title: Cerebral diffusional changes in the early phase of anthrax: is cutaneous anthrax only limited to skin?
abstract: OBJECTIVE
  Characteristics of cerebral diffusion in the acute period of the anthrax infection were investigated to understand the pathophysiology of the disease.
  
  
  METHODS
  Six cutaneous anthrax patients (mean age: 33.3, SD: 18.1) and six healthy control subjects (mean age: 33.7, SS: 19.6) were examined at the acute phase of the infection with diffusion weighted imaging on 1.5 T scanner. ADC values were measured from five different cerebral locations. T-tests, logistic regression and ROC curves were used.
  
  
  RESULTS
  Anthrax patients were significantly different than controls regarding cortical ADC values (p<0.05). Logistic regression model accurately classified five out of the six anthrax cases (83.3%). A cut-off value of 574 mm2/s x 10(-3) was found by using ROC curve coordinates. A sensitivity of 100% and a specificity of 67% were attained by means of this value.
  
  
  CONCLUSIONS
  This study shows the existence of cerebral parenchymal changes at microstructural level in cutaneous anthrax without neurological findings. These changes are possibly related to the components of the toxin. Our results support the general but unproven opinion that anthrax treatment does not change the existence and the effects of the toxin. Pathophysiological mechanisms towards classification should therefore be reviewed.
authors.affiliation: Department of Radiology, Inonu University Medical Faculty, Turgut Ozal Medical Center, Elazig Karayolu, 44280 Malatya, Turkey. hkarakas@inonu.edu.tr
authors.forename: Hakki Muammer
authors.initials: HM
authors.lastname: Karakas
authors.forename: Yasar
authors.initials: Y
authors.lastname: Bayindir
authors.forename: Ahmet K
authors.initials: AK
authors.lastname: Firat
authors.forename: Cengiz
authors.initials: C
authors.lastname: Yagmur
authors.forename: Alpay
authors.initials: A
authors.lastname: Alkan
authors.forename: Uner
authors.initials: U
authors.lastname: Kayabas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000881:Anthrax / Q000150:complications* / Q000382:microbiology*; D000942:Antigens, Bacterial / Q000378:metabolism / Q000633:toxicity; D001408:Bacillus anthracis / Q000502:physiology*; D001427:Bacterial Toxins / Q000378:metabolism / Q000633:toxicity; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009928:Organ Specificity; D017192:Skin Diseases, Bacterial / Q000150:complications* / Q000382:microbiology*; D013687:Telencephalon / Q000098:blood supply / Q000187:drug effects / Q000473:pathology*
chemical_list: D000942:Antigens, Bacterial; D001427:Bacterial Toxins; C030325:anthrax toxin