RESUMEN
PURPOSE: Pseudo-continuous arterial spin labeling (pCASL) is a non-invasive magnetic resonance (MR) perfusion technique. Our study aimed at estimating the diagnostic performance of the pCASL sequence in assessing the perfusion of skull base lesions both qualitatively and quantitatively and at providing cut-off values for differentiation of specific skull base lesions. METHODS: In this study 99 patients with histopathologically confirmed skull base lesions were retrospectively enrolled. Based on a pathological analysis, the lesions were classified as hypervascular and non-hypervascular. Patients were divided into two subgroups according to the anatomical origin of each lesion. The MRI study included pCASL and 3D T1-weighted fat-saturated post-contrast sequences. Of the patients seven were excluded due to technical difficulties or patient movement. The lesions were classified by two raters, blinded to the diagnosis as either hyperperfused or non-hyperperfused, based on the pCASL sequence. The normalized tumor blood flow (nTBF) of each lesion was determined. Qualitative and quantitative characteristics of hypervascular and non-hypervascular lesions were compared. RESULTS: Visual assessment enabled correct classification of 98% of the lesions to be performed. Quantitatively, we found significant differences between the nTBF values for hypervascular and non-hypervascular lesions (p < 0.001) and provided cut-off values, allowing meningioma and schwannoma to be distinguished from meningioma and adenoma. Significant differences were also found within the hypervascular group, namely, paraganglioma was more hyperperfused than meningioma (p = 0.003) or metastases (p = 0.009). CONCLUSION: The present study demonstrates the high diagnostic performance of pCASL in characterizing skull base lesions by either visual assessment or nTBF quantification. Adding the pCASL sequence to the conventional protocol of skull base assessment can be recommended.
Asunto(s)
Imagen por Resonancia Magnética/métodos , Neoplasias de la Base del Cráneo/diagnóstico por imagen , Adenoma/irrigación sanguínea , Adenoma/diagnóstico por imagen , Adulto , Anciano , Medios de Contraste , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagen , Meningioma/irrigación sanguínea , Meningioma/diagnóstico por imagen , Persona de Mediana Edad , Neurilemoma/irrigación sanguínea , Neurilemoma/diagnóstico por imagen , Neuroma Acústico/irrigación sanguínea , Neuroma Acústico/diagnóstico por imagen , Neoplasias Orbitales/irrigación sanguínea , Neoplasias Orbitales/diagnóstico por imagen , Neoplasias Hipofisarias/irrigación sanguínea , Neoplasias Hipofisarias/diagnóstico por imagen , Estudios Retrospectivos , Neoplasias de la Base del Cráneo/irrigación sanguínea , Neoplasias de la Base del Cráneo/clasificación , Marcadores de Spin , Hueso Temporal/diagnóstico por imagenAsunto(s)
Intoxicación por Monóxido de Carbono/complicaciones , Intoxicación por Monóxido de Carbono/diagnóstico , Enfermedades Desmielinizantes/diagnóstico por imagen , Enfermedades Desmielinizantes/etiología , Sustancia Blanca/patología , Diagnóstico Diferencial , Progresión de la Enfermedad , Vivienda , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
A 45-year-old woman was treated by Capecitabine (Xeloda®) during 6days for breast cancer with metastatic bone lesions when she presented with nausea, headaches, muscle cramps, dysarthria and swallowing disorders. A stroke was first suspected. Brain CT was normal. MRI showed bilateral and symmetric high signal intensities of deep white matter, corpus callosum and corticospinal tracts on diffusion-weighted imaging and T2 fluid-attenuated inversion recovery (FLAIR) sequence, similar to 5-FU acute leukoencephalopathy. An acute toxic leukoencephalopathy was diagnosed prompting to discontinue capecitabine, which allowed a regression of the symptoms. Though acute toxic leukoencephalopathies with pseudo-stroke presentation have been reported with other chemotherapy agents such as methotrexate or 5-fluorouracil (5-FU), cases of leukoencephalopathy induced by capecitabine are less reported and less well known. This oral precursor of 5-FU is commonly used to treat colorectal, stomach or breast cancers. Neurotoxicity of other 5-FU derivates like cormafur and tergafur have rarely been depicted as well. Although 5-FU-induced leukoencephalopathy is known, the potential toxicity of its precursor should be acknowledged as well. Early detection of chemotherapy-induced toxicity by MRI is crucial as symptoms may be reversible to the condition that chemotherapy is immediately discontinued.
Asunto(s)
Antimetabolitos Antineoplásicos/efectos adversos , Huesos/patología , Neoplasias de la Mama/patología , Capecitabina/efectos adversos , Leucoencefalopatías/inducido químicamente , Neoplasias de la Mama/tratamiento farmacológico , Femenino , Humanos , Leucoencefalopatías/diagnóstico por imagen , Imagen por Resonancia Magnética , Persona de Mediana Edad , Tractos Piramidales/diagnóstico por imagen , Tractos Piramidales/efectos de los fármacosAsunto(s)
Traumatismos del Nervio Oculomotor/diagnóstico por imagen , Traumatismos del Nervio Oculomotor/patología , Accidentes de Tránsito , Adulto , Traumatismos Craneocerebrales/complicaciones , Traumatismos Craneocerebrales/diagnóstico por imagen , Traumatismos Craneocerebrales/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Motocicletas , Traumatismos del Nervio Oculomotor/etiologíaRESUMEN
In the recently published article, "Unilateral fetal-type circle of Willis anatomy causes right-left asymmetry in cerebral blood flow with pseudo-continuous arterial spin labeling: A limitation of arterial spin labeling-based cerebral blood flow measurements?", it was shown by the method of arterial spin labeling (ASL) that unilateral fetal-type circle of Willis could induce variation of blood flow in cerebellar and posterior cerebral artery territory. We believe that the reported observation, rather than being a limitation, gives several interesting cues for understanding the ASL sequence. In this commentary, we formulate some suggestions regarding the use of ASL in clinical practice, discuss the potential causes of the above-mentioned pseudo-asymmetry and consider future improvements of the ASL technique.