Dados do Trabalho

Título

MAGNETIC RESONANCE IMAGING OF THE SPINAL CORD FOR EVALUATION OF HTLV-1 ASSOCIATED URINARY DYSFUNCTION.

Introdução e Objetivo

Patients with myelopathy associated with tropical spastic paraparesis/human T-cell lymphotropic virus type 1 (HAM/TSP) may have spinal cord narrowing. The objective of the work is to investigate the role MRI with tractography in detecting SC abnormalities in HTLV-1 patients presenting lower urinary tract symptoms.

Método

Patients followed in a cohort study were selected and grouped according to Castro-Costa classification in  HTLV-1 asymptomatic carries (AC), urinary dysfunction (UD) patients and seronegative age matched control (SN). They were submitted to 1.5-Tesla-MR scanner, with two regions of interest (ROI) positioned side by side at T5 and T12-L1. Two neuroradiologists established the measurements of the SC: antero-posterior (AP) and latero-lateral (LL) radius and area. Diffusion tensor image (DTI) and fractional anisotropy (FA) were established by the manufactory application. LUTS were evaluated by overactive symptoms score (OABSS).

Resultados

MRI exams were completely performed in 99/116 patients. The mean age and standard deviation (SD) was 55.0 (13.6), 56.9 (11.0) and 60.9 (10.3) in SN, AC and UD, respectively. There was no difference between groups regarding age, sex , proviral load and inflammatory cytokines (P > 0.05). SN and AC patients presented a higher educational level. The mean (SD) OABSS was 1.05 (0.83) and 7.53 (3.92) in AC and UD, respectively (P<0.01). The median and interquartile range (IQR) of SC thoracic area were 0.40 (0.38 – 0.45), 0.36 (0.33 – 0.40) and 0.33 (0.27 – 0.37) for SN, AC and UD and statistically significant differences (P<0.05) were found in SN versus AC, SN versus UD and AC versus UD. The median (IQR) of SC lumbar area were 0.67 (0.55 – 0.72), 0.59 (0.54 – 0.67), and 0.53 (0.48 – 0.63) for SN, AC and UD, respectively. We also observed differences in SN vs UD and AC versus UD (P = 0.02 and P=0.04, respectively). There were no differences regarding fractional anisotropy (FA) values of thoracic field in SN compared to  AC and UD. Mean diffusivity (MD) of thoracic field was also similar between groups. Median (IQR) of FA values of lumbar field were 0.54 (0.51 – 0.62), 0.50 (0.41 – 0.57) and 0.45 (0.41 – 0.52), with statistically significant differences comparing SN and UD (P = 0.00). Median (IQR) DM values in lumbar field were similar in SN, AC and UD.

Conclusão

Patients with UD exhibited lesser values of SC measurements. SC area seems to be the most reliable parameter in explaining LUTS in HTLV-1 infected patients.