Baldoli

Publications and source records attributed to Cristina Baldoli.

4 recordsLinked to original sources

PubMed2007

Sedation for children with metachromatic leukodystrophy undergoing MRI.

BACKGROUND: Metachromatic leukodystrophy (MLD) is a lysosomal storage disease with infantile and juvenile onset with a poor prognosis and magnetic resonance imaging (MRI) plays a fundamental role in its diagnosis. Procedural sedation is needed to carry out MRI on children. Very few case reports have been published on anesthesia or sedation for MLD patients. METHODS: We prospectively studied 18 MLD patients undergoing sedation for brain MRI. Twenty consecutive similar-aged ASA I children undergoing MRI during the same time span for suspected seizures and exhibiting no MRI brain alteration healthy (HLT) patients were also studied for comparison. In patients up to 3 years of age (T_MLD and T_HLT groups), sedation was induced with thiopental 5 mg x kg(-1) i.v. and further 2.5 mg x kg(-1) i.v. rescue boluses were given if the sedation level was inadequate. In patients over 3 years of age (P_MLD and P_HLT groups), sedation was induced with propofol 1-1.5 mg x kg(-1) i.v. and maintained with 0.1-0.15 mg x kg(-1) x min(-1) continuous i.v. infusion, which was increased if the sedation level was inadequate. We recorded complications, if any, caused by sedation (hypoxia, vomiting, bradycardia, other major arrhythmias, convulsions, MRI artifact movements with increasing sedation, prolonged recovery). RESULTS: No sedation complications occurred. The mean dose of thiopental required to warrant patient immobility was 0.227 +/- 0.053 mg x kg(-1) x min(-1) of procedure in T_MLD patients and 0.119 +/- 0.061 mg x kg(-1) x min(-1) of procedure in T_HLT patients (difference not significant). The mean dose of propofol required for immobility was 0.119 +/- 0.054 mg x kg(-1) x min(-1) of procedure in T_MLD patients and 0.115 +/- 0.043 mg x kg(-1) x min(-1) of procedure in T_HLT patients (difference not significant). CONCLUSIONS: Our protocol for sedation in the MRI setting proved safe and effective in children with MLD, who do not require different doses of sedatives compared with healthy children.

Anesthesia↗

PubMed2003

Apparent diffusion coefficient determination in normal fetal brain: a prenatal MR imaging study.

BACKGROUND AND PURPOSE: Diffusion-weighted MR imaging studies of normal brain development have focused on premature babies who were free of focal lesions on conventional MR images. The condition of prematurity, however, is dissimilar to intrauterine life. We sought to establish normal values of fetal brain apparent diffusion coefficient (ADC) to highlight its abnormal changes in pathologic conditions and to obtain information about normal brain development. METHODS: We measured the ADC, in utero, by using an echo-planar three-axes diffusion-sensitized sequence (b factor, 0 and 600 s/mm(2)), in frontal and occipital white matter and basal ganglia gray matter of 15 fetuses. Their gestational ages ranged from 22 to 35 weeks, and the postnatal MR images or sonograms revealed normal brain. RESULTS: Mean ADC value was 1.96 +/- 0.1 micro m(2)/ms (SD) in frontal white matter, 1.95 +/- 0.1 micro m(2)/ms in occipital white matter, and 1.56 +/- 0.1 micro m(2)/ms in basal ganglia. A significant negative correlation between ADC and gestational age was found for basal ganglia, whereas only a trend was present for frontal white matter. CONCLUSION: Although moderately higher, the ADC determinations we obtained are consistent with those reported in the literature in postnatal studies performed in premature babies.

Adult↗

PubMed2002

Demonstration of acute ischemic lesions in the fetal brain by diffusion magnetic resonance imaging.

The possibility of detecting acute hypoxic-ischemic brain lesions by prenatal magnetic resonance imaging or ultrasound is low. We present a case of a fetus with a vein of Galen arteriovenous malformation in whom prenatal diffusion-weighted magnetic resonance imaging at 33 weeks of gestation clearly detected cerebral acute ischemic lesions, associated with remarkable decrease of the average apparent diffusion coefficient, whereas T2-weighted imaging was still not informative.

Acute Disease↗

PubMedDate not supplied

Terminal zones of myelination: MR evaluation of children aged 20-40 months.

BACKGROUND AND PURPOSE: MR imaging is the method of choice for assessment in vivo of the development of myelination of the human central nervous system. During the first months of life, the myelination process follows well-defined steps, whereas little information exists about the later phases of myelination. To improve our understanding of this aspect and to identify the specific sites involved in the process of myelination in its terminal phase, we evaluated normal MR brain studies in children aged 20-40 months. METHODS: We retrospectively evaluated 85 MR brain studies of 81 children aged 20-40 months who were without diseases potentially affecting white matter. The MR studies were performed with a 1.5-T system, with T2-weighted spin-echo and turbo spin-echo sequences. Subjective analysis of the signal intensity of the white matter was made in four areas: subcortical frontal, temporal, and parietal lobes and peritrigonal region. Extension of myelination was graded on an ordinal scale; 0 indicated the absence of myelin, and the maximum value indicated complete myelination. RESULTS: A persistent T2 hyperintensity of the subcortical areas was noted after 20 months of age. With advancing age, a progressive increase in the grade of myelination was noted in these regions, and at about 40 months of age myelination was complete. However, in most of our patients aged 20 months, myelination in the peritrigonal areas appeared complete. CONCLUSION: The only area that can still exhibit a persistent T2 hyperintensity on MR images at about 2 years of age is considered to be the peritrigonal region: the so-called terminal zone. At this age in our patients, however, a persistent T2 hyperintensity was noted in the frontotemporal subcortical regions. In these areas, the myelination appeared complete at 36-40 months of age. The so-called terminal zones were the subcortical areas rather than the peritrigonal area, and complete myelination took place by about age 3 years.

Age Factors↗