RESUMEN
AIMS: To evaluate potential prognostic factors for predicting survival after radiotherapy in patients with painful spinal metastases and normal neurological function. MATERIALS AND METHODS: In total, 173 patients were included. The following prognostic factors were assessed: primary cancer site, age, gender, albumin and haemoglobin levels, Karnofsky performance status (KPS), analgesic use, pain intensity, number of extraspinal bone metastases and visceral metastases, presence of tumour-conditioned spinal canal stenosis and metastatic spinal cord compression, and extension of spinal metastatic disease on magnetic resonance imaging (MRI). Ongoing systemic treatment, use of bisphosphonates and response to radiotherapy were also evaluated. A simple scoring system for predicting survival was used. RESULTS: The following predictive factors were found to be significant in multivariate analysis: primary cancer site, KPS, albumin level, number of visceral metastases and analgesic use. Three survival groups were proposed. The overall survival probabilities for groups 1-3 were 13, 46 and 94% at 6 months; 4, 28 and 79% at 12 months, respectively. The median survival times for groups 1-3 were 2.1, 5.5 and 24.9 months, respectively (P < 0.001). CONCLUSION: The pretreatment albumin level was a significant prognostic indicator for survival. Similarly, the primary cancer site, KPS and number of visceral metastases were associated with survival; these findings were consistent with the results of previous studies. The pretreatment analgesic use was significant using the univariate and multivariate analyses and this factor can be verified in future trials. Self-reported pain intensity, pain response to radiotherapy and MRI findings did not influence survival times.
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Neoplasias de la Columna Vertebral/radioterapia , Neoplasias de la Columna Vertebral/secundario , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Neoplasias de la Mama/radioterapia , Femenino , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/radioterapia , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Pronóstico , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/radioterapia , Neoplasias de la Columna Vertebral/fisiopatología , Análisis de SupervivenciaRESUMEN
BACKGROUND: Magnetic resonance imaging (MRI) is the recommended primary investigation method for metastatic spinal cord compression (MSCC). Initiating treatment before the development of motor deficits is essential to preserve neurological function. However, the relationship between MRI-assessed grades of spinal metastatic disease and neurological status has not been widely investigated. PURPOSE: To analyze the association between neurological function and MRI-based assessment of the extent of spinal metastases using two different grading systems. MATERIAL AND METHODS: A total of 284 patients admitted to our institution for initial radiotherapy or surgery for symptomatic spinal metastases were included in the study. Motor and sensory deficits were categorized according to the Frankel classification system. Pre-treatment MRI evaluations of the entire spine were scored for the extent of spinal metastases, presence and severity of spinal cord compression, and nerve root compression. Two MRI-based scales were used to evaluate the degree of cord compression and spinal canal narrowing and relate these findings to neurological function. RESULTS: Of the patients included in the study, 28 were non-ambulatory, 49 were ambulatory with minor motor deficits, and 207 had normal motor function. Spinal cord compression was present in all patients with Frankel scores of B or C, 23 of 35 patients with a Frankel score of D (66%), and 48 of 152 patients with a Frankel score of E (32%). The percentage of patients with severe spinal canal narrowing increased with increasing Frankel grades. The grading according to the scales showed a significant association with the symptoms according to the Frankel scale (P < 0.001). CONCLUSION: In patients with neurological dysfunction, the presence and severity of impairment was associated with the epidural tumor burden. A significant number of patients had radiological spinal cord compression and normal motor function (occult MSCC).
Asunto(s)
Imagen por Resonancia Magnética/métodos , Actividad Motora , Neoplasias de la Columna Vertebral/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Espacio Epidural/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Neurológico/métodos , Examen Neurológico/estadística & datos numéricos , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Canal Medular/patología , Compresión de la Médula Espinal/patología , Neoplasias de la Columna Vertebral/secundario , Columna Vertebral/patología , Adulto JovenRESUMEN
OBJECTIVES: Explore the genetic and clinical incidence of von Hippel-Lindau disease in patients presenting with isolated central nervous system hemangioblastomas. RESULTS: We report a 3.2% (1/31) and 25% (8/32) incidence of genetic and clinical VHL, respectively. One patient tested positive for a VHL mutation that has not previously been reported. This genotype phenotypically predicts VHL type 2B. We had seven patients with renal cysts. In a total follow-up of 33 person years, none of these cysts progressed to renal cell carcinoma. CONCLUSION: von Hippel-Lindau disease anchored in germline mutations of the VHL gene is rare in the Norwegian population as opposed to clinical VHL disease, which appears to be relatively common in patients with apparently sporadic hemangioblastomas. There exists insufficient data regarding the natural history of patients with renal cysts, which makes it difficult to include or disregard these lesions as an entity of VHL disease.
Asunto(s)
Neoplasias del Sistema Nervioso Central/genética , Hemangioblastoma/genética , Enfermedad de von Hippel-Lindau/genética , Adulto , Neoplasias del Sistema Nervioso Central/diagnóstico , Neoplasias del Sistema Nervioso Central/epidemiología , Estudios Transversales , Análisis Mutacional de ADN , Femenino , Tamización de Portadores Genéticos , Pruebas Genéticas , Mutación de Línea Germinal , Hemangioblastoma/diagnóstico , Hemangioblastoma/epidemiología , Humanos , Enfermedades Renales Quísticas/diagnóstico , Enfermedades Renales Quísticas/epidemiología , Enfermedades Renales Quísticas/genética , Masculino , Persona de Mediana Edad , Noruega , Enfermedad de von Hippel-Lindau/diagnóstico , Enfermedad de von Hippel-Lindau/epidemiologíaRESUMEN
BACKGROUND AND PURPOSE: Dural ectasia (DE) is one of the major criteria of Marfan syndrome (MFS). Our aim was to establish the prevalence of DE in an adult population fulfilling the Ghent criteria for MFS and to assess definitions of DE. MATERIALS AND METHODS: One hundred five adults with suspected MFS were included. MR imaging at 1.5T was performed unless contraindicated; then CT was obtained. Lumbosacral anteroposterior vertebral body diameters (VBD) and dural sac diameters (DSD) were measured. Dural sac ratios (DSR = DSD/VBD) at levels L3 through S1 were calculated. Anterior meningoceles, herniations of nerve root sleeves, and scalloping were characterized. One hundred one sex- and age-matched patients were included as controls. RESULTS: We identified 3 patient groups: 1) fulfilling Ghent criteria independent of DE (n = 73), 2); fulfilling Ghent criteria dependent on DE (n = 14), and 3); and suspected MFS, not fulfilling Ghent criteria (n = 18). DE was found in 86% of group 1. At levels L4-S1, mean DSRs were significantly higher in group 1 than in group 3 and controls (P < .001). Herniations of the nerve root sleeves were present in 73% in group 1 versus 1% in controls. Anterior meningoceles were found in 37% and 14% in groups 1 and 2, respectively, but not in group 3 or controls. CONCLUSIONS: The diagnosis of DE on MR imaging or CT should be based on the presence of at least 1 of the following criteria: anterior meningoceles or nerve root sleeve herniation, DSD at S1 or below larger than DSD at L4, and DSR at S1 >0.59.
Asunto(s)
Duramadre/diagnóstico por imagen , Duramadre/patología , Imagen por Resonancia Magnética/estadística & datos numéricos , Síndrome de Marfan/diagnóstico , Síndrome de Marfan/epidemiología , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Adulto , Estudios de Casos y Controles , Comorbilidad , Dilatación Patológica/patología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Noruega/epidemiologíaRESUMEN
Spindle cell oncocytoma (SCO) of the adenohypophysis is a recently defined pituitary tumor mimicking a non-functioning macroadenoma and composed of mitochondrion rich tumor cells, positive for S-100, vimentin, epithelial membrane antigen and galectin-3 but lacking cytokeratins, pituitary hormones, and neuroendocrine markers. Derivation from pituitary folliculostellate cells (FSCs) has been suggested based upon immunohistochemical and ultrastructural characteristics shared by SCO and FSCs. 10 cases of SCO have been reported to date; of these, 8 underwent a benign clinical course and 2 recurred. We report a case of SCO with typical histologic and immunohistochemical features in addition to marked cellular pleomorphism and nuclear atypia. It showed slow regrowth over a 30-month period of follow-up despite combined surgical and radiotherapy. Despite the benign course of most reported cases, additional experience with longer follow-up are needed to assess clinical, histopathologic, and proliferative indices and their relevance to optimal therapy for this rare pituitary tumor.
Asunto(s)
Adenoma Oxifílico/patología , Adenohipófisis , Neoplasias Hipofisarias/patología , Adenoma Oxifílico/química , Adenoma Oxifílico/radioterapia , Adenoma Oxifílico/cirugía , Femenino , Galectina 3/análisis , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Persona de Mediana Edad , Mucina-1/análisis , Recurrencia Local de Neoplasia , Neoplasias Hipofisarias/química , Neoplasias Hipofisarias/radioterapia , Neoplasias Hipofisarias/cirugía , Radioterapia Adyuvante , Proteínas S100/análisis , Resultado del TratamientoRESUMEN
BACKGROUND: Early detection of hypoxic-ischemic (HI) injury in the asphyxic newborn is important because present prognostic factors are inadequate. Furthermore, therapeutic interventions may have additional benefit if initiated in time. PURPOSE: To assess whether the use of a combined protocol including conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), and proton MR spectroscopy (MRS) could detect pathological findings in a piglet model 7 hours after HI. MATERIAL AND METHODS: Ten piglets were submitted to HI for 30 min followed by reoxygenation with 21% O2 for 7 hours. MRI at 1.5T was done prior to and 7 hours after the HI. Single-voxel proton MRS was performed, and apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were measured in the basal ganglia. MRS identified N-acetylaspartate (NAA), choline (Cho), creatine (Cr), and lactate (Lac). Histology and microtubule-associated protein 2 (MAP-2) staining was performed in the basal ganglia at the end of the experiment. RESULTS: Compared to baseline, ADC, NAA/Cho, and NAA/Cr were significantly reduced after 7 hours (P<0.001, P=0.01, and P=0.05, respectively) and FA values were increased (P<0.025). The ratios of Lac/Cho and Lac/NAA were significantly higher after 7 hours compared to baseline (P<0.001). Presence of necrosis correlated well with reduced ADC (R(S)=0.91) and presence of Lac (R(S)=0.80). Histology and MAP-2 staining showed more than 90% necrosis in eight piglets, 60% in one piglet, and no necrosis in one piglet. CONCLUSION: Diffusion MRI and proton MRS can detect HI injury in the piglet brain 7 hours after hypoxia. DWI and MRS can be used to give useful prognostic information. This piglet model may potentially be used to mimic clinical situations and is suitable for further research investigating HI injury.
Asunto(s)
Imagen de Difusión por Resonancia Magnética , Hipoxia-Isquemia Encefálica/diagnóstico , Imagen por Resonancia Magnética , Espectroscopía de Resonancia Magnética , Animales , Animales Recién Nacidos , Ácido Aspártico/análogos & derivados , Ácido Aspártico/análisis , Ganglios Basales/química , Encéfalo/patología , Química Encefálica , Colina/análisis , Creatina/análisis , Modelos Animales de Enfermedad , Ácido Láctico/análisis , Proteínas Asociadas a Microtúbulos/análisis , PorcinosRESUMEN
BACKGROUND AND PURPOSE: Inclusion of oligodendroglial tumors may confound the utility of MR based glioma grading. Our aim was, first, to assess retrospectively whether a histogram-analysis method of MR perfusion images may both grade gliomas and differentiate between low-grade oligodendroglial tumors with or without loss of heterozygosity (LOH) on 1p/19q and, second, to assess retrospectively whether low-grade oligodendroglial subtypes can be identified in a population of patients with high-grade and low-grade astrocytic and oligodendroglial tumors. MATERIALS AND METHODS: Fifty-two patients (23 women, 29 men; mean age, 52 years; range, 19-78 years) with histologically confirmed gliomas were imaged by using dynamic susceptibility contrast MR imaging at 1.5T. Relative cerebral blood volume (rCBV) maps were created, and 4 neuroradiologists defined the glioma volumes independently. Averaged over the 4 observers, a histogram-analysis method was used to assess the normalized histogram peak height of the glioma rCBV distributions. RESULTS: Of the 52 patients, 22 had oligodendroglial tumors. The histogram method was able to differentiate high-grade gliomas (HGGs) from low-grade gliomas (LGGs) (Mann-Whitney U test, P < .001) and to identify low-grade oligodendroglial subtypes (P = .009). The corresponding intraclass correlation coefficients were 0.902 and 0.801, respectively. The sensitivity and specificity in terms of differentiating low-grade oligodendroglial tumors without LOH on 1p/19q from the other tumors was 100% (6/6) and 91% (42/46), respectively. CONCLUSION: With histology as a reference, our results suggest that histogram analysis of MR imaging-derived rCBV maps can differentiate HGGs from LGGs as well as low-grade oligodendroglial subtypes with high interobserver agreement. Also, the method was able to identify low-grade oligodendroglial tumors without LOH on 1p/19q in a population of patients with astrocytic and oligodendroglial tumors.
Asunto(s)
Volumen Sanguíneo/fisiología , Neoplasias Encefálicas/irrigación sanguínea , Glioma/irrigación sanguínea , Procesamiento de Imagen Asistido por Computador/métodos , Angiografía por Resonancia Magnética/métodos , Oligodendroglioma/irrigación sanguínea , Adulto , Anciano , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patología , Diagnóstico Diferencial , Femenino , Glioma/diagnóstico , Glioma/patología , Humanos , Pérdida de Heterocigocidad , Masculino , Persona de Mediana Edad , Oligodendroglioma/diagnóstico , Oligodendroglioma/genética , Oligodendroglioma/patología , Reacción en Cadena de la Polimerasa , Pronóstico , Sensibilidad y EspecificidadRESUMEN
Diffusion-weighted (DW) MR imaging usually identifies acute cerebral infarction injury in symptomatic patients. We report a patient with severe hypoxic brain injury following suicide attempt by hanging, but with normal DW MR imaging 5-6 h after the event. Follow-up DW MR imaging 3 days after the event, and subsequent autopsy, revealed extensive cerebral anoxic injury.
Asunto(s)
Encéfalo/patología , Imagen de Difusión por Resonancia Magnética , Hipoxia Encefálica/patología , Intento de Suicidio , Adolescente , Femenino , Humanos , Hipoxia Encefálica/etiología , Factores de TiempoRESUMEN
PURPOSE: Minimal- or non-invasive methods replacing intra-arterial digital subtraction angiography (IA-DSA) would be of great importance in patients suffering from acute subarachnoid haemorrhage (SAH). The aims of this study were to compare CTA with IA-DSA in patients with acute SAH, to compare CTA interpretations with those of blinded, independent reviewers and to evaluate improvement in CTA diagnostics after 1 year of experience with CTA. MATERIAL AND METHOD: During 2 years 162 patients with SAH underwent CTA as well as IA-DSA. Independent blinded review of 77 patients was performed for 1 year. RESULTS: Totally 144 aneurysms were demonstrated in 119 patients at IA-DSA, while 43 patients had normal intracranial arteries. Initially 131 aneurysms were detected at CTA while 2 normal, tortuous arteries were misinterpreted as aneurysms, giving a sensitivity of 91% and a specificity of 95%. At independent blinded review the observer agreement was 87% and the kappa value 0.68. CONCLUSION: CTA in SAH is of great value in demonstrating vascular anatomy and the exact size of an aneurysm. However, IA-DSA is still needed for diagnostic evaluation in aneurysms smaller than 5 mm in diameter, especially in those located near bony structures.
Asunto(s)
Angiografía de Substracción Digital , Angiografía Cerebral/métodos , Hemorragia Subaracnoidea/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Enfermedad Aguda , Adolescente , Adulto , Anciano , Aneurisma Roto/complicaciones , Aneurisma Roto/diagnóstico por imagen , Arterias Cerebrales/diagnóstico por imagen , Femenino , Humanos , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Estudios Retrospectivos , Rotura Espontánea , Sensibilidad y Especificidad , Hemorragia Subaracnoidea/etiologíaRESUMEN
The aim of this study was to evaluate the efficacy of contrast-medium (CM)-ehanced MR imaging of operated pituitary macroadenomas with reduced dose of gadopentetate dimeglumine. In a prospective study 18 patients were examined with coronal T1-weighted MR imaging prior to and following intravenous CM injections. Two sets of contrast-enhanced coronal images were obtained in each patient; the first set after 50% of the recommended dose of 0.1 mmol/kg body weight (b.w.) had been administered, and the second set immediately after additional CM had been given to make up a total dose of 0.1 mmol/kg b.w. The images were evaluated by three neuroradiologists. The SIPAP classification system was used to evaluate tumour extension, whereas tumour margin conspicuity was scored using an arbitrary scale of 1-5 (1 = indistinct, 5 = well defined). Signal intensity measurements obtained from the most enhancing part of the adenomas demonstrated increased enhancement with increased CM dose. Tumour delineation scores were significantly better on the reduced- and full-dose images than on pre-CM injection images, but, with one exception, tumour extension was identified as the same on all imaging sequences. Postoperative MR imaging of large macroadenoma residues can routinely be performed without intravenous CM. When CM is indicated a reduced dose of gadopentetate dimeglumine should provide sufficient diagnostic information.
Asunto(s)
Adenoma/patología , Adenoma/cirugía , Gadolinio DTPA/administración & dosificación , Imagen por Resonancia Magnética , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/cirugía , Cuidados Posoperatorios , Adulto , Anciano , Anciano de 80 o más Años , Medios de Contraste/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Magnetic resonance tomography is considered the most important technique in modern neuroradiology. This article demonstrates the importance of MR imaging in the diagnosis of diseases of the central nervous system. Modern neuroradiology is completely dependent upon this modality, and sections and departments of neuroradiology should have great responsibility for both diagnostic MR imaging and the day-to-day operation MR laboratories.
Asunto(s)
Encefalopatías/diagnóstico , Enfermedades del Sistema Nervioso Central/diagnóstico , Trastornos Cerebrovasculares/diagnóstico , Imagen por Resonancia Magnética , Astrocitoma/diagnóstico , Encéfalo/anatomía & histología , Encéfalo/patología , Encéfalo/fisiología , Neoplasias Encefálicas/diagnóstico , Humanos , Imagen por Resonancia Magnética/métodos , Imagen por Resonancia Magnética/estadística & datos numéricos , Meduloblastoma/diagnóstico , Enfermedades de la Médula Espinal/diagnóstico , Enfermedades de la Columna Vertebral/diagnósticoRESUMEN
PURPOSE: To compare the pre- and postoperative MR appearance of craniopharyngiomas with respect to lesion size, tumour morphology and identification of surrounding normal structures. MATERIAL AND METHODS: MR images obtained prior to and following craniopharyngioma resection were evaluated retrospectively in 10 patients. Tumour signal characteristics, size and extension with particular reference to the optic chiasm, the pituitary gland, the pituitary stalk and the third ventricle were evaluated. RESULTS: Following surgery, tumour volume was reduced in all patients. In 6 patients there was further tumour volume reduction between the first and second postoperative images. Two of these patients received radiation therapy between the 2 postoperative studies, while 4 had no adjuvant treatment to the surgical intervention. There was improved visualization of the optic chiasm in 3, the pituitary stalk in one, and the third ventricle in 9 of the 10 patients. The pituitary gland was identified preoperatively only in one patient, postoperatively only in another, pre- and postoperatively in 5, and neither pre- nor postoperatively in 3 patients. In 3 patients MR imaging 0-7 days postoperatively identified tumour remnants not seen at the end of the surgical procedure. The signal intensities of solid and cystic tumour components were stable from pre- to the first postoperative MR images. Optic tract increased signal prior to surgery was gone 28 days postoperatively in one patient, but persisted on the left side for 197 days after surgery in another. CONCLUSION: Postoperative MR imaging of craniopharyngiomas demonstrated tumour volume reduction and tumour remnants not seen at surgery. Early postoperative MR imaging of craniopharyngiomas may overestimate the size of residual tumour. Improved visualization of peritumoral structures may be achieved.
Asunto(s)
Craneofaringioma/patología , Hipófisis/patología , Neoplasias Hipofisarias/patología , Adulto , Ventrículos Cerebrales/patología , Craneofaringioma/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasia Residual , Quiasma Óptico/patología , Neoplasias Hipofisarias/cirugía , Cuidados Posoperatorios , Cuidados Preoperatorios , Factores de TiempoRESUMEN
PURPOSE: To identify the CT and MR characteristics of craniopharyngiomas, to evaluate the histologic types of craniopharyngioma, and to compare the radiologic/histologic appearance and type of therapy with tumor recurrence. METHODS: We reviewed the records of 45 patients with craniopharyngiomas for which surgical specimens (n = 45), preoperative MR or CT studies (n = 27), or other MR or CT studies or reports (n = 18) were available. Radiologic appearance, histologic morphology, treatment, and tumor recurrence were studied. RESULTS: Adamantinomatous epithelium was found in 40 of 45 surgical specimens, keratin in 34 of 45, and squamous epithelium in 11 of 45. A continuum of mixed morphology rather than distinct subtypes of tumors was found. The radiologic appearance did not correlate with the histologic features. No statistically significant difference was found between children and adults with respect to tumor size, calcification, histology, or tumor recurrence. Patients treated with radiation after subtotal resection had far fewer tumor recurrences (n = 3) than patients treated with surgery alone (n = 18). CONCLUSION: Craniopharyngiomas could not be divided into distinct histologic types. No differentiating radiologic or histologic characteristics could be established for craniopharyngiomas in children versus adults. Radiation treatment was strongly associated with tumor regression or lack of recurrence.
Asunto(s)
Craneofaringioma/diagnóstico , Recurrencia Local de Neoplasia/patología , Neoplasias Hipofisarias/diagnóstico , Adolescente , Adulto , Factores de Edad , Calcinosis/patología , Niño , Preescolar , Craneofaringioma/diagnóstico por imagen , Craneofaringioma/patología , Craneofaringioma/cirugía , Epitelio/patología , Femenino , Estudios de Seguimiento , Humanos , Queratinas/análisis , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Neoplasias Hipofisarias/diagnóstico por imagen , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/cirugía , Radioterapia Adyuvante , Inducción de Remisión , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
To compare the detectability of craniopharyngiomas by CT and MR imaging, preoperative CT and MR studies obtained within 16 days of each other were evaluated retrospectively in 9 patients. MR imaging demonstrated cystic and solid tumor components in all 9 tumors, and enhancement in the 7 tumors that were studied after contrast medium injection. MR imaging demonstrated a signal void consistent with calcification in 4 patients. Combining unenhanced and contrast medium-enhanced studies, CT also identified all the tumors. CT demonstrated cysts in 7 lesions, calcification in 7 and enhancement in 6 of the 7 lesions that received i.v. contrast medium. Calcification was better seen by CT than MR imaging, while MR imaging identified cystic tumor components not seen on CT. The contrast medium enhancement pattern was the same with the 2 modalities. MR imaging of the sellar region, including at least one contrast medium-enhanced sequence, should be sufficient in most instances to establish a preoperative diagnosis of craniopharyngioma.
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Craneofaringioma/diagnóstico , Neoplasias Hipofisarias/diagnóstico , Adulto , Calcinosis/diagnóstico , Craneofaringioma/cirugía , Quistes/diagnóstico , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Enfermedades de la Hipófisis/diagnóstico , Neoplasias Hipofisarias/cirugía , Cuidados Preoperatorios , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
To evaluate the efficacy of i.v. contrast medium administration in MR imaging at 1.5 T in patients with craniopharyngiomas, MR studies of 10 men and 6 women with pathologically proven craniopharyngiomas were made. The MR images were obtained as 3- to 5-mm-thick coronal (n = 13) or axial (n = 3) Tl-weighted images (T1WI) prior to and following i.v. Gd-DTPA administration. Proton density- (PD) and T2-weighted images (T2WI) were also obtained. Conspicuity of tumor margins, cystic versus solid components, size, location and effect upon adjacent structures were separately characterized in all imaging sequences. In 6 patients contrast medium-enhanced T1WI. PD and T2WI demonstrated cystic tumor components not seen on unenhanced T1WI. There were significant differences (p < 0.004) on 2-tailed Student's t-test comparing tumor conspicuity on contrast medium-enhanced T1WI with unenhanced T1WI, PD and T2WI. Optimal tumor delineation on MR imaging of patients with craniopharyngiomas justifies the use of i.v. contrast medium.
Asunto(s)
Medios de Contraste , Craneofaringioma/patología , Imagen por Resonancia Magnética , Neoplasias Hipofisarias/patología , Adolescente , Adulto , Niño , Preescolar , Combinación de Medicamentos , Femenino , Gadolinio , Gadolinio DTPA , Humanos , Masculino , Meglumina , Persona de Mediana Edad , Quiasma Óptico/patología , Compuestos Organometálicos , Ácido Pentético/análogos & derivadosRESUMEN
Twelve patients with known or suspected pituitary lesions underwent MR imaging with gadodiamide injection at a dose of 0.1 (n = 5) or 0.3 (n = 7) mM/kg. Six of the patients were also studied with 0.1 mM/kg gadopentetate dimeglumine. Consistent with previous reports gadodiamide injection was found to be a safe and effective contrast medium for MR imaging of the pituitary region. No additional diagnostic information was obtained using 0.3 mM/kg gadodiamide injection compared to 0.1 mM/kg gadopentate dimeglumine in the same patients. The high dose (0.3 mM/kg) gadodiamide injection in 7 patients did not shorten the T2 value sufficiently to overwhelm the T1 shortening and leave pathologic lesions hypointense compared to precontrast studies. With the comparable relaxivities of gadodiamide injection and gadopentetate dimeglumine, similarities in results have to be expected when using these media for MR image enhancement.
Asunto(s)
Medios de Contraste , Gadolinio , Imagen por Resonancia Magnética , Compuestos Organometálicos , Ácido Pentético/análogos & derivados , Enfermedades de la Hipófisis/diagnóstico , Adenoma/diagnóstico , Adulto , Anciano , Medios de Contraste/administración & dosificación , Craneofaringioma/diagnóstico , Combinación de Medicamentos , Femenino , Gadolinio/administración & dosificación , Gadolinio DTPA , Humanos , Aumento de la Imagen , Inyecciones Intravenosas , Imagen por Resonancia Magnética/métodos , Masculino , Meglumina , Persona de Mediana Edad , Compuestos Organometálicos/administración & dosificación , Ácido Pentético/administración & dosificación , Neoplasias Hipofisarias/diagnóstico , Prolactinoma/diagnóstico , Estudios RetrospectivosRESUMEN
A 13-year-old girl with Klippel-Trenaunay-Weber syndrome and intradural extramedullary spinal arteriovenous fistulas is presented. Pre-embolization balloon test occlusions and embolization with platinum fibre coils were carried out in three sessions, after which the myelopathy and the intense back pain disappeared. Our conclusion is that spinal fistulas can be safely and effectively treated with fibre coils in combination with balloon testing.
Asunto(s)
Fístula Arteriovenosa/terapia , Embolización Terapéutica , Síndrome de Klippel-Trenaunay-Weber/terapia , Médula Espinal/irrigación sanguínea , Adolescente , Fístula Arteriovenosa/diagnóstico por imagen , Embolización Terapéutica/instrumentación , Femenino , Humanos , Platino (Metal) , Radiografía IntervencionalRESUMEN
A reduction in gray scale resolution of digital images from 12 to 8 bits per pixel usually means halving the storage space needed for the images. Theoretically, important diagnostic information may be lost in the process. We compared the sensitivity and specificity achieved by 4 radiologists in reading laser-printed films of original 12-bit MR images and cathode ray tube displays of the same images which had been compressed to 8 bits per pixel using a specially developed computer program. Receiver operating characteristic (ROC) curves showed no significant differences between film reading and screen reading. A paired 2-tailed t-test, applied on the data for actually positive cases, showed that the combined, average performance of the reviewers was significantly better at screen reading than at film reading. No such differences were found for actually negative cases. Some individual differences were found, but it is concluded that gray scale resolution of MR images may be reduced from 12 to 8 bits per pixel without any significant reduction in diagnostic information.
Asunto(s)
Sistema Nervioso Central/patología , Imagen por Resonancia Magnética , Sistemas de Información Radiológica , Presentación de Datos , Humanos , Curva ROCRESUMEN
MR findings before and after transsphenoidal surgery were evaluated in 6 cases. T1-weighted (TR/TE 600/20) sagittal and coronal images with 2 or 4 acquisitions were obtained, using 3-mm slice thickness and 0.3-mm interslice gaps. Of 18 MR examinations, 13 included coronal i.v. contrast medium enhanced images. Image quality, sinus cavernosus invasion, identification of normal pituitary tissue and tumor size were examined. All MR studies clearly demonstrated the macroadenomas whether 2 or 4 acquisitions were used, and whether i.v. contrast medium was administered or not. Surgically confirmed sinus cavernosus infiltration was seen in 4 patients. The pituitary stalk was identified separate from the tumor in 2 patients, and the gland in one. There was reduction in tumor size over time, indicating that final radiologic assessment after transphenoidal surgery is best performed 4 to 6 months postoperatively. It should not be necessary to routinely include i.v. contrast medium injection in the postoperative evaluation of macroadenomas.
Asunto(s)
Adenoma/diagnóstico , Adenoma/cirugía , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/cirugía , Adenoma/epidemiología , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Neoplasias Hipofisarias/epidemiología , Estudios Retrospectivos , Hueso Esfenoides/cirugíaRESUMEN
Glutaric aciduria type I is a congenital metabolic disease caused by an enzymatic defect in the degradation of the amino acids lysine and tryptophane. This article presents five Norwegian patients with this condition. Early clinical features may be similar to those of encephalitis. The further clinical course is dominated by choreoathetosis, hyperkinesis and spasticity. The diagnosis is made by tracing enhanced glutaric acid in the urine. The treatment is a low protein diet containing only small quantities of lysine and tryptophane. Four of our patients underwent a neuropsychological examination. Despite the fact that such patients are difficult to test, our examination indicates that the condition has a greater effect on motor than on cognitive functions.