Índice Bitalámico como posible nuevo biomarcador de atrofia talámica en pacientes con Esclerosis Múltiple
Autor: Aguilar Velasco, Juan David
Asesor: Lozano Castillo, Alfonso Javier
Fecha: 2019-11
Programa: Bogotá - Medicina - Especialidad en Anestesiología y Reanimación
Facultad: Facultad de Medicina

Resumen: Multiple sclerosis (MS) is the most common chronic and inflammatory demyelinating neurodegenerative disease in young adults with poorly understood pathophysiology. Cerebral Atrophy (CA) has been recognized as a marker of disease progression, which affects the regions affected by its different phenotypes as a child Relapsed-Remission Multiple Sclerosis (RRMS), Progressive Primary Multiple Sclerosis (PPMS), Secondary Multiple Sclerosis Progressive (SMSP), and Progressive Relapsed Multiple Sclerosis (PRMS). This has generated interest in the exploration and quantification of the volume of the structures of the Central Nervous System (CNS). The quantification of CA is limited to the evaluation of cadaveric specimens, but the advent of Magnetic Resonance Imaging (MR) and volumetric software recognized in vivo intracranial volume, taking into account the inherent limitations such as the need for machinery additionally, specialized software and trained personnel restricted to its use in the field of research.
Thalamic Atrophy (TA) has been directly related to the neurodegeneration process that implies an alteration of the clinical assessment scales (Expanded Disability Status Scale (EEED), Ambulatory Index (AI), among others), so The Thalamic Volume (TV) has been proposed as a marker of progression and assessment of the response to Modified Disease Therapy (MDT). The evaluation of the TV has been determined directly (volumetry by thalamic segmentation -VTS-), this being the gold test for the in vivo quantification of the volume of the thalamus), and indirectly (amplitude of the third ventricle -ATV-), with proper relation to clinical evaluation tests. In our work we propose a new linear morphometric measurement by MRI, the Bitalamic Index (BI), the quality can obtain the initial evaluation and follow-up studies; This was compared with another morphometric linear measure that is the
ATV and with the VTS that is the gold test in the quantification of thalamic atrophy in vivo, to determine if the BI allows quantifying the thalamic atrophy and can be used in the analysis of images of patients with MS by the radiologist and the treating neurologist.
For this purpose, a correlation study of concordance type was conducted that sought to determine if the IB measurement correlated with the ATV measurements and the VST issued by the volBrain version 1.0 free access program, to determine thalamic atrophy.
Since there was no reference in the literature to determine whether the loss of brain volume secondary to gender and age in the Colombian population behaved similarly to that reported in the information libraries of international literature, it was also determined the thalamic volume of a seemingly comparable population without the diagnosis of MS or of the known neurological disease chosen at random, to verify whether the report issued by the volBrain program could be taken as a reference. Taking into account that these results are valid for the population of patients who were analyzed and cannot be extrapolated beyond these.
The results that the BI does not allow to quantify the thalamic atrophy, on the other hand, the increase in the ATV is acceptably related to the atrophy of the thalamus, something already reported in the literature. Therefore, it can be concluded that new measures should be explored in two-dimensional images for the quantification of TA, since the volume by segmentation programs imply an increase in time and resources, which restricts their use in clinical practice.