RESUMEN
Studies of twenty-five patients with loculated leptomeningeal tumor metastases diagnosed by CT and/or MR were analyzed retrospectively. Medulloblastoma was the most frequent primary tumor (8/25, 32%). Four subgroups of loculated patterns were identified. Type A included mass(es) limited to the subarachnoid space without obvious direct parenchymal infiltration; this pattern occurred in 12 patients, of whom five had associated diffuse pattern. Type B was characterized by mass(es) still predominantly in the subarachnoid space but with minor transpinal parenchymal infiltration; this pattern was found in five patients. Type C comprised subarachnoid mass(es) with marked transpinal extension mimicking parenchymal lesion; this pattern was observed in three patients. Type D consisted of subarachnoid mass(es) growing along the perineural CSF space; this pattern was noted in two patients. Additionally, two patients presented with combined A and C patterns, and one patient had a combined B and C pattern. More than half the patients (14/25, 56%) presented with a single lesion. The most frequent locations were the suprasellar cistern, ventricular walls, and lateral recesses of the fourth ventricle, Gd-DTPA-enhanced T1-weighted MR images appeared best for demonstrating the site and extent of disease. Recognition of the loculated patterns of leptomeningeal metastases, which are less common than the diffuse pattern, is important to radiologists and clinicians for correct diagnosis and proper management of patients with this disease.
Asunto(s)
Imagen por Resonancia Magnética , Neoplasias Meníngeas/secundario , Tomografía Computarizada por Rayos X , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/secundario , Ángulo Pontocerebeloso , Ventrículos Cerebrales , Líquido Cefalorraquídeo , Medios de Contraste , Gadolinio , Gadolinio DTPA , Glioma/diagnóstico , Glioma/diagnóstico por imagen , Glioma/secundario , Humanos , Meduloblastoma/diagnóstico , Meduloblastoma/diagnóstico por imagen , Meduloblastoma/secundario , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/diagnóstico por imagen , Compuestos Organometálicos , Ácido Pentético , Estudios Retrospectivos , Espacio SubaracnoideoRESUMEN
Studies of twenty-five patients with loculated leptomeningeal tumor metastases diagnosed by CT and/or MR were analyzed retrospectively. Medulloblastoma was the most frequent primary tumor (8/25, 32%). Four subgroups of loculated patterns were identified. Type A included mass(es) limited to the subarachnoid space without obvious direct parenchymal infiltration; this pattern occurred in 12 patients, of whom five had associated diffuse pattern. Type B was characterized by mass(es) still predominantly in the subarachnoid space but with minor transpinal parenchymal infiltration; this pattern was found in five patients. Type C comprised subarachnoid mass(es) with marked transpinal extension mimicking parenchymal lesion; this pattern was observed in three patients. Type D consisted of subarachnoid mass(es) growing along the perineural CSF space; this pattern was noted in two patients. Additionally, two patients presented with combined A and C patterns, and one patient had a combined B and C pattern. More than half the patients (14/25, 56%) presented with a single lesion. The most frequent locations were the suprasellar cistern, ventricular walls, and lateral recesses of the fourth ventricle, Gd-DTPA-enhanced T1-weighted MR images appeared best for demonstrating the site and extent of disease. Recognition of the loculated patterns of leptomeningeal metastases, which are less common than the diffuse pattern, is important to radiologists and clinicians for correct diagnosis and proper management of patients with this disease.
Asunto(s)
Aracnoides , Imagen por Resonancia Magnética , Neoplasias Meníngeas/secundario , Piamadre , Tomografía Computarizada por Rayos X , Aracnoides/diagnóstico por imagen , Aracnoides/patología , Medios de Contraste , Gadolinio DTPA , Humanos , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/diagnóstico por imagen , Compuestos Organometálicos , Ácido Pentético , Piamadre/diagnóstico por imagen , Piamadre/patología , Estudios RetrospectivosRESUMEN
The MR findings in six cases of paranasal sinus mucoceles are described. Two basic MR appearances were encountered: either moderate to marked signal hypointensity in the expanded sinuses on T1- and T2-weighted images (four patients) or moderate to marked signal hyperintensity on T1- and T2-weighted images (two patients). These patterns appear to represent inspissated or hydrated sinus contents, respectively. CT correlation revealed hyperdense mucoceles in the decreased MR signal group and hypo- or isodense mucoceles in the increased MR signal group. Superimposed allergic Aspergillus sinusitis was also present in two patients with hypointense mucoceles on MR.
Asunto(s)
Imagen por Resonancia Magnética , Mucocele/diagnóstico , Enfermedades de los Senos Paranasales/diagnóstico , Tomografía Computarizada por Rayos X , Humanos , Mucocele/diagnóstico por imagen , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Senos Paranasales/diagnóstico por imagen , Senos Paranasales/patologíaRESUMEN
Twenty-four patients with advanced paranasal sinus tumors were treated with combined superselective intra-arterial and systemic chemotherapy, yielding an immediate satisfactory tumor response rate of 91%, significantly better than previously reported. Eight patients had craniofacial surgery circumvented because of complete or near complete response. Repetitive uncomplicated catheterization of the pterygoid segment of the internal maxillary artery using a coaxial system is the cornerstone of successful induction chemotherapy. Strenuous screening of medical status is mandatory for this aggressive introduction chemotherapy.