Terminal Myelinasyon Zonlarının Görülme Sıklığı: 3-30 Yaş Arası Değerlendirme

Year 2023, Volume: 13 Issue: 1, 78 - 81, 31.01.2023

Turgut Seber Tuğba Uylar Seber

https://doi.org/10.16899/jcm.1232345

Abstract

Öz
Amaç: Terminal miyelinasyon zonları (TMZ) ile ilgili çalışmalar genellikle infant-erken çocukluk dönemlerini kapsayacak şekilde yapılmıştır. Erişkinlikte insidans ve lokalizasyonu ile ilgili bilgiler nadirdir ve tartışmalıdır. Amacımız, manyetik rezonans görüntüleme (MRG) ile 3-30 yaş arası hastalarda TMZ lokalizasyonunu ve sıklığını belirlemektir.
Gereç ve Yöntem: Kranial MRG’leri normal olarak raporlanan, yaşları 3-30 arasında değişen 560 hastanın görüntüleri, iki radyolog tarafından çift kör, retrospektif yöntemle tekrar değerlendirildi. TMZ için beş farklı beyaz cevher (BC) bölgesi (parietal peritrigonal BC; frontal, temporal, parietal ve insular subkortikal BC) tekrar gözden geçirildi. T2 ve T1 ağırlıklı turbo spin eko ve T2-FLAIR (fluid-attenuated inversion recovery) sekansları kullanıldı.
Bulgular: Tüm yaş gruplarında TMZ insidansı insulada %28.7, temporal loblarda %14.6 ve peritrigonal bölgede %5.2 idi. TMZ, en sık insulada lokalizeydi, bunu temporal poller izliyordu. Beş yaşından sonra peritrigonal TMZ varlığı çok nadirdi (%2.6). Gözlemciler arası uyum tüm bölgeler için anlamlıydı (Kappa değeri < 0.05).
Sonuç: TMZ’yi, en sık insular subkortikal BC'de saptadık. Insular ve temporal TMZ’lerin, üçüncü dekatta bile oldukça sıklıkla (sırasıyla %13.8 ve %9.8) izlenebileceği unutulmamalıdır.

Keywords

insula, subcortical white matter, myelination, MRI

Supporting Institution

Yok

Project Number

Yok

Incidences of Terminal Zones of Myelination: An Evaluation of Patients aged 3–30 Years

Abstract

Abstract
Aim: Studies on terminal zones of myelination (TZM) generally focus on the infant to early childhood periods. Information concerning the incidence and localization in adulthood is rare and controversial. To determine the localization and frequency TZM in patients aged 3–30 years using magnetic resonance imaging (MRI).
Material and Method: Images of 560 patients aged 3-30 years, whose cranial MRIs were reported as normal, were re-evaluated by two radiologists using a double-blind, retrospective method. Five different white matter (WM) regions (parietal peritrigonal WM; frontal, temporal, parietal, and insular subcortical WM) were reviewed for TZM. Turbo spin echo T2- and T1-weighted imaging and T2 fluid-attenuated inversion recovery sequences were used.
Results: The incidences of TZM in all age groups were 28.7% in the insula, 14.6% in the temporal lobes, and 5.2% in the peritrigonal region. TZM were localized most commonly in the insula, followed by the temporal poles. The presence of peritrigonal TZM after 5 years of age was very rare (2.6%). Interobserver agreement was significant for all regions (Kappa value < 0.05).
Conclusion: We detected TZM most often in the insular subcortical WM. It should be noted that insular and temporal TZM can be observed quite frequently (13.8% and 9.8%, respectively), even in third decade.

Keywords

insula, subcortical white matter, myelination, MRI

Project Number

Yok

References

• 1 Yakovlev PI, Lecours AR. The myelogenetic cycles of regional maturation of the brain. In: Minkowski A, ed. Regional development of the brain in early life. Oxford, UK: Blackwell, 1967:3–70.
• 2 Dietrich RB, Bradley WG, Zaragoza E J, et al. MR evaluation of early myelination patterns in normal and developmentally delayed infants. AJNR Am J Neuroradiol 1988;9:69–76
• 3 Martin E, Kikinis R, Zuerrer M, et al. Developmental stages of human brain: an MR study. J Comput Assist Tomogr 1988;12:917– 922
• 4 Staudt M, Schropp C, Staudt F, Obletter N, Bise K, Breit A. Myelination of the brain in MR: a staging system. Pediatr Radiol 1993;23:169–176
• 5 Barkovich AJ. MR of the normal neonatal brain: assessment of deep structures. AJNR Am J Neuroradiol 1998;19:1397–1403
• 6 Staudt M, Schropp C, Staudt F, et al. MRI assessment of myelination: an age standardization. Pediatr Radiol 1994:24:122–127
• 7 Barkovich AJ, Kjos BO, Jackson DE, Norman D. Normal maturation of the neonatal and infant brain: MR imaging at 1.5 T. Radiology 1988;166:173–180
• 8 Bird CR, Hedberg M, Drayer BP, Keller PJ, Flom RA, Hodak JA. MR assessment of myelination in infants and children: usefulness of marker sites. AJNR Am J Neuroradiol 1989;10:731–740
• 9 Curnes JT, Burger PC, Djang WT, Boyko O B. MR imaging of compact WM pathways. AJNR Am J Neuroradiol 1988;9:1061–1068
• 10 Barkovich AJ. Normal development of the neonatal and infant brain, skull, and spine. In: Pediatric neuroimaging. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2000:13–69
• 11 Maricich SM, Azizi P, Jones JY, et al. Myelination as assessed by conventional MR imaging is normal in young children with idiopathic developmental delay. AJNR Am J Neuroradiol. 2007;28(8):1602-1605. doi:10.3174/ajnr.A0602
• 12 Parazzini C, Baldoli C, Scotti G, Triulzi F. Terminal zones of myelination: MR evaluation of children aged 20-40 months. AJNR Am J Neuroradiol. 2002;23(10):1669‐1673.
• 13 Kinney HC, Brody BA, Kloman AS, Gilles FH. Sequence of central nervous system myelination in human infancy: patterns of myelination in autopsied infants. J Neuropathol Exp Neurol 1988;47:3, 217–234
• 14 Baierl P, Forster CH, Fendel H, Naegele M, Fink U, Kenn W. Magnetic resonance imaging of normal and pathological WM maturation. Pediatr Radiol 1988;18:183–189
• 15 Curnes JT, Burger PC, Djang WT, Boyko O B. MR imaging of compact WM pathways. AJNR Am J Neuroradiol 1988;9: 1061–1068.
• 16 Dennis EL, Jahanshad N, McMahon KL, de Zubicaray GI, Martin NG, Hickie IB, Toga AW, Wright MJ, Thompson PM (2014) Development of insula connectivity between ages 12 and 30 revealed by high angular resolution diffusion imaging. Hum Brain Mapp 35(4):1790–1800.