CLAUDIA DA COSTA LEITE
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Radiologia, Faculdade de Medicina - Docente
LIM/44 - Laboratório de Ressonância Magnética em Neurorradiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/44 - Laboratório de Ressonância Magnética em Neurorradiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
14 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 14
- Toxic Leukoencephalopathies, Including Drug, Medication, Environmental, and Radiation-Induced Encephalopathic Syndromes(2014) RIMKUS, Carolina de Medeiros; ANDRADE, Celi Santos; LEITE, Claudia da Costa; MCKINNEY, Alexander M.; LUCATO, Leandro TavaresToxic leukoencephalopathies can be secondary to the exposure to a wide variety of exogenous agents, including cranial irradiation, chemotherapy, antiepileptic agents, drugs of abuse, and environmental toxins. There is no typical clinical picture, and patients can present with a wide array of signs and symptoms. Involvement of white matter is a key finding in this scenario, although in some circumstances other high metabolic areas of the central nervous system can also be affected. Magnetic resonance (MR) imaging usually discloses bilateral and symmetric white matter areas of hyperintense signal on T2-weighted and fluid-attenuated inversion recovery images, and signs of restricted diffusion are associated in the acute stage. In most cases, the changes are reversible, especially with prompt recognition of the disease and discontinuation of the noxious agent. Either the MR or clinical features may be similar to several nontoxic entities, such as demyelinating diseases, leukodystrophies, hepatic encephalopathy, vascular disease, hypoxic-ischemic states, and others. A high index of suspicion should be maintained whenever a patient presents recent onset of neurologic deficit, searching the risk of exposure to a neurotoxic agent. Getting to know the most frequent MR appearances and mechanisms of action of causative agents may help to make an early diagnosis and begin therapy, improving outcome. In this review, some of the most important causes of leukoencephalopathies are presented; as well as other 2 related conditions: strokelike migraine attacks after radiation therapy syndrome and reversible splenial lesions.
- Computed tomography and magnetic resonance imaging in the osseous phase of Nasu-Hakola disease(2014) BRENNER, Christiana; SPECK-MARTINS, Carlos Eduardo; BRUM, Jaime Moritz; LUCATO, Leandro Tavares; LEITE, Claudia da Costa
- Diffusion abnormalities of the corpus callosum in patients with malformations of cortical development and epilepsy(2014) ANDRADE, Celi S.; LEITE, Claudia C.; OTADUY, Maria C. G.; LYRA, Katarina P.; VALENTE, Kette D. R.; YASUDA, Clarissa L.; BELTRAMINI, Guilherme C.; BEAULIEU, Christian; GROSS, Donald W.Purpose: Diffusion tensor imaging (DTI) is a magnetic resonance imaging (MRI) technique that can characterize white matter (WM) architecture and microstructure. DTI has demonstrated extensive WM changes in patients with several epileptic syndromes, but few studies have focused on patients with malformations of cortical development (MCD). Our aim was to investigate the quantitative diffusion properties of the corpus callosum (CC), a major commissural bundle critical in inter-hemispheric connectivity, in a large group of patients with MCD. Methods: Thirty-two MCD patients and 32 age and sex-matched control subjects were evaluated with DTI at 3.0 T. We analyzed the three major subdivisions of the CC (genu, body, and splenium) with deterministic tractography to yield fractional anisotropy (FA), mean diffusivity (MD), parallel diffusivity (lambda parallel to) and perpendicular diffusivity (lambda perpendicular to). We further assessed the CC with region of interest (ROI)-based analyses and evaluated different subgroups of MCD (polymicrogyria/schizencephaly, heterotopia, and cortical dysplasia). Partial correlations between diffusion changes and clinical parameters (epilepsy duration and age at disease onset) were also queried. Results: There were significant reductions of FA, accompanied by increases in MD and lambda perpendicular to in all segments of the CC in the patients group with both analytical methods. The absolute differences in FA were greater on ROI-analyses. There were no significant differences between the MCD subgroups, and no correlations between clinical parameters of epilepsy and FA. Conclusions: Our study indicates DTI abnormalities consistent with microstructural changes in the corpus callosum of MCD patients. The findings support the idea that patients with epilepsy secondary to cortical malformations present widespread WM changes that extend beyond the macroscopic MRI-visible lesions.
- MRI investigation of a 6-week trial of lithium in medication-free patients with bipolar depression(2014) ZANETTI, M. V.; OTADUY, M. C. G.; SOUSA, R. T. de; SOEIRO-DE-SOUZA, M. G.; CHAIM, K. T.; GATTAZ, W. F.; BUSATTO, G. F.; LEITE, C. C.; MACHADO-VIEIRA, R.
- Executive function and depressive symptoms of retardation in nonelderly stroke patients(2014) SOBREIRO, Matildes F. M.; MIOTTO, Eliane Correa; TERRONI, Luisa; TINONE, Gisela; IOSIFESCU, Dan V.; LUCIA, Mara C. S. de; SCAFF, Milberto; LEITE, Claudia da Costa; AMARO JR., Edson; FRAGUAS, RenerioThe depression-executive dysfunction syndrome, a late-onset depression of vascular origin with executive dysfunction and psychomotor retardation, has also been described after stroke. We verified whether this syndrome also occurs in nonelderly stroke patients by investigating the association between domains of depressive symptoms with executive functions in 87 first-ever ischemic stroke patients. The retardation domain of the 31-item Hamilton Rating Scale for Depression was associated with decreased performance on verbal fluency (assessed with FAS). The association was maintained for younger patients (aged <60 years) after adjusting for confounders. This result supports the clinical presentation of depression-executive dysfunction syndrome in younger stroke patients. Confirmation of this finding, its neural correlates, and clinical implication deserve further investigation.
- Assessment of irradiated brain metastases using dynamic contrast-enhanced magnetic resonance imaging(2014) ALMEIDA-FREITAS, Daniela B.; PINHO, Marco C.; OTADUY, Maria C. G.; BRAGA, Henrique F.; MEIRA-FREITAS, Daniel; LEITE, Claudia da CostaThe purpose of this study was to evaluate the effect of stereotactic radiosurgery (SRS) on cerebral metastases using the transfer constant (K (trans)) assessed by dynamic contrast-enhanced (DCE) MRI. Furthermore, we aimed to evaluate the ability of K (trans) measurements to predict midterm tumor outcomes after SRS. The study received institutional review board approval, and informed consent was obtained from all subjects. Twenty-six adult patients with a total of 34 cerebral metastases underwent T1-weighted DCE MRI in a 1.5-T magnet at baseline (prior to SRS) and 4-8 weeks after treatment. Quantitative analysis of DCE MRI was performed by generating K (trans) parametric maps, and region-of-interest-based measurements were acquired for each metastasis. Conventional MRI was performed at least 16 weeks after SRS to assess midterm tumor outcome using volume variation. The mean (+/- SD) K (trans) value was 0.13 +/- 0.11 min(-1) at baseline and 0.08 +/- 0.07 min(-1) after 4-8 weeks post-treatment (p < 0.001). The mean (+/- SD) total follow-up time was 7.9 +/- 4.7 months. Seventeen patients (22 lesions) underwent midterm MRI. Of those, nine (41 %) lesions had progressed at the midterm follow-up. An increase in K (trans) after SRS was predictive of tumor progression (hazard ratio = 1.50; 95 % CI = 1.16-1.70, p < 0.001). An increase of 15 % in K (trans) showed a sensitivity of 78 % and a specificity of 85 % for the prediction of progression at midterm follow-up. SRS was associated with a reduction of K (trans) values of the cerebral metastases in the early post-treatment period. Furthermore, K (trans) variation as assessed using DCE MRI may be helpful to predict midterm outcomes after SRS.
- Imaging of adult leukodystrophies(2014) LEITE, Claudia Costa; LUCATO, Leandro Tavares; SANTOS, Germano Titoneli; KOK, Fernando; BRANDAO, Anderson Rodrigues; CASTILLO, MauricioLeukodystrophies are genetically determined white matter disorders. Even though leukodystrophies essentially affect children in early infancy and childhood, these disorders may affect adults. In adults, leukodystrophies may present a distinct clinical and imaging presentation other than those found in childhood. Clinical awareness of late-onset leukodystrophies should be increased as new therapies emerge. MRI is a useful tool to evaluate white matter disorders and some characteristics findings can help the diagnosis of leukodystrophies. This review article briefly describes the imaging characteristics of the most common adult leukodystrophies.
- The value of gamma probe in the detection of epileptogenic focus(2014) LEITE, Claudia da Costa
conferenceObject DIFFUSION TENSOR IMAGING ABNORMALITIES OF THE CORPUS CALLOSUM IN MALFORMATIONS OF CORTICAL DEVELOPMENT(2014) ANDRADE, C. S.; LEITE, C. C.; OTADUY, M. C. G.; LYRA, K. P.; VALENTE, K. D. R.; YASUDA, C. L.; BELTRAMINI, G. C.; BEAULIEU, C.; GROSS, D. W.- Gamma Ventral Capsulotomy for Obsessive-Compulsive Disorder A Randomized Clinical Trial(2014) LOPES, Antonio C.; GREENBERG, Benjamin D.; CANTERAS, Miguel M.; BATISTUZZO, Marcelo C.; HOEXTER, Marcelo Q.; GENTIL, Andre F.; PEREIRA, Carlos A. B.; JOAQUIM, Marines A.; MATHIS, Maria E. de; D'ALCANTE, Carina C.; TAUB, Anita; CASTRO, Douglas G. de; TOKESHI, Lucas; SAMPAIO, Leonardo A. N. P. C.; LEITE, Claudia C.; SHAVITT, Roseli G.; DINIZ, Juliana B.; BUSATTO, Geraldo; NOREN, Georg; RASMUSSEN, Steven A.; MIGUEL, Euripedes C.IMPORTANCE Select cases of intractable obsessive-compulsive disorder (OCD) have undergone neurosurgical ablation for more than half a century. However, to our knowledge, there have been no randomized clinical trials of such procedures for the treatment of any psychiatric disorder. OBJECTIVE To determine the efficacy and safety of a radiosurgery (gamma ventral capsulotomy [GVC]) for intractable OCD. DESIGN, SETTING, AND PARTICIPANTS In a double-blind, placebo-controlled, randomized clinical trial, 16 patients with intractable OCD were randomized to active (n = 8) or sham (n = 8) GVC. Blinding was maintained for 12 months. After unblinding, sham-group patients were offered active GVC. INTERVENTIONS Patients randomized to active GVC had 2 distinct isocenters on each side irradiated at the ventral border of the anterior limb of the internal capsule. The patients randomized to sham GVC received simulated radiosurgery using the same equipment. MAIN OUTCOMES AND MEASURES Scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Clinical Global Impression-Improvement (CGI-I) Scale. Response was defined as a 35% or greater reduction in Y-BOCS severity and ""improved"" or ""much improved"" CGI-I ratings. RESULTS Three of 8 patients randomized to active treatment responded at 12 months, while none of the 8 sham-GVC patients responded (absolute risk reduction, 0.375; 95% CI, 0.04-0.71). At 12 months, OCD symptom improvement was significantly higher in the active-GVC group than in the sham group (Y-BOCS, P = .046; Dimensional Y-BOCS, P = .01). At 54 months, 2 additional patients in the active group had become responders. Of the 4 sham-GVC patients who later received active GVC, 2 responded by post-GVC month 12. The most serious adverse event was an asymptomatic radiation-induced cyst in 1 patient. CONCLUSIONS AND RELEVANCE Gamma ventral capsulotomy benefitted patients with otherwise intractable OCD and thus appears to be an alternative to deep-brain stimulation in selected cases. Given the risks inherent in any psychiatric neurosurgery, such procedures should be conducted at specialized centers.