Tumefactive intracranial presentation of precursor B-cell acute lymphoblastic leukemia

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Forester, Craig M. [University of Utah, Salt Lake City, UT (United States); Braunreiter, Chi L. [University of Utah, Division of Pediatric Hematology Oncology, Primary Children' s Medical Center, Salt Lake City, UT (United States); Helen DeVos Children' s Hospital, Department of Pediatric Hematology Oncology, Grand Rapids, MI (United States); Yaish, Hasan; Afify, Zeinab [University of Utah, Division of Pediatric Hematology Oncology, Primary Children' s Medical Center, Salt Lake City, UT (United States); Hedlund, Gary L. [Primary Children' s Medical Center, Department of Pediatric Radiology, Salt Lake City, UT (United States)

2009-11-15

In children, leukemia is the most common malignancy, and approximately 75% of leukemias are acute lymphoblastic leukemia (ALL). Central nervous system leukemia is found at diagnosis in fewer than 5% of children with ALL. Leukemic intracranial masses have been described with acute myeloid leukemia, but ALL presenting as a mass lesion is rare. We describe a unique case of an intracranial confirmed precursor B cell (pre-B) ALL mass in a 13-year-old girl that was diagnosed by brain CT, MRI and cerebral angiography, and confirmed by biopsy. This report details pertinent history and distinguishing imaging features of an intracranial ALL tumefaction. (orig.)

Usefulness of multi-plane dynamic subtraction CT (MPDS-CT) for intracranial high density lesions

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Takagi, Ryo; Kumazaki, Tatsuo [Nippon Medical School, Tokyo (Japan)

1996-02-01

We present a new CT technique using the high speed CT scanner in detection and evaluation of temporal and spatial contrast enhancement of intracranial high density lesions. A multi-plane dynamic subtraction CT (MPDS-CT) was performed in 21 patients with intracranial high density lesions. These lesions consisted of 10 brain tumors, 7 intracerebral hemorrhages and 4 vascular malformations (2 untreated, 2 post-embolization). Baseline study was first performed, and 5 sequential planes of covering total high density lesions were selected. After obtaining the 5 sequential CT images as mask images, three series of multi-plane dynamic CT were performed for the same 5 planes with an intravenous bolus injection of contrast medium. MPDS-CT images were reconstructed by subtracting dynamic CT images from the mask ones. MPDS-CT were compared with conventional contrast-enhanced CT. MPDS-CT images showed the definite contrast enhancement of high density brain tumors and vascular malformations which were not clearly identified on conventional contrast-enhanced CT images because of calcified or hemorrhagic lesions and embolic materials, enabling us to eliminate enhanced abnormalities with non-enhanced areas such as unusual intracerebral hemorrhages. MPDS-CT will provide us further accurate and objective information and will be greatly helpful for interpreting pathophysiologic condition. (author).

Simple Improvisation to Enhance Utility of Fluorescein Sodium in Resection of Intracranial Lesions at Routine Neurosurgical Centers.

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Gollapudi, Prakash Rao; Mohammed, Imran; Pittala, Sandeep R; Kotha, Arjun Reddy; Reddycherla, Naga Raju; Ginjupally, Dhanunjaya Rao

2018-04-01

Fluorescein sodium is one of the fluorophores that is used in the resection of intracranial lesions. It is commonly used along with a customized microscope, which is expensive and not available universally. In this study, we describe a simple, inexpensive method for better visualization of intracranial and spinal cord lesions with fluorescein. After a test dose, 20 mg/kg of fluorescein sodium was administered intravenously at the time of intubation. A blue light source was used before resection for precise localization of the intracranial lesions after durotomy. Most of the resection was done under the white light, while the blue light was used intermittently to delineate the pathologic tissue from the normal tissue and to ensure safe maximal resection. The intensity of fluorescein staining under white light and blue light was noted. The study comprised 40 cases of gliomas, meningiomas, abscesses, spinal cord tumors, and cerebellopontine angle lesions. Thirty-five lesions showed good fluorescence under the blue light, which helped us achieve better resection of the pathologic lesions. Fluorescein sodium is a safe dye; it can be used to aid in precise localization and safe maximal resection of the pathologic tissue with the help of a blue light source at any center with challenged resources. The blue light enhances the fluorescence and visualization of the pathologic tissue, and this technique can be adopted by any surgeon without much difficulty even with a basic neurosurgical setup. Copyright © 2018 Elsevier Inc. All rights reserved.

Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (FDG PET/CT) Findings in an Unusual Case of Multiple Myeloma Presenting with a Large Extra-Axial Intracranial Mass.

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Ayaz, Sevin; Ayaz, Ümit Yaşar

2016-01-01

We aimed to present unusual cranial FDG PET/CT findings of a 56-year-old female with multiple myeloma (MM). Plain CT images revealed a lytic lesion in the right parietal bone, filled with an oval-shaped, large, extra-axial, extradural, intracranial mass which measured 75×75×40 mm and had smooth borders. The right parietal lobe was compressed by the mass. The maximum standardized uptake value (SUV max ) of the mass lesion was 8.94 on FDG PET/CT images. Multiple lytic lesions with an increased uptake were also detected in other calvarial bones, in several vertebras and in the proximal left femur. After seven months, a control FDG PET/CT following radiotherapy and chemotherapy revealed almost complete regression of the right parietal extra-axial mass lesion. The number, size and metabolism of lytic lesions in other bones also decreased. FDG PET/CT was useful for an initial evaluation of MM lesions and was effective in monitoring the response of these lesions to therapy.

Imaging features of intracranial solitary fibrous tumors

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Yu Shuilian; Man Yuping; Ma Longbai; Liu Ying; Wei Qiang; Zhu Youkai

2012-01-01

Objective: To summarize the imaging features of intracranial solitary fibrous tumors (ISFT). Methods: Ten patients with ISFT proven histopathologically were collected. Four cases had CT data and all cases had MR data. The imaging features and pathological results were retrospectively analyzed. Results: All cases were misdiagnosed as meningioma at pre-operation. All lesions arose from intracranial meninges including 5 lesions above the tentorium, 4 lesions beneath the tentorium and 1 lesion growing around the tentorium. The margins of all the masses were well defined, and 8 lesions presented multilobular shape. CT demonstrated hyerattenuated masses in all 4 lesions, smooth erosion of the basicranial skull in 1 lesion, and punctiform calcification of the capsule in 1 lesion. T 1 WI showed most lesions with isointense or slight hyperintense signals including homogeneous in 4 lesions and heterogeneous in 6 lesions. T 2 WI demonstrated isointense or slight hyperintense in 2 lesions, mixed hypointense and hyperintense signals in 4, cystic portion in 2, and two distinct portion of hyperintense and hypointense signal, so called 'yin-yang' pattern, in 2. Strong enhanced was found in all lesions, especially in 8 lesion with heterogeneous with the low T 2 signal. 'Dural tail' was found in 4 lesions. Conclusions: ISFI has some specific CT and MR features including heterogeneous signal intensity on T 2 WI, strong enhancement of areas with low T 2 signal intensity, slight or no 'dural tail', without skull thickening, and the typical 'yin-yang' pattern. (authors)

Intracranial metastases: spectrum of MR imaging findings

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Lee, Eun Kyoung; Lee, Eun Ja; Lee, Yong Seok [Department of Radiology, Dongguk University Ilsan Hospital, Goyang-shi (Korea, Republic of)], E-mail: ejl1048@hanmail.net; Kim, Mi Sung; Park, No Hyuck [Department of Radiology, Kwandong University, College of Medicine, Myongji Hospital, Goyang-shi (Korea, Republic of); Park, Hee-Jin [Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); II, Sung Park [Department of Diagnostic Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of)

2012-12-15

Intracranial metastatic lesions arise through a number of routes. Therefore, they can involve any part of the central nervous system and their imaging appearances vary. Magnetic resonance imaging (MRI) plays a key role in lesion detection, lesion delineation, and differentiation of metastases from other intracranial disease processes. This article is a reasoned pictorial review illustrating the many faces of intracranial metastatic lesions based on the location - intra-axial metastases, calvarial metastases, dural metastases, leptomeningeal metastases, secondary invasion of the meninges by metastatic disease involving the calvarium and skull base, direct or perineural intracranial extension of head and neck neoplasm, and other unusual manifestations of intracranial metastases. We also review the role of advanced MRI to distinguish metastases from high-grade gliomas, tumor-mimicking lesions such as brain abscesses, and delayed post-radiation changes in radiosurgically treated patients.

Clinical application of proton magnetic resonance spectroscopy in differential diagnosis of intracranial lesions with ring-like enhancement

International Nuclear Information System (INIS)

Lai Ying; Cheng Kailiang; Zhang Mengchao; Liu Yunxia; Wang Wei

2009-01-01

Objective: To study the value of clinical application of 1 H proton magnetic resonance spectroscopy ( 1 H MRS) in the differential diagnosis of intracranial lesions with ring-like enhancement. Methods: 28 cases were diagnosed of intracranial lesions with ring-like enhancement by clinical examination and pathologic test. A total of 28 ratios cases included 6 cases high grade glioma, 10 cases of metastatic carcinoma (n=10) and 12 cases of brain abscess, after examined with 1HMRS, the ratios of various metabolites in focal center, enhancement ring,perifocal edema region and normal control group were detected and compared. Results: The ratios of NAA/Cho, Cho/Cr and NAA/Cr in focal center had no significantly differences between high grade glioma and metastatic carcinoma (P>0.05). The peak of NAA was significantly different between high grade glioma and metastatic carcinoma (P 0.05). The peak of AA was characteristic of brain abscess. The ratio of Cho/Cr 0 in brain abscess was significantly lower than those in high grade glioma and metastatic carcinoma (P 0 denoted the Cho content of contralateral normal brain region). These results accorded with the result of pathological examination. Conclusion: 1 HMRS can improve the diagnostic accuracy of intracranial lesions with ring-like enhancement. (authors)

Neonatal Acute Megakaryoblastic Leukemia Presenting with Leukemia Cutis and Multiple Intracranial Lesions Successfully Treated with Unrelated Cord Blood Transplantation

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Hiroshi Tsujimoto

2015-01-01

Full Text Available Neonatal acute megakaryoblastic leukemia (AMKL without Down syndrome (DS is an extremely rare disorder. We report of a one-day-old male infant without DS who developed AMKL with leukemia cutis and right facial nerve palsy. Magnetic resonance imaging of the patient’s brain revealed multiple intracranial tumors. A biopsy specimen of the skin lesion was suggestive of AMKL, but the bone marrow leukemic cells were less than 5% of the marrow nucleated cells. The skin and intracranial lesions had spontaneously regressed within one and a half months, but the patient’s anemia and thrombocytopenia gradually worsened and the leukemic cells in the bone marrow gradually increased to more than 20% of the nucleated cells. In addition, multiple intracranial lesions reappeared at 72 days of life. We diagnosed the patient with AMKL, and chemotherapy followed by unrelated cord blood transplantation after a reduced-intensity conditioning regimen resulted in sustained complete remission. At present, the patient is well, and he has demonstrated normal development for five years.

Intracranial tuberculoma: MR imaging

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Salgado, P; Zenteno, M A; Rodriguez-Carbajal, J; Brutto, O.H. del; Talamas, O

1989-09-01

MR studies of 6 patients with intracranial tuberculoma are reviewed. All patients also underwent CT scans which showed hypo- or isodense lesions with abnormal enhancement following contrast administration. MR showed lesions with prolongation of the T1 relaxation time in every case. On the T2-weighted sequences, the signal properties of the tuberculoma varied according to the stage of evolution of the lesion. Incipient tuberculomas appeared as scattered areas of hypointensity surrounded by edema. Mature tuberculomas were composed of a dark necrotic center surrounded by an isointense capsule which was, in turn, surrounded by edema. In one patient, the center of the lesion was hyperintense probably because of liquefaction and pus formation (tuberculous abscess). While both, CT and MR, were equally sensitive in visualizing the intracranial tuberculoma in every patient, MR was slightly superior in demonstrating the extent of the lesion, especially for brainstem tuberculomas. Nevertheless, the potential role for MR diagnosis of intracranial tuberculoma is limited by the fact that other infectious or neoplasic diseases may present similar findings. The diagnosis of intracranial tuberculoma should rest on a proper integration of data from clinical manifestations, cerebrospinal fluid analysis, and neuroimaging studies. (orig.).

Intracranial tuberculoma: MR imaging

International Nuclear Information System (INIS)

Salgado, P.; Zenteno, M.A.; Rodriguez-Carbajal, J.; Brutto, O.H. del; Talamas, O.

1989-01-01

MR studies of 6 patients with intracranial tuberculoma are reviewed. All patients also underwent CT scans which showed hypo- or isodense lesions with abnormal enhancement following contrast administration. MR showed lesions with prolongation of the T1 relaxation time in every case. On the T2-weighted sequences, the signal properties of the tuberculoma varied according to the stage of evolution of the lesion. Incipient tuberculomas appeared as scattered areas of hypointensity surrounded by edema. Mature tuberculomas were composed of a dark necrotic center surrounded by an isointense capsule which was, in turn, surrounded by edema. In one patient, the center of the lesion was hyperintense probably because of liquefaction and pus formation (tuberculous abscess). While both, CT and MR, were equally sensitive in visualizing the intracranial tuberculoma in every patient, MR was slightly superior in demonstrating the extent of the lesion, especially for brainstem tuberculomas. Nevertheless, the potential role for MR diagnosis of intracranial tuberculoma is limited by the fact that other infectious or neoplasic diseases may present similar findings. The diagnosis of intracranial tuberculoma should rest on a proper integration of data from clinical manifestations, cerebrospinal fluid analysis, and neuroimaging studies. (orig.)

Intraventricular mass lesions at magnetic resonance imaging: iconographic essay - part 2

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Castro, Felipe Damasio de; Reis, Fabiano; Guerra, Jose Guilherme Giocondo, E-mail: fdamasiocastro@gmail.com [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil)

2014-07-15

The present essay is illustrated with magnetic resonance images obtained at the authors’ institution over the past 15 years and discusses the main imaging findings of intraventricular tumor-like lesions (colloid cyst, oligodendroglioma, astroblastoma, lipoma, cavernoma) and of inflammatory/infectious lesions (neurocysticercosis and an atypical presentation of neurohistoplasmosis). Such lesions represent a subgroup of intracranial lesions with unique characteristics and some imaging patterns that may facilitate the differential diagnosis. (author)

STUDY OF INTRAOPERATIVE SQUASH CYTOLOGY OF INTRACRANIAL AND SPINAL CORD LESIONS WITH HISTOPATHOLOGICAL AND IHC STUDY

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Naval Kishore Bajaj

2016-07-01

Full Text Available BACKGROUND The causes of discordant diagnoses achieved at squash cytology of intracranial and spinal cord tumours were ascertained. Lesions having the advantage of diagnostic accuracy by squash cytology of intracranial and spinal cord lesions was also determined. METHODS Squash preparations of 72 patients suspected to have neoplasia were made and stained with rapid haematoxylin and eosin stain and toluidine blue stain. The smears were classified according to the cytomorphological criteria and the squash cytodiagnoses were compared. RESULTS Total 72 cases were studied, 93.9% were neoplastic and 6.1% non-neoplastic on histopathology. Amongst neoplasms, Astrocytic tumours constituted 26.3% of cases followed by Meningiomas comprising 20.8%. Amongst the benign lesions, Tuberculoma was seen most frequently (6.95%. Overall diagnostic accuracy of squash was 98.65%. On statistical analysis, Sensitivity, Specificity, Positive Predictive value (PPV and Negative Predictive Value (NPV of squash cytology were 98.6%, 100%, 100% and 80% respectively. CONCLUSION Intraoperative Squash is reliable, accurate, cost effective diagnostic modality when combined with histopathological and immunohistochemical techniques.

Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging

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Schubiger, O.; Valavanis, A.; Wichmann, W.

1987-05-01

In four cases of giant intracranial aneurysm, CT demonstrated a hyperdense open-, or closed-ring structure at the periphery of the aneurysm. Surgery in two of the cases demonstrated that this peripheral hyperdensity represents fresh clot inside the wall of the thrombosed mass. An analogy is established between giant intracranial aneurysms, chronic subdural hematomas and growing encapsulated intracerebral hematomas. The common feature of the three entities is slow growth by recurrent hemorrhages into the lesion. It is proven that growth of chronic subdural hematomas and of growing encapsulated hematomas is related to recurrent hemorrhage from capillaries sprouting within the membrane of the lesion. The highly vascularized membranous wall of a giant intracranial aneurysm seems to behave like the membrane of a chronic subdural hematoma. It is suggested that the giant intracranial aneurysm grows by recurrent hemorrhage into its wall and behaves like growing encapsulated hematomas.

IMAGING OF INTRACRANIAL SPACE OCCUPYING LESIONS- A PROSPECTIVE STUDY IN A TERTIARY CARE CENTRE- GGH, KAKINADA, A.P.

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Radha Rani Kaki

2017-02-01

Full Text Available BACKGROUND The high morbidity and mortality associated with ICSOLs necessitates their early diagnosis so as to plan the required intervention. An analysis of 50 cases of Intracranial Space Occupying Lesions (ICSOL including neoplastic and non-neoplastic masses diagnosed and treated at GGH, Kakinada, over a period of one year is presented. CT scan and MRI were used for the diagnosis. MATERIALS AND METHODS In this prospective cohort study, 50 patients with ICSOL were studied predominantly by MRI and also by CT and MRS (wherever necessary. Imaging findings were evaluated, tabulated and correlated with histopathological findings and also clinical findings (wherever available. The findings were statistically analysed. RESULTS Most patients were in age range of 50-60 years. Male:female ratio was 2:3. Most common presenting symptom was headache associated with vomiting. Predominantly, solitary lesions were present in 47 patients (94% and multiple lesions in three patients (6%. 39 cases were supratentorial, 10 cases were infratentorial and one lesion was both supra and infratentorial in location. 40 patients were having neoplastic lesions (80% and 10 had non-neoplastic lesions (20%. In our study, meningiomas were the most common neoplastic lesion while among non-neoplastic lesions, arachnoid cysts were the most common. Of the neoplastic cases, 12 cases (30% were malignant and 28 (70% cases were benign mass effect was the most common associated imaging finding. For neoplastic lesions, the imaging sensitivity was 92.5%, specificity was 70%, accuracy was 88%, positive predictive value was 92.5% and negative predictive value was 70%. While for the non-neoplastic lesions, imaging sensitivity was 70%, specificity was 92.5% and accuracy was 88%. CONCLUSION Neuroimaging in combination with clinical findings can be helpful in early diagnosis and localisation of ICSOL and for proper management of the patient. The neurosurgeon, neuroradiologist and

Three-dimensional reconstruction and volumetry of intracranial haemorrhage and its mass effect

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Strik, H.M.; Baehr, M.; Borchert, H.; Fels, C.; Knauth, M.; Rienhoff, O.; Verhey, J.F.

2005-01-01

Intracerebral haemorrhage still causes considerable disability and mortality. The studies on conservative and operative management are inconclusive, probably due to inexact volumetry of the haemorrhage. We investigated whether three-dimensional (3-D), voxel-based volumetry of the haemorrhage and its mass effect is feasible with routine computed tomography (CT) scans. The volumes of the haemorrhage, ventricles, midline shift, the intracranial volume and ventricular compression in CT scans of 12 patients with basal ganglia haemorrhage were determined with the 3-D slicer software. Indices of haemorrhage and intracranial or ventricular volume were calculated and correlated with the clinical data. The intended measures could be determined with an acceptable intra-individual variability. The 3-D volumetric data tended to correlate better with the clinical course than the conventionally assessed distance of midline shift and volume of haemorrhage. 3-D volumetry of intracranial haemorrhage and its mass effect is feasible with routine CT examination. Prospective studies should assess its value for clinical studies on intracranial space-occupying diseases. (orig.)

Application of sonoelastography: Comparison of performance between mass and non-mass lesion

International Nuclear Information System (INIS)

Ko, Eun Sook; Choi, Hye Young; Kim, Rock Bum; Noh, Woo-Chul

2012-01-01

Objectives: The purpose of this study was to determine the performance of the conventional ultrasonography (US) and sonoelastography (SE) in three conditions of all lesions, confined to mass, and confined to non-mass lesion and to compare the performance of each modality between mass and non-mass lesion. Materials and methods: A total 364 patients with 375 lesions were evaluated with US and subsequently SE before performing US-guided biopsy. Two radiologists retrospectively analyzed conventional US and elasticity images by consensus. The US findings were classified as mass or non-mass lesion. With final pathology as reference, in each case of all lesions, masses, and non-mass lesions, areas under the ROC curves (Az) were calculated and compared for the two techniques. The comparison of Az values between the curves for US and SE, and between the curves for mass and non-mass lesion was performed. Results: Among 375 lesions, 104 (28%) lesions were malignant and 271 (72%) lesions were benign. 36 (9.6%) of 375 lesions were classified as non-mass lesion at US. There were statistically significant difference of performance between US and SE in cases of all lesion (p = 0.003) and mass (p = 0.023). However, there was no statistically significant difference of performance in case of non-mass lesion (p = 0.5). Comparisons of the Az values of US and SE between mass and non-mass lesions were not statistically significant (p = 0.745, p = 0.415, respectively). Conclusion: There was no statistically significant difference of performance of US and SE between mass and non-mass lesion.

Enhancing Mass Lesion of the Sphenoid: Atypical Presentation of Ongoing Pneumatization

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Deepak Vallabhaneni

2016-01-01

Full Text Available Sinus pneumatization is a complex variable process that begins in early life and continues for many years. We present a case of a 6-year-old boy with progressive headaches and neurologic symptoms suggestive of intracranial pathology. The presence of enhancing tissue within the sphenoid sinus created a diagnostic dilemma which leads to a transsphenoidal biopsy. Knowledge of imaging characteristics associated with incomplete pneumatization can help differentiate it from more ominous skull base pathology and prevent unnecessary testing. We describe four-year imaging follow-up in a patient with incomplete pneumatization of the sphenoid sinus presenting as an enhancing mass lesion with subsequent follow-up imaging demonstrating gradual regression and increased aeration of the sphenoid sinus.

ROLE OF MAGNETIC RESONANCE SPECTROSCOPY IN INTRACRANIAL LESIONS- A STUDY OF 75 CASES

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Rajendra N. Solank

2017-10-01

Full Text Available BACKGROUND Our study have shown the role of MR spectroscopy in lesions whenever results are equivocal or non-conclusive even on MRI. MR spectroscopy can differentiate the lesions, particularly intracranial lesions on the basis of various metabolites. The aims of this study is to diagnose the intracranial lesions and to show the advantage of MR spectroscopy over the conventional MRI, to differentiate the neoplastic from non-neoplastic lesion, to prove the reliability of MR spectroscopy in identifying the different grades of glioma with histopathological correlation as well as to differentiate recurrent tumour from post-operative changes or radiation necrosis. MATERIALS AND METHODS During the period of August 2009 to July 2011, a prospective study of 75 patients was carried out at Department of Radiodiagnosis, Civil Hospital and BJ Medical College, Ahmedabad, Gujarat. MRI was performed on 1.5 Tesla MR scanner (GE HDXT using dedicated head coil. Conventional MR imaging was performed followed by MR spectroscopy using point resolved spectroscopy. After deciding the region of interest voxel was kept and 2D multivoxel proton spectroscopy (TR- 1000 msec, TE- 144 msec, voxel size 20 x 20 mm or single voxel proton spectroscopy (TR- 1500 msec, TE- 35 msec, voxel size 20 x 20 mm was performed and spectra obtained. RESULTS In the present study of 75 patients, the maximum number of patients were between 31 to 50 years of age. The approximate ratio of male: female was 2: 1. In our study sensitivity, specificity, positive predictive value, negative predictive value of MRI are 89%, 87%, 87% and 89% respectively and of MRI + MRS are 100%, 97%, 97% and 100% respectively in tumours. CONCLUSION MRS (Magnetic Resonance Spectroscopy is a non-invasive imaging technique that studies the chemical activity in the brain and detects the presence of certain chemical substances. Through this imaging technique, images and graphs of the brain can be obtained.

Intracranial germinomas with simultaneous lesions at pineal and suprasellar regions: diagnostics and therapeutics considerations

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Cardenas, Bolivar; Cardenas, Nancy; Vasconez, Jose; Mena, Ivan

1998-01-01

Germinomas are the most common intracranial germ cell tumor. Germinomas comprise 65% of this type of tumor and represent a less malignant form. This neoplasm constitutes approximately 0.1% to 3.4% of all intracranial tumors. The embryologic origin remains a mystery. Ninety-five percent of germinomas arise in the region of the third ventricle, along an axis from the suprasellar cistern (48%) to the pineal region (37%, involvement of both sites, either sequentially or simultaneously, ocurred rarely (6%). Clinical presentation depends on tumor location and may involve endocrine, hypothalamic, visual and cognitive dysfunction. We report two cases of patients with germinomas with simultaneous lesions in both the suprasellar and pineal regions and review on the clinical presentation, means of diagnosis, treatment using radiotherapy and outcome of this rate treatable neoplasm. (The author)

INTRACRANIAL MASS LESIONS IN HIV-POSITIVE PATIENTS ...

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'encephalitis of obscure origin', brain abscess and tuberculoma / mycobacterial ... Studies of IML in HN-positive patients emanate primarily from the ... Fig. 3. Mass on this CT scan found to be due to toxoplasmosis. Table H. Histological findings in the operated cases. Total biopsied/operated. 38'. Diagnosis. 0. Toxoplasmosis.

Association between intracranial plasmacytoma and multiple myeloma: clinicopathological outcome study.

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Schwartz, T H; Rhiew, R; Isaacson, S R; Orazi, A; Bruce, J N

2001-11-01

Intracranial plasmacytomas are rare lesions that can arise from the calvarium, dura, or cranial base and exhibit a benign course unless associated with myeloma. Attention has recently been focused on the role of the cell adhesion molecules CD56 and CD31 in the pathogenesis of myeloma. No such information is available for intracranial plasmacytomas and myeloma-associated lesions. We investigated the relationship between CD56 and CD31 expression, intracranial location, and progression to myeloma for a series of nine intracranial plasmacytomas (three dural, one calvarial, and five cranial base lesions). These parameters were also correlated with proliferation indices, as assessed by MIB-1 immunostaining of the histological sections. A single pathologist (AO) performed immunohistochemical analyses and reviewed all slides. Intracranial plasmacytomas presented more commonly in female patients (89%). The three dural lesions were CD56- and CD31-negative and exhibited MIB-1 staining of less than 10%; no patient developed myeloma or recurrence. Of the five cranial base lesions, three were CD56-positive, none was CD31-positive, and two exhibited MIB-1 labeling of more than 45%, with plasmablastic morphological features. Compared with other intracranial plasmacytomas, five of five patients with cranial base lesions developed bone marrow biopsy-proven myeloma (P myeloma soon after diagnosis. Both of the two highly proliferative plasmablastic lesions recurred, one after gross total resection without radiotherapy and the other after a biopsy and 2000-cGy radiotherapy. Among intracranial plasmacytomas, cranial base location was the strongest predictor of the development of multiple myeloma. Expression of the cell adhesion molecules CD31 and CD56 was not predictive of outcome. Extramedullary dural-based lesions were CD56-negative and were not associated with myeloma. A high proliferation index and plasmablastic morphological features were predictive of a short time to recurrence

Fast FLAIR MR images of intracranial hemorrhage

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Chun, Eun Ju; Choi, Hye Young; Cho, Young A; Kim, Wha Young

1998-01-01

The purpose of this study is to evaluate the signal characteristics of intracranial hemorrhage, as seen on fluid attenuated inversion recovery (FLAIR) MR imaging according to various stages, and to compare FLAIR imaging with spin-echo T1- and T2-weighted MR imaging. We retrospectively evaluated fast FLAIR images along with spin-echo T1- and T2 weighted MR images of 32 lesions in 25 patients (12 males and 14 females, aged 3 - 84 yrs) with intracranial hemorrhagic lesions. For imaging, 1.5 T unit was used, and the nature of the lesions was found to be as follows : intracranial hemorrhage (n=15); tumor (n=9); infarction (n=4); arteriovenous malformation (n=3); and arachnoid cyst with hemorrhage (n=1). On the basis of spin-echo MR imaging, lesions were classified as acute, early subacute, late subacute, early chronic, or late chronic stage. The signal characteristics of intracranial hemorrhage were analysed in accordance with each staging, as seen on MR FLAIR imaging, and compared to the staging seen on spin-echo T1- and T-2 weighted MR imaging. The signal intensity of intracranial hemorrhage, as seen on FLAIR imaging, was not characteristic; it was similar to that of T2WI during the acute and subacute stages, and similiar to that of T1WI during the chronic stage. When used together with spin-echo T1- and T2-weighted MR imaging, however, FLAIR imaging may be useful for the classification of chronic intracranial hemorrhage as either early or late stage. (author). 20 refs., 2 tabs., 6 figs

Risk factors for cervical carotid and intracranial cerebrovascular lesions in patients undergoing coronary artery bypass grafting. Preoperative evaluation using magnetic resonance imaging and angiography

International Nuclear Information System (INIS)

Makino, Masahiro

2001-01-01

Recently neurologic complications after coronary artery bypass grafting (CABG) have received increasing attention. There is no detailed report about the risk factors for these complications, although stenosis in the cervical and intracranial arteries, especially in Japanese patients, latent ischemic brain lesions and preoperative neurological conditions are related to these events. In this prospective study, we evaluated occlusive lesions in the cervical carotid and intracranial arteries, silent brain infarction and cerebral deep white matter lesion with MRA and MRI in patients scheduled to undergo CABG to determine the prevalence of occlusive diseases in cervical carotid and intracranial arteries, latent ischemic change in the brain in this population and to identify preoperative risk factors for these patients. The subjects were 144 consecutive patients (103 men and 41 women, mean age 65.9±9.2 years old) who were scheduled for CABG under elective conditions and who were examined by the same MRI apparatus using the same protocol between November 1998 and March 2001. After routine neurological examination and Mini-Mental State Examination (MMSE) were completed, MRI and MRA were obtained, then the prevalence of abnormalities on MRI and MRA studies and risk factors were evaluated. Cervical carotid artery stenosis with ≥50% luminal narrowing was detected in 29.2% of the subjects, and that with ≥75% luminal narrowing was detected in 16.0% of the subjects. Intracranial arterial stenosis showing ≥50% luminal narrowing was detected in 38.2% of subjects, and that showing ≥75% luminal narrowing was detected in 19.4% of subjects. Brain infarction was observed in 74.3% of subjects, cerebral deep white matter lesion showing grade 2 or higher on Fazekas classification was observed in 17.4% of the subjects. The characteristics, including possible risk factors of subjects with and without these abnormal findings, were compared. Patients with cervical carotid lesions were

Risk factors for cervical carotid and intracranial cerebrovascular lesions in patients undergoing coronary artery bypass grafting. Preoperative evaluation using magnetic resonance imaging and angiography

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Makino, Masahiro [Kyoto Prefectural Univ. of Medicine (Japan). Research Inst. for Neurological Diseases and Geriatrics

2001-12-01

Recently neurologic complications after coronary artery bypass grafting (CABG) have received increasing attention. There is no detailed report about the risk factors for these complications, although stenosis in the cervical and intracranial arteries, especially in Japanese patients, latent ischemic brain lesions and preoperative neurological conditions are related to these events. In this prospective study, we evaluated occlusive lesions in the cervical carotid and intracranial arteries, silent brain infarction and cerebral deep white matter lesion with MRA and MRI in patients scheduled to undergo CABG to determine the prevalence of occlusive diseases in cervical carotid and intracranial arteries, latent ischemic change in the brain in this population and to identify preoperative risk factors for these patients. The subjects were 144 consecutive patients (103 men and 41 women, mean age 65.9{+-}9.2 years old) who were scheduled for CABG under elective conditions and who were examined by the same MRI apparatus using the same protocol between November 1998 and March 2001. After routine neurological examination and Mini-Mental State Examination (MMSE) were completed, MRI and MRA were obtained, then the prevalence of abnormalities on MRI and MRA studies and risk factors were evaluated. Cervical carotid artery stenosis with {>=}50% luminal narrowing was detected in 29.2% of the subjects, and that with {>=}75% luminal narrowing was detected in 16.0% of the subjects. Intracranial arterial stenosis showing {>=}50% luminal narrowing was detected in 38.2% of subjects, and that showing {>=}75% luminal narrowing was detected in 19.4% of subjects. Brain infarction was observed in 74.3% of subjects, cerebral deep white matter lesion showing grade 2 or higher on Fazekas classification was observed in 17.4% of the subjects. The characteristics, including possible risk factors of subjects with and without these abnormal findings, were compared. Patients with cervical carotid

Three cases of intracranial lipoma

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Kurokawa, Hiroyuki; Kikuchi, Kenji; Yanagida, Noritaka; Fujii, Satoshi; Watanabe, Kazuo; Miyauchi, Takaharu

1987-12-01

Intracranial lipoma is an uncommon lesion that can be found in both symptomatic and asymptomatic patients. Because of CT (computerized tomography), the tumors can now be easily diagnosed in asymptomatic individuals. Three cases of intracranial lipoma in asymptomatic patients are presented, along with a review of the literature, and the value of CT, especially coronal section, in the diagnosis of intracranial lipomas and associated anomalies, such as the agenesis of corpus callosum, is discussed.

Eleven cases of neonatal intracranial hemorrhage

International Nuclear Information System (INIS)

Matsuda, Tadashi; Asao, Toyohiko; Shibata, Takeo

1981-01-01

Eleven cases of neonatal intracranial hemorrhage were diagnosed and followed up by CT scanning. By CT, hemorrhagic lesions were shown as high density areas in an acute stage and imaged as low density areas after the hemorrhage was absorbed. The time of absorption varies depending upon the site and the severity of hemorrhage. Intraventricular hemorrhage, petechial hemorrhage and subdural hematoma were absorbed rapidly in more than 70% of the exanimed cases, CT scanning 1 - 2 weeks after the onset revealed absorption of hemorrhage. However, the absorption delayed in intracerebral hematoma; CT scan taken after one month showed hemorrhagic lesions remaining in 75% of the cases. In nine cases who survived, following the absorption of the hemorrhagic lesions, cerebral atrophy was observed in 4 cases (44%), ventricular enlargement in 3 cases (33%), and complete recovery in 2 cases (22%). From these results, CT scanning for diagnosis of neonatal intracranial hemorrhage should be done before the hemorrhagic lesion is absorbed (within 7 days of the onset). Follow-up study by CT is important for observing changes and predicting prognosis of intracranial hemorrhage. (Ueda, J.)

Diagnostic value of optical coherence tomography for intracranial pressure in idiopathic intracranial hypertension

DEFF Research Database (Denmark)

Skau, M; Yri, H; Sander, B

2013-01-01

BACKGROUND: Idiopathic intracranial hypertension (IIH) is a condition of raised intracranial pressure (ICP) in the absence of space-occupying lesions or other known etiology. It primarily affects young obese females, and potentially causes permanent visual loss due to papilledema and secondary...... optic atrophy. The aim of this study was to evaluate the diagnostic value of optical coherence tomography (OCT) as a marker for CSF opening pressure in patients with idiopathic intracranial hypertension (IIH). METHODS: We conducted a case-control study of 20 newly diagnosed, 21 long-term IIH patients...

Functional MRI in Patients with Intracranial Lesions near Language Areas.

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Hakyemez, B; Erdogan, C; Yildirim, N; Bora, I; Bekar, A; Parlak, M

2006-06-30

We aimed to depict Broca's area and Wernicke's area by word generation and sentence formation paradigms in patients with various intracranial lesions adjacent to language areas using functional MRI technique and to evaluate the ability of functional MRI to lateralize the hemispheric dominance for language. Twenty-three right-handed patients were included in this study. Lesions were classified as low-grade glioma (n=8), high-grade glioma (n=9), metastasis (n=1), meningioma (n=1), arteriovenous malformation (n=2) and mesial temporal sclerosis (n=2). We performed blood-oxygenated-level-dependant functional MRI using a 1.5-T unit. Word generation and sentence formation tasks were used to activate language areas. Language areas were defined as Brodmann 44, 45 (Broca's area) and Brodmann 22 area (Wernicke's area). Laterality index was used to show the dominant hemisphere. Two poorly cooperative patients showed no activation and were excluded from the study. Broca's area was localized in 21 patients (100 %). Wernicke's area, on the other hand, could only be localized in eight of the 21 patients (38 %).The left hemisphere was dominant in 86% of patients while atypical language lateralization (right or bilateral) was demonstrated in 14% of the patients. Bilateral activation areas were shown in 10% of those patients while right cerebral hemisphere was dominant in 4% of the patients. Word generation and sentence formation tasks are especially helpful in localizing Broca's area. Wernicke's area could also be demonstrated in some of the cases. Functional MRI can be used as an important and useful means of demonstrating language areas in patients with lesions adjacent to those areas and depicting the hemispheric dominance.

Intracranial metastasis from primary transitional cell carcinoma of female urethra: case report & review of the literature

International Nuclear Information System (INIS)

Moon, Kyung-Sub; Jung, Shin; Lee, Kyung-Hwa; Hwang, Eu Chang; Kim, In-Young

2011-01-01

Transitional cell carcinoma (TCC) of the female urethra is a rare urological malignancy, and intracranial metastasis of this cancer has not yet been reported in the literature. This review is intended to present a case of multiple intracranial metastasis in a female patient with a remote history of primary urethral TCC. A 49-year-old woman, presented with a prolapsed mass in urethral orifice that was diagnosed as primary urethral TCC with distant lung and multiple bone metastases. The patient subsequently underwent chemotherapy under various regimens. A year later, the patient developed headache and vomiting which as was found to be due to multiple intracranial metastasis. The patient underwent surgical resection of the largest lesion located on the cerebellum, and consecutively gamma knife radiosurgery was performed for other small-sized lesions. Pathological examination of the resected mass revealed a metastatic carcinoma from a known urethral TCC. Serial work-up of systemic metastasis revealed concomitant aggravation of lung, spleen, and liver metastasis. The patient died of lung complication 2 months after the diagnosis of brain metastasis. To the best of our knowledge, this is the first reported case of cerebral metastasis from primary urethral TCC, with pathological confirmation. As shown in intracranial metastasis of other urinary tract carcinoma, this case occurred in the setting of uncontrolled systemic disease and led to dismal prognosis in spite of aggressive interventional modalities

Minimally invasive trans-portal resection of deep intracranial lesions.

Science.gov (United States)

Raza, S M; Recinos, P F; Avendano, J; Adams, H; Jallo, G I; Quinones-Hinojosa, A

2011-02-01

The surgical management of deep intra-axial lesions still requires microsurgical approaches that utilize retraction of deep white matter to obtain adequate visualization. We report our experience with a new tubular retractor system, designed specifically for intracranial applications, linked with frameless neuronavigation for a cohort of intraventricular and deep intra-axial tumors. The ViewSite Brain Access System (Vycor, Inc) was used in a series of 9 adult and pediatric patients with a variety of pathologies. Histological diagnoses either resected or biopsied with the system included: colloid cyst, DNET, papillary pineal tumor, anaplastic astrocytoma, toxoplasmosis and lymphoma. The locations of the lesions approached include: lateral ventricle, basal ganglia, pulvinar/posterior thalamus and insular cortex. Post-operative imaging was assessed to determine extent of resection and extent of white matter damage along the surgical trajectory (based on T (2)/FLAIR and diffusion restriction/ADC signal). Satisfactory resection or biopsy was obtained in all patients. Radiographic analysis demonstrated evidence of white matter damage along the surgical trajectory in one patient. None of the patients experienced neurological deficits as a result of white matter retraction/manipulation. Based on a retrospective review of our experience, we feel that this access system, when used in conjunction with frameless neuronavigational systems, provides adequate visualization for tumor resection while permitting the use of standard microsurgical techniques through minimally invasive craniotomies. Our initial data indicate that this system may minimize white matter injury, but further studies are necessary. © Georg Thieme Verlag KG Stuttgart · New York.

Histological Characteristics of Intracranial Atherosclerosis in a Chinese Population: A Postmortem Study

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Wen Jie Yang

2017-09-01

Full Text Available BackgroundAnterior and posterior circulation atherosclerosis differ in vascular risk factors and stroke mechanisms. However, few studies have compared the pathological features between these lesions. Using a series of intracranial artery specimens, we characterized the intracranial atherosclerotic lesions and compared pathological features among different arteries of the intracranial vasculature.MethodsIntracranial large arteries of 32 consecutively recruited autopsy cases of Chinese adults aged 45 years or older were examined pathologically using routine histology and immunostaining, to characterize the pathological features of the atherosclerotic lesions. We analyzed middle cerebral arteries (MCAs (both left and right, vertebral arteries (VAs (side more affected, and basilar arteries (BAs.ResultsProgressive atherosclerotic lesions were present in 91(71% of the 128 arteries examined. Features of complicated plaques were infrequently detected: plaque hemorrhage was encountered in 12%, neovasculature in 12%, lumen thrombi in 13%, macrophage infiltration in 20%, and calcification in 25% of arteries. Luminal narrowing of MCA was the most severe, followed by VA; the BA least stenotic (37 ± 25 vs. 30 ± 24 vs. 20 ± 20%, all p < 0.05. MCA had more eccentric (vs. concentric plaques than VA (69 vs. 25%, p = 0.003 and BA (69 vs. 38%; p = 0.03. Lumen thrombi were more frequent in BA, and calcification most commonly occurred in VA atherosclerotic lesions.ConclusionIntracranial atherosclerotic plaques were commonly present in this sample, but the lesions generally lacked features of complicated plaques. MCA lesions had demonstrable differences compared with VA and BA lesions. Further studies are needed to determine whether these characteristics indicate a distinctive atherosclerotic phenotype for the intracranial vasculature.

Simultaneous Spinal and Intracranial Chronic Subdural Hematoma Cured by Craniotomy and Laminectomy: A Video Case Report

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Hideki Kanamaru

2016-04-01

Full Text Available Simultaneous spinal and intracranial chronic subdural hematoma (CSDH is a rare entity. A 67-year-old man visited our hospital due to headache after diving into a river 2 weeks before. Non-enhanced computed tomography (CT and magnetic resonance imaging (MRI revealed bilateral intracranial CSDH. The bilateral CSDH was evacuated and his symptoms improved. Three days after craniotomy, he complained of sensory disturbance on his buttocks. Lumbar MRI showed a space-occupying lesion behind the thecal sac at L5. CT with myelography showed a subdural mass lesion; there was no communication with the subarachnoid space. Fourteen days after craniotomy, L5 laminectomy was performed and the dura mater was incised carefully. The video shows that a liquid hematoma similar to the intracranial CSDH flowed out, followed by cerebrospinal fluid. His symptoms improved after the operation and the hematoma did not recur. This is a rare condition of spinal CSDH demonstrated by neuroimaging and intraoperative video.

Extramedullary Plasmacytoma Presenting as a Solitary Mass in the Intracranial Posterior Fossa

International Nuclear Information System (INIS)

Daghighi, Mohammad Hossein; Poureisa, Masoud; Shimia, Mohammad; Mazaheri-Khamene, Ramin; Daghighi, Shadi

2012-01-01

A patient with a 3-month history of headache refractory to pain medication was admitted. The CT scan and MRI showed evidence of a posterior fossa mass. This was pathologically confirmed as an extra medullary plasmacytoma (EMP). He had a pathologic fracture of the left humerus 7 years ago while the radiologist was unaware at the time of diagnosis. A solitary bone plasmacytoma (SBP) was the cause of the pathologic fracture. This report includes the first description of MRI findings in a patient with a rare-incidence intracranial solitary extra medullary plasmacytoma (SEP) in Iran. There is a striking similarity between the features of intracranial SEP and meningiomas. Intracranial SEP, although rare, should be included in the differential diagnosis of brain tumors in areas where meningiomas commonly arise. The MRI findings and differential diagnosis of plasmacytoma are reviewed. Before this case report, only few cases have been reported in the literature. Nonetheless, this is the first report of posterior fossa EMP from Iran

MRI findings of intracranial cavernous malformations

International Nuclear Information System (INIS)

Han, Byoung Hee; Kim, Dong Ik; Cho, Yong Kuk

1995-01-01

To analyze the variable MRI features and clinical significance of intracranial cavernous malformations. Forty patients(mean age 35.4) with cavernous malformation were evaluated by MRI. Eleven patients were surgically confirmed. Cavernous malformations were divided into four categories on the basis of the MR imaging characteristics, especially on T2-weighted image. Type I lesion was defined as an extralesional subacute hemorrhage outside the low signal rim, type II as an intralesional hemorrhage surrounded by low signal rim, type III lesion as an intralesional thrombosis with variegated central core surrounded by low signal rim, and type IV lesion as a focal old hemorrhagic core with small low signal intensity. Type IV was further divided into IVa and IVb, whether the lesion has small iso-or hypersignal central core (IVa) or not (IVb). Follow-up MRI was evaluated in 12 patients who were managed conservatively. Follow-up intervals ranged from 2 weeks to 29 months (mean 6 months). Total 80 lesions were detected in 40 patients. Multiple lesions were noted in 10 patients. The topography of the cavernous malformations was supratentorial in 75% and infratentorial in 23%. There were 10 lesions in type I, 15 in type II, 21 in type III, 14 in type IVa, and 20 in type IVb. Type I lesions mainly showed mass effect and edema. Type III lesions showed minimal contrast enhancements in 7 lesions on delayed images. Type II lesions showed the characteristics of both type I and type III lesions. On follow up images, decrease in size in 5, change of type in 7, rebleeding in 2 and no change in 12 lesions were demonstrated. Hemorrhage, edema and mass effect were combined in the cases of rebleeding. On follow-up study, the estimated risk of bleeding was 32.3%/person-year and 13.7%/lesion-year. Cavernous malformations show as variable appearance, on MR imaging suggesting variable stages of evolution. The MR morphologic classification and evaluation of secondary findings are helpful to

Idiopathic intracranial hypertension with altered consciousness in a ...

African Journals Online (AJOL)

Idiopathic intracranial hypertension (IIH) is a clinical condition of increased intracranial pressure (ICP) without an obvious underlying pathological brain lesion. It is usually characterized by headache, neck pain, vomiting, visual disturbances, papilledema, cranial nerve palsy or a combination of these signs and symptoms.

Imaging in cardiac mass lesions

International Nuclear Information System (INIS)

Mundinger, A.; Gruber, H.P.; Dinkel, E.; Geibel, A.; Beck, A.; Wimmer, B.; Schlosser, V.

1992-01-01

In 26 patients with cardiac mass lesions confirmed by surgery, diagnostic imaging was performed preoperatively by means of two-dimensional echocardiography (26 patients), angiography (12 patients), correlative computed tomography (CT, 8 patients), and magnetic resonance imaging (MRI, 3 patients). Two-dimensional echocardiography correctly identified the cardiac masses in all patients. Angiography missed two of 12 cardiac masses; CT missed one of eight. MRI identified three of three cardiac masses. Although the sensitivity of two-dimensional echocardiography was high (100%), all methods lacked specificity. None of the methods allowed differentiation between myxoma (n=13) and thrombus (n=7). Malignancy of the lesions was successfully predicted by noninvasive imaging methods in all six patients. However, CT and MRI provided additional information concerning cardiac mural infiltration, pericardial involvement, and extracardiac tumor extension, and should be integrated within a preoperative imaging strategy. Thus two-dimensional echocardiography is the method of choice for primary assessment of patients with suspected cardiac masses. Further preoperative imaging by CT or MRI can be limited to patients with malignancies suspected on the grounds of pericardial effusion or other clinical results. (author)

Results of radiation therapy for intracranial malignant lymphoma

International Nuclear Information System (INIS)

Churei, Hisahiko; Miyaji, Noriaki; Takeshita, Tsuyoshi; Hiraki, Yoshiyuki; Nakajo, Masataka; Ohkubo, Koichi; Kajiya, Yoriko; Baba, Yasutaka.

1996-01-01

Survival and prognostic factors were retrospectively analyzed in 10 patients with primary intracranial lymphoma and 7 patients with secondary intracranial lymphoma from 1983 to 1994 at Kagoshima University Hospital and affiliated hospitals. The 1-year survival rate was 62.5% in primary cases and 35.7% in secondary cases. In primary cases, there were no significant differences in survival between surgically treated and non-surgically treated cases, or between multiple-lesion and solitary-lesion cases. In secondary cases with a solitary lesion, excluding one case of Hodgkin's lymphoma, survival was better in cases treated within 3 months after the appearance of neurologic symptoms than in cases treated over 3 months after the appearance of symptoms. There was no significant difference in survival between cases treated with whole-brain irradiation of 40 Gy or more and those treated with less than 40 Gy. The results suggest that intracranial involvement of an extracranial malignant lymphoma should be diagnosed and treated as early as possible. (author)

Imaging mass spectrometry identifies prognostic ganglioside species in rodent intracranial transplants of glioma and medulloblastoma.

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Leonardo Ermini

Full Text Available Matrix-assisted laser desorption ionization (MALDI imaging mass spectrometry (MALDI-MSI allows us to investigate the distribution of lipid molecules within tissues. We used MALDI-MSI to identify prognostic gangliosides in tissue sections of rat intracranial allografts of rat glioma and mouse intracranial xenografts of human medulloblastoma. In the healthy adult rodent brain, GM1 and GD1 were the main types of glycolipids. Both gangliosides were absent in both intracranial transplants. The ganglioside GM3 was not present in the healthy adult brain but was highly expressed in rat glioma allografts. In combination with tandem mass spectrometry GM3 (d18:1/C24:0 was identified as the most abundant ganglioside species in the glioma allotransplant. By contrast, mouse xenografts of human medulloblastoma were characterized by prominent expression of the ganglioside GM2 (d18:0/C18:0. Together, these data demonstrate that tissue-based MALDI-MSI of gangliosides is able to discriminate between different brain tumors and may be a useful clinical tool for their classification and grading.

Stereotactic intracranial radiotherapy: Dose prescription

International Nuclear Information System (INIS)

Schlienger, M.; Lartigau, E.; Nataf, F.; Mornex, F.; Latorzeff, I.; Lisbona, A.; Mahe, M.

2012-01-01

The aim of this article was the study of the successive steps permitting the prescription of dose in stereotactic intracranial radiotherapy, which includes radiosurgery and fractionated stereotactic radiotherapy. The successive steps studied are: the choice of stereotactic intracranial radiotherapy among the therapeutic options, based on curative or palliative treatment intent, then the selection of lesions according to size/volume, pathological type and their number permitting the choice between radiosurgery or fractionated stereotactic radiotherapy, which have the same methodological basis. Clinical experience has determined the level of dose to treat the lesions and limit the irradiation of healthy adjacent tissues and organs at risk structures. The last step is the optimization of the different parameters to obtain a safe compromise between the lesion dose and healthy adjacent structures. Study of dose-volume histograms, coverage indices and 3D imaging permit the optimization of irradiation. For lesions close to or included in a critical area, the prescribed dose is planned using the inverse planing method. Implementation of the successively described steps is mandatory to insure the prescription of an optimized dose. The whole procedure is based on the delineation of the lesion and adjacent healthy tissues. There are sometimes difficulties to assess the delineation and the volume of the target, however improvement of local control rates and reduction of secondary effects are the proof that the totality of the successive procedures are progressively improved. In practice, stereotactic intracranial radiotherapy is a continually improved treatment method, which constantly benefits from improvements in the choice of indications, imaging, techniques of irradiation, planing/optimization methodology and irradiation technique and from data collected from prolonged follow-up. (authors)

Computed tomography in intracranial malignant lymphoma

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Naruse, S; Odake, G; Fujimoto, M; Yamaki, T; Mizukawa, N [Kyoto Prefectural Univ. of Medicine (Japan)

1978-09-01

Malignant lymphoma of the central nervous system has been found more and more often in recent years, partly because of the increased use of radiation and such drugs as steroids and antibiotics. However, the definite diagnosis of this disease is difficult until histological verification has been done by operation or autopsy. Since the revolutionary development of computed tomography, however, several reports have been presented, on the computed tomography of malignant lymphoma of the thorax and abdomen. Nevertheless, only a few cases of intracranial malignant lymphoma have been reported. The purpose of this paper, using four patients, is to emphasize the value of computed tomography in the diagnosis of intracranial malignant lymphoma. The characteristic CT findings of intracranial malignant lymphoma may be summarized follows: (1) the tumors are demonstrated to be well-defined, nodular-shaped, and homogenous isodensity - or slightly high-density - lesions in plain scans, and the tumors homogenously increase in density upon contrast enhancement; (2) the disease always has multifocal intracranial lesions, which are shown simultaneously or one after another, and (3) perifocal edema is prominent around the tumors in the cerebral hemisphere.

3D-CT angiography. Intracranial arterial lesions

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Asato, Mikio; Tong, X.Q.; Tamura, Shozo [Miyazaki Medical Coll., Kiyotake (Japan)] [and others

1997-06-01

Since its introduction, three dimensional CT angiography (3D-CTA) on spiral (helical) CT has played an important role in clinical imaging. Initially it was reported to be useful in depicting aortic abnormalities, afterwards the merit in detecting intracranial aneurysm by 3D-CTA was also described. We have investigated the usefullness of 3D-CTA in detecting patients of intracranial aneurysm as well as arterio-venous malformation (AVM), Moyamoya disease and stenosis of middle cerebral artery, meanwhile the MR angiography (MRA) and digital subtraction angiography (DSA) examination of these patients were also studied as comparison to the 3D-CTA results. The sensitivity and specificity on investigating intracranial aneurysm were similar with other reports so far. 3D-CTA was possible to identify the feeding artery, nidus and draining vein of AVM, although DSA showed higher detectability. Occlusion of internal carotid artery and post-operative anastomosis in Moyamoya disease were all demonstrated by 3D-CTA, however the Moyamoya collaterals were shown better on MRA. 3D-CTA revealed the site of stenosis of middle cerebral artery in all of our cases, but in general maximum intensity projection (MIP) images can provide more exact information about the degree of stenosis. Five years has passed since the emergence of spiral CT and utilizing of 3D-CTA in clinical applications. With the development of hard and soft ware in the near future, it is possible to delineate more small vessels by 3D-CTA. We predict that 3D-CTA would be widely used for detecting vasculature of the whole body, and may take the place of conventional angiography in many cases. (author)

MR imaging of intracranial calcification; experimental and clinical studies

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Yoon, Jong Hoon; Kim, Byung Jin; Kim, Yun Hyeon; Seo, Jeong Jin; Kang, Heoung Keun; Yang, Sung Yeul [Chonnam University Medical School, Kwangju (Korea, Republic of)

1995-05-15

This study was performed to evaluate MR signal intensity (SI) of calcification and to assess the capability of MRI in detection of various intracranial calcifications. The MR findings and ROI value of experimental model of calcium carbonate suspension according to each concentration (20, 35, 50%) and diameter (1-10 mm) and hydroxyapatite suspension according to each concentration (10, 20, 30, 40, 50%) were analyzed. A specimen of calcification in craniopharyngioma was analyzed for its composition by XRD (X-ray diffractometer) and ICP (inductively coupled plasma) methods. MRI of 34 patients with intracranial calcifications were retrospectively analyzed for signal intensity of the calcification and its capability to detect calcifications according to size, location, and contrast with adjacent lesion. The calcium carbonate phantom with larger diameter and low concentration showed lower signal intensity on T2 than T1WI. Hydroxyapatite phantom showed high signal intensity in 10-30% concentration and low signal intensity in 40-50% concentration on T1 weighted image. The 5 cases of 34 intracranial calcifications showed high signal intensity on T1 weighted image. The capability of MRI in the detection of intracranial calcifications decreased in the circumstances such as small size (< 2.5 mm) and intraventricular location. Although the size of calcification was small, the detection was easy in the good contrast with adjacent lesion. However, the detection of the small sized calcification was easy if the contrast with adjacent lesion was good. Intracranial calcification shows generally low signal intensity on T1 and T2 weighted image with the exception of occasional high SI on T1WI. Detection of intracranial calcification in MRI is affected by its composition, size, location, and contrast with adjacent lesion.

INTRACRANIAL STENOSIS IN PATIENTS WITH ACUTE CEREBROVASCULAR ACCIDENTS

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Hossein Zarei

2010-12-01

Full Text Available Abstract    INTRODUCTION: This study was conducted to investigate pattern and risk factors associated with the location of atherosclerotic occlusive lesions in cerebral vessels. Previous studies of patients with stroke or transient ischemic attack (TIA suggest that extracranial atherosclerosis is more common in the white race. Noninvasive techniques such as duplex ultrasound, transcranial Doppler (TCD, and magnetic resonance angiography (MRA allow vascular assessment of a more representative proportion of the patients, compared to conventional angiography alone.    METHODS: We evaluated patients with cerebrovascular problems (stroke and/or TIA during a period of 6 months, using duplex ultrasonography, TCD and MRA to detect significant stenosis according to standard criteria.    RESULTS: Stenosis of extracranial and intracranial arteries was detected in 38% and 29% of cases, respectively. MCA was the most frequent involved intracranial artery (11% bilaterally and 5% unilaterally. Intracranial lesions tend to be multiple. There was no significant difference between men and women in terms of frequency and distribution of stenosis. No correlation was found between opium use and stenosis. The women had significantly more poor windows than men (P<0.05. The extracranial stenosis was significantly more frequent than intracranial stenosis (P<0.01.    CONCLUSION: The relations between hypertension and extracranial stenosis, and diabetes and MCA stenosis were statistically significant. TCD seemed to be a better technique for evaluating intracranial lesions in men than in women.      Keywords: Atherosclerosis, Stenosis, Carotid artery, Doppler Sonography.  

A dosimetric comparison of fan-beam intensity modulated radiotherapy with gamma knife stereotactic radiosurgery for treating intermediate intracranial lesions

International Nuclear Information System (INIS)

Ma Lijun; Xia Ping; Verhey, Lynn J.; Boyer, Arthur L.

1999-01-01

Purpose: To compare and evaluate treatment plans for the fan-beam intensity modulated radiotherapy and the Gamma Knife radiosurgery for treating medium-size intracranial lesions (range 4-25 cm 3 ). Methods and Materials: Treatment plans were developed for the Leksell Gamma Knife and a fan-beam inverse treatment planning system for intensity modulated radiotherapy. Treatment plan comparisons were carried out using dose-volume histogram (DVH), tissue-volume ratio (TVR), and maximum dose to the prescription dose (MDPD) ratio. The study was carried out for both simulated targets and clinical targets with irregular shapes and at different locations. Results: The MDPD ratio was significantly greater for the Gamma Knife plans than for the fan-beam IMRT plans. The Gamma Knife plans produced equivalent TVR values to the fan-beam IMRT plans. Based on the DVH comparison, the fan-beam IMRT delivered significantly more dose to the normal brain tissue than the Gamma Knife. The results of the comparison were found to be insensitive to the target locations. Conclusion: The Gamma Knife is better than the fan-beam IMRT in sparing normal brain tissue while producing equivalent tumor dose conformity for treating medium-size intracranial lesions. However, the target dose homogeneity is significantly better for the fan-beam IMRT than for the Gamma Knife

Enhancement of intracranial meningeal lesions with Gd-DTPA MR imaging

International Nuclear Information System (INIS)

Brown, E.; De La Paz, R.

1989-01-01

Pathologic intracranial meningeal enhancement on Gd-DTPA MR images (T1-weighted spin-echo sequence, 800/20 [repetition time msec/echo time msec] 1.5 T) was evaluated in 23 patients. Diagnoses included metastatic neoplasm (13 cases), benign neoplasm (four), infection (one), subarachnoid hemorrhage (three), and subdural hematoma (two). Eleven patients had undergone previous surgery. Diffuse enhancement occurred in 11 patients: eight with malignant infiltration, two with postoperative inflammation, and one with meningitis. Focal enhancement occurred in 12 patients, equally divided between those with malignant and benign processes: six cases were adjacent to intra- or extra-axial malignancy; three were at sites of recent (1--3 weeks) subarachnoid hemorrhage; and three were postoperative, adjacent to a craniotomy or subdural hematoma. Meningeal lesions were rarely diagnosed on the precontrast images, and Gd-DTPA enhancement was needed to distinguish between thickened meninges and thin fluid collections. Precontrast T1- and T2-weighted images were needed to discriminate high-signal meningeal enhancement from subacute subdural or subarachnoid hemorrhage, diploic marrow, normal vascular structures, and benign dural plaques. Meningeal enhancement was not pathology specific, and precontrast images are recommended to avoid misdiagnosis of subacute hemorrhage and misinterpretation of normal anatomy

Ultrasonographic Findings of Fetal Congenital Intracranial Teratoma

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Lee, Hak Jong [Seoul National University College of Medicine, Seoul (Korea, Republic of); Lee, Young Ho; Song, Mi Jin; Cho, Jeong Yeon; Min, Jee Yeon; Moon, Min Hwan; Kim, Jeong Ah [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

2005-06-15

To evaluate the sonographic findings of fetal congenital intracranial teratoma. From 1994 to 2002, of the 11 fetuses which had been diagnosed with fetal intracranial tumors after second level fetal ultrasonography, the six that were confirmed after autopsy as congenital intracranial teratomas were included in our study. The sonographic findings, including size, homogeneity, echogenicity compared with surrounding normal brain tissues, cystic components, and tumor related calcification, were retrospectively evaluated. The incidence of fetal congenital intracranial teratoma out of all fetal intracranial tumors was 54.5% (6 of 11 cases) during the 8-year period. The mean mass size was 7.4 cm (3.0-15.0 cm). Two thirds of (4/6) of the teratoma cases showed high echogenicity compared with normal brain tissues, and two thirds (4/6) showed heterogeneous echogenicity. Four teratoma cases (67%) showed cysts in the mass with a mean size of 1.9cm. One third (2/6) showed calcifications within the tumor. Out of the six cases, two had oropharyngeal teratoma with extension into the intracranial portion (so called epignathus) and showed homogenous mass without any cysts or calcifications. The typical sonographic appearance of intracranial teratoma was a heterogeneous, hyperechoic mass with cysts. In the epignathus cases, the sonographic appearances differed somewhat from the others. An understanding of the sonographic findings of fetal intracranial teratoma will help in the timely counseling of the parents and in obstetric decision making

Characteristic CT and MRI findings of intracranial chondroma

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Duan, Fuhong; Qiu, Shijun; Liu, Zhenyin; Lv, Xiaofei; Feng, Xia; Xiong, Wei; An, Jie; Chen, Jing; Yang, Weicong; Wen, Chuhong [Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong (China)], E-mail: qiushijun006@163.com; Jiang, Jianwei; Chang, Jun [Department of Radiology, The Third Affiliated Hospital of Nantong University, Wuxi, Jiangsu (China)

2012-12-15

Background. Intracranial chondromas are rare benign tumors. To date, few data are available on their neuroradiological features. Purpose. To describe a series of patients with intracranial chondroma and to analyze and discuss the computed tomography (CT) and magnetic resonance imaging (MRI) features that may distinguish chondromas from other intracranial neoplasms. Material and Methods. We retrospectively analyzed clinical and medical imaging data of six patients who had pathologically confirmed intracranial chondromas in our two institutions between July 2006 and September 2011. Both CT and MRI scanning were performed in all six cases. Results. Five tumors were located at the skull base and one originated from the falx. CT images revealed well-demarcated, irregular lobulated and variable density masses with obvious calci?cation (6/6), no or slight enhancement, without peritumoral edema, and frequently accompanied by erosion and destruction of surrounding bone (5/6). Tumor parenchyma appeared heterogeneously hypointense on T1WI, and hyperintense or mixed hyperintense and hypointense on T2WI, while the calcification appeared hypointense on T1WI and T2WI in five cases, demonstrating significant inhomogeneous enhancement on postcontrast MRI, which revealed the typical 'punica granatum seeds' sign. Only one case showed homogeneous low signal intensity on T1WI and high signal intensity on T2WI, and relatively uniform obvious enhancement on postcontrast scans. Conclusion. These characteristic CT and MR findings, combined with the location of the lesions and the history of a long duration of clinical symptoms, may prove helpful in differentiating intracranial chondromas from other more common tumors.

Characteristic CT and MRI findings of intracranial chondroma

International Nuclear Information System (INIS)

Duan, Fuhong; Qiu, Shijun; Liu, Zhenyin; Lv, Xiaofei; Feng, Xia; Xiong, Wei; An, Jie; Chen, Jing; Yang, Weicong; Wen, Chuhong; Jiang, Jianwei; Chang, Jun

2012-01-01

Background. Intracranial chondromas are rare benign tumors. To date, few data are available on their neuroradiological features. Purpose. To describe a series of patients with intracranial chondroma and to analyze and discuss the computed tomography (CT) and magnetic resonance imaging (MRI) features that may distinguish chondromas from other intracranial neoplasms. Material and Methods. We retrospectively analyzed clinical and medical imaging data of six patients who had pathologically confirmed intracranial chondromas in our two institutions between July 2006 and September 2011. Both CT and MRI scanning were performed in all six cases. Results. Five tumors were located at the skull base and one originated from the falx. CT images revealed well-demarcated, irregular lobulated and variable density masses with obvious calci?cation (6/6), no or slight enhancement, without peritumoral edema, and frequently accompanied by erosion and destruction of surrounding bone (5/6). Tumor parenchyma appeared heterogeneously hypointense on T1WI, and hyperintense or mixed hyperintense and hypointense on T2WI, while the calcification appeared hypointense on T1WI and T2WI in five cases, demonstrating significant inhomogeneous enhancement on postcontrast MRI, which revealed the typical 'punica granatum seeds' sign. Only one case showed homogeneous low signal intensity on T1WI and high signal intensity on T2WI, and relatively uniform obvious enhancement on postcontrast scans. Conclusion. These characteristic CT and MR findings, combined with the location of the lesions and the history of a long duration of clinical symptoms, may prove helpful in differentiating intracranial chondromas from other more common tumors

Intracranial Hemorrhage

Science.gov (United States)

2011-01-01

Intracranial hemorrhage is a life-threatening condition, the outcome of which can be improved by intensive care. Intracranial hemorrhage may be spontaneous, precipitated by an underlying vascular malformation, induced by trauma, or related to therapeutic anticoagulation. The goals of critical care are to assess the proximate cause, minimize the risks of hemorrhage expansion through blood pressure control and correction of coagulopathy, and obliterate vascular lesions with a high risk of acute rebleeding. Simple bedside scales and interpretation of computed tomography scans assess the severity of neurological injury. Myocardial stunning and pulmonary edema related to neurological injury should be anticipated, and can usually be managed. Fever (often not from infection) is common and can be effectively treated, although therapeutic cooling has not been shown to improve outcomes after intracranial hemorrhage. Most functional and cognitive recovery takes place weeks to months after discharge; expected levels of functional independence (no disability, disability but independence with a device, dependence) may guide conversations with patient representatives. Goals of care impact mortality, with do-not-resuscitate status increasing the predicted mortality for any level of severity of intraparenchymal hemorrhage. Future directions include refining the use of bedside neuromonitoring (electroencephalogram, invasive monitors), novel approaches to reduce intracranial hemorrhage expansion, minimizing vasospasm, and refining the assessment of quality of life to guide rehabilitation and therapy. PMID:22167847

Stent-assisted recanalization of atherosclerotic intracranial stenosis

International Nuclear Information System (INIS)

Soo Mee Lim; Dae Chul Suh

2006-01-01

Intracranial atherosclerosis is a major cause of ischemic stroke, and depending on the studied population, it accounts for 8%-15% of all strokes that are due to cerebral atherosclerosis. The prognosis of patients with symptomatic intracranial stenoses seems to depend on the location and extent of intracranial atherosclerosis. Currently, the primary treatment in intracranial atherosclerosis is the control of vascular risk factors such as hypertension, diabetes, hypercholesterolemia, and smoking. Secondary prevention with antiplatelet therapy has been shown to reduce the risk of subsequent vascular events in patients who have suffered a recent ischemic stroke or transient ischemic attack (TIA). Unfortunately, a significant number of patients with intracranial atherosclerosis continue to suffer from repeated strokes or TIA despite maximal medical treatment. Although endovascular revascularization for symptomatic intracranial stenoses remains at the investigational stage and much of the pertinent information is anecdotal, intracranial angioplasty and stenting are being increasingly performed to treat stenotic lesions. This article reviews basic principles involved in the patient selection, premedication, angio-interventional procedures, angiographic and clinical results, periprocedural complication, patients aftercare. (authors)

Parasitic lesion of the insula suggesting cerebral sparganosis: case report

International Nuclear Information System (INIS)

Cummings, T.J.; Madden, J.F.; McLendon, R.E.; Gray, L.; Friedman, A.H.

2000-01-01

Cerebral sparganosis, a parasitic disease, rarely produces a chronic active inflammatory response in the brain. Clinically and radiographically the process may mimic a neoplasm. We report a 30-year-old man who underwent surgical exploration for a mass in the insular cortex. Histology revealed a densely fibrotic mass heavily infiltrated with plasma cells and lymphocytes, in which were embedded parasitic forms consistent with sparganosis. We describe the MRI appearances and pathologic features. Intracranial mass lesions secondary to sparganosis must be considered in patients with a history of travel to endemic areas, especially Asia. (orig.)

CT diagnosis of hyperdense intracranial neoplasms. Review of the literature

International Nuclear Information System (INIS)

Ishikura, Reiichi; Ando, Kumiko; Tominaga, Satoru; Nakao, Norio; Ikeda, Jouta; Takemura, Yuriko; Morikawa, Tsutomu

1999-01-01

In contrast to typical astrocytic tumors that show hypodense areas on computed tomographic images, some intracranial tumors show hyperdense areas on CT images. The major reasons for hyperdensity on CT images are hypercellular lesions, intratumoral calcification, and intratumoral hemorrhage. Malignant lymphomas, germinomas, and medulloblastomas show homogenous hyperdensity on CT images because of their hypercellularity. Tumorous lesions such as subependymal giant cell astrocytomas, oligodendrogliomas, ependymomas, central neurocytomas, craniopharyngiomas, and meningiomas often present with hyperdense calcified lesions on CT images. Intratumoral hemorrhage also causes hyperdensity on CT images, and is often associated with metastatic brain tumors, glioblastomas, pituitary adenomas, and rarely with any of the other intracranial tumors. Although magnetic resonance imaging is now the major diagnostic tool for diseases of the central nervous system, the first imaging studies for patients with neurologic symptoms are still CT scans. Hyperdense areas on CT images are a clue to making an accurate diagnosis of intracranial neoplasms. (author)

Spinal level of myelomeningocele lesion as a contributing factor in posterior fossa volume, intracranial cerebellar volume, and cerebellar ectopia.

LENUS (Irish Health Repository)

Sweeney, Kieron J

2013-02-01

McLone and Knepper\\'s unified theory of Chiari malformation Type II (CM-II) describes how the loss of CSF via the open posterior neuropore fails to create adequate distending pressure for the developing rhomboencephalic vesicle. The authors of the present article describe the relationship between the posterior fossa volume and intracranial cerebellar volume as being related to the distance from the obex of the fourth ventricle to the myelomeningocele lesion using a common mathematical model, the Hagen-Poiseuille law.

Increased intracranial pressure: evaluation by computerized tomography

International Nuclear Information System (INIS)

Lightfoote, W.E.; Pressman, B.D.

1975-01-01

Computerized tomography is clearly very useful in the evaluation of patients with increased intracranial pressure and suspected pseudotumor cerebri. It provides an index of ventricular size and configuration and has the capability of demonstrating intracranial lesions. Moreover, this new technique is rapid and non-invasive, and is without attendant risks. Examinations may be performed serially as the clinical process evolves, thereby giving roentgenographic correlation to the clinical features. (U.S.)

Fetal MRI evaluation of an intracranial mass: in utero evolution of hemorrhage

International Nuclear Information System (INIS)

Emamian, Seyed A.; Bulas, Dorothy I.; Vezina, Gilbert L.; Dubovsky, Elizabeth C.; Cogan, Phillip

2002-01-01

The role of MRI in the evaluation of fetal abnormalities is still under evaluation. We describe a case of an intracranial mass that was initially identified by prenatal ultrasound and was further evaluated by MRI. Ultimately, the findings were most consistent with hematoma secondary to an underlying dural malformation with spontaneous involution. The advantages of fetal MRI in the assessment and management of this abnormality will be discussed. (orig.)

Fetal MRI evaluation of an intracranial mass: in utero evolution of hemorrhage

Energy Technology Data Exchange (ETDEWEB)

Emamian, Seyed A.; Bulas, Dorothy I.; Vezina, Gilbert L.; Dubovsky, Elizabeth C. [Department of Diagnostic Imaging and Radiology, Children' s National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010 (United States); Cogan, Phillip [Department of Neurosurgery, Children' s National Medical Center, George Washington University,Washington, DC (United States)

2002-08-01

The role of MRI in the evaluation of fetal abnormalities is still under evaluation. We describe a case of an intracranial mass that was initially identified by prenatal ultrasound and was further evaluated by MRI. Ultimately, the findings were most consistent with hematoma secondary to an underlying dural malformation with spontaneous involution. The advantages of fetal MRI in the assessment and management of this abnormality will be discussed. (orig.)

CT findings of solitary intracranial metastasis

International Nuclear Information System (INIS)

Suh, Dae Chul; Lee, Kyung Soo; Chang, Kee Hyun

1987-01-01

The authors retrospectively reviewed and analyzed CT scans of fifty patients with solitary intracranial lesion selected from 118 patients who had been confirmed to have intracranial metastasis from 1979 to 1985. The results were as follows: 1. The most common primary tumors with solitary metastasis, in order of frequency, were lung cancer, breast cancer, choriocarcinoma, colon cancer, lymphoma and others. 2. Precontrast scans obtained in 35 cases showed cystic very low density in 20%, slightly low density in 9%, isodensity in 20%, high density in 51% when he densities of the lesions were compared with that of the normal brain tissue. 3. After contrast enhancement 43 out of 50 showed one of 4 patterns of enhancement. Homogeneous enhancement without necrosis were found in 26%, homogeneous enhancement with necrosis in 18%, ring-enhancement in 26% and irregular enhancement in 16%. No enhancement was found in 14%. 4. The locations of the metastatic lesions were intra axial in 45 and extra axial in 5. Among the intra axial lesions, the parietal lobe was the most common location. Extra axial metastases were epidural, calvarial and leptomeningeal. 5. Degrees of surrounding edema were mild in 32%, moderate in 19% and severe in 49%

Computerized classification of mass lesions in digital mammograms

International Nuclear Information System (INIS)

Giger, M.L.; Doi, K.; Yin, F.F.; Schmidt, R.A.; Vyborny, C.J.

1989-01-01

Subjective classification of masses on mammograms is a difficult task. On average, about 25% of masses referred for surgical biopsy are actually malignant. The authors are developing, as an aid to radiologists, a computerized scheme for the classification of lesions in mammograms to reduce the false-negative and false-positive diagnoses of malignancies. The classification scheme involves the extraction of border information from the mammographic lesion in order to quantify the degree of spiculation, which is related to the possibility of malignancy. Clinical film mammograms are digitized with an optical drum scanner (0.1-mm pixel size) for analysis on a Micro VAX 3500 computer. Border information (fluctuations) is obtained from the difference between the lesion border and its smoothed border. Using the rms variation of the frequency content of these fluctuations, approximately 85% of the cancerous lesions were correctly classified as malignant, while 15% of benign lesions were misclassified, in a preliminary study

Study of MRI features of intracranial tuberculosis and its dynamic evolution during antituberculous treatment

International Nuclear Information System (INIS)

Guo Lifang; Lu Yan; Zhou Xinhua; He Wei; Xie Ruming; Xu Jinping; Ning Fenggang; Zhou Zhen; Zhao Zegang

2014-01-01

Objective: To explore MRI features of intracranial tuberculosis, and the dynamic evolution of intracranial tuberculosis during antituberculous treatment. Methods: From September 2009 to February 2012, seventy-two patients with intracranial tuberculosis were reviewed retrospectively. Intracranial tuberculosis lesions were divided into 3 categories: pure parenchymal tuberculosis, tuberculous meningitis and hybrid type with both parenchymal tuberculosis and tuberculous meningitis. The MRI characteristics of these lesions were analysed. According to the lesion size, pure parenchymal tuberculosis was divided into 3 subtypes: 0.3 cm or less was defined as miliary, >0.3 cm and <1.0 cm as nodule, greater than or equal to 1.0 cm as tuberculoma. Serial follow-up scans were performed in 36 patients, and dynamic MRI changes in the process of anti-tuberculosis treatment during 3 to 6 months were observed. The disappearance rate of the lesions was calculated and statistically analysed by using Chi-square test. Results: There were 883 lesions in 38 cases with parenchymal tuberculosis. Multiple lesions distributed widely, 423 lesions (47.9%) ≤0.3 cm, 330 lesions (37.4%) between 0.3-1.0 cm, and 130 lesions (14.7%) ≥ 1.0 cm. Twenty-four cases with tuberculous meningitis showed meningeal enhancement at basilar cistern. Ten cases with hybrid type presented both parenchymal tuberculosis and meningitis. Among 36 patients with serial MRI follow-up scans, 22 cases were pure parenchymal tuberculosis. The disappearance rates of military, nodules and tuberculomas were 52.2% (59/113), 33.3% (33/99) and 0, respectively, after 3 months treatment. The disappearance rates were 87.6% (99/113), 50.5% (50/99) and 18.2% (2/11), respectively, after 6 months treatment. Disappearance rate of miliary lesions was obviously higher than that of nodules at both 3 and 6 months, and the difference was statistically significant,(χ 2 =7.657, 34.786, P<0.01). Nine lesions of parenchymal tuberculosis enlarged

Solitary intracranial tuberculoma mimicking a malignant tumor in a patient without tubercular lesions or a history of disease: a case report

Directory of Open Access Journals (Sweden)

Javier A. Bustamante-Rengifo

2013-05-01

Full Text Available Cerebral tuberculoma is a rare cause of intracranial mass. In Latin America and Colombia where tuberculosis is endemic, it represents between 5 and 30% of brain tumours. A 53-year-old Colombian woman was admitted to a third-level hospital in Cali, Colombia, after reporting loss of consciousness, headache, paresthesia, and flight of ideas for a two-week period. Imaging studies showed a left frontal mass of malignant appearance whose first possible diagnosis was metastatic neoplasia or glioma. With the initial results, absence of history of chronic infectious diseases and a history of thyroidectomy, a surgical procedure was carried out and a histopathological and molecular evaluation was conducted. The pathology report noted necrotizing granulomatous inflammation and tissue staining and molecular tests for detection of M. tuberculosis were positive and the patient was managed with anti-tubercular treatment. Intracranial masses are frequently targeted as a malignant neoplastic disease for surgical treatment. Considering an infectious etiology must be a diagnostic option.

Decreased muscle mass in Korean subjects with intracranial arterial stenosis: The Kangbuk Samsung Health Study.

Science.gov (United States)

Jung, Ho-Jung; Jung, Hwanseok; Lee, Taeyoung; Kim, Jongho; Park, Jongsin; Kim, Hacsoo; Cho, Junghwan; Lee, Won-Young; Park, Sung-Woo; Rhee, Eun-Jung; Oh, Hyung-Geun

2017-01-01

Intracranial arterial stenosis (ICAS) is a common cause of ischemic stroke in Asians. Decreased muscle mass is one of the major causes of chronic disease in adults. The purpose of this study was to analyze the relationship between muscle mass and ICAS in Korean adults. For this study, we selected a total of 10,530 participants (mean age, 43.3 years; 8558 men) in a health screening program, for whom transcranial Doppler (TCD) ultrasound was used to detect >50% ICAS based on criteria modified from the stroke outcomes and neuroimaging of intracranial atherosclerosis trial. Body composition was evaluated by bioelectrical impedance analysis (BIA). Skeletal muscle index (SMI) was calculated with muscle mass/weight (kg) * 100. Among the total patient population, 322 (3.1%) subjects had ICAS. Subjects with ICAS were older, and had higher mean values for fasting glucose, body mass index and blood pressure compared with those without ICAS. Subjects with ICAS had significantly lower muscle mass, SMI and higher percent body fat compared with those without ICAS. In logistic regression analysis, the subjects in the highest tertile of muscle mass had the lowest odds ratio for ICAS with the lowest tertile group of muscle mass as the reference group even after adjusting for age, systolic blood pressure, fasting blood glucose, sex, smoking and exercise (OR 0.650, 95% CI 0.442-0.955). Subjects with ICAS had significantly decreased muscle mass compared with those without ICAS in Korean adults. The risk for ICAS was lower in subjects with higher muscle mass. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Computerized tomography in the study of intracranial complications in hematology

International Nuclear Information System (INIS)

Gastaut, J.L.; Gastaut, J.A.

1979-01-01

CT was used to examine 100 patients with various hematologic disorders. It was generally in patients with clinical signs of encephalic alteration (68% of the cases) that we demonstrated lesions. In several cases, the lesions were detected by CT, whereas common neurological investigational methods remained negative. The most interesting findings were in acute leukemias (leucoblastic infiltrations, cerebral hemorrhages and infarctions, and iatrogenic morphologic modifications) and in Hodgkin diseases (intracranial localizations). CT permits a more complete neurologic work-up for patients with hematologic disorders and provides a better knowledge of the frequency and varieties of intracranial complications. (orig.) 891 MG/orig. 892 MB [de

Occipital Intraosseous Hemangioma over Torcula: Unusual Presentation with Raised Intracranial Pressure.

Science.gov (United States)

Rao, K V L N; Beniwal, Manish; Vazhayil, Vikas; Somanna, Sampath; Yasha, T C

2017-12-01

Hemangiomas of the bone are benign, uncommon, slow-growing lesions accounting for occipital hemangiomas are rare, and occipital hemangiomas presenting with features of raised intracranial tension are, with only 2 cases reported to date. In this case report, we describe the unique case of a 30-year-old male patient presenting with raised intracranial pressure due to venous obstruction at the torcula. The patient underwent excision of the lesion and became symptom free. Although these are benign lesions, they can have a varied clinical presentation. An understanding of the different clinical presentations and surgical nuances in excising such tumors can lead to early diagnosis and good patient outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

SU-E-J-123: Targeting Accuracy of Image-Guided Radiosurgery for Intracranial Lesions

Energy Technology Data Exchange (ETDEWEB)

Huang, Y; Wen, N; Zhao, B; Kim, J; Gordon, J; Chetty, I [Henry Ford Health System, Detroit, MI (United States)

2014-06-01

Purpose: To evaluate the setup accuracies of image-guided intracranial radiosurgery across several different linear accelerator platforms. Methods: A CT scan with a slice thickness of 1.0 mm was acquired of a Rando head phantom (The Phantom Laboratory) in a U-frame mask (BrainLAB AG). The phantom had three embedded BBs, simulating a central, left, and anterior lesion. The phantom was setup with each BB placed at the radiation isocenter under image guidance. Four different setup procedures were investigated: (1) NTX-ExacTrac: 6 degree-of-freedom (6D) correction on a Novalis Tx (BrainLAB AG) with ExacTrac localization (BrainLAB AG); (2) NTX-CBCT: 4D correction on the Novalis Tx with cone-beam computed tomography (CBCT); (3) TrueBeam-CBCT: 4D correction on a TrueBeam (Varian) with CBCT; (4) Edge-CBCT: 6D correction on an Edge (Varian) with CBCT. The experiment was repeated 5 times with different initial setup error at each BB location on each platform, and the mean (μ) and one standard deviation (σ) of the residual error was compared.The congruence between radiation and imaging isocenters on each platform was evaluated by acquiring Winston Lutz (WL) images of a WL jig followed by imaging using ExacTrac or CBCT. The difference in coordinates of the jig relative to radiation and imaging isocenters was then recorded. Results: Averaged over all three BB locations, the residual vector setup errors (μ±σ) of the phantom in mm were 0.6±0.2, 1.0±0.5, 0.2±0.1, and 0.3±0.1 on NTX-ExacTrac, NTX-CBCT, TrueBeam-CBCT, and Edge-CBCT, with their ranges in mm being 0.4∼1.1, 0.4∼1.9, 0.1∼0.5, and 0.2∼0.6, respectively. And imaging isocenter was found stable relative to radiation isocenter, with the congruence to radiation isocenter in mm being 0.6±0.1, 0.7±0.1, 0.3±0.1, 0.2±0.1, respectively, on the four systems in the same order. Conclusion: Millimeter accuracy can be achieved with image-guided radiosurgery for intracranial lesions based on this set of experiments.

Magnetic Resonance Imaging Susceptibility-Weighted Imaging Lesion and Contrast Enhancement May Represent Infectious Intracranial Aneurysm in Infective Endocarditis.

Science.gov (United States)

Cho, Sung-Min; Rice, Cory; Marquardt, Robert J; Zhang, Lucy Q; Khoury, Jean; Thatikunta, Prateek; Buletko, Andrew B; Hardman, Julian; Uchino, Ken; Wisco, Dolora

2017-01-01

Infectious intracranial aneurysm (IIA) can complicate infective endocarditis (IE). We aimed to describe the magnetic resonance imaging (MRI) characteristics of IIA. We reviewed IIAs among 116 consecutive patients with active IE by conducting a neurological evaluation at a single tertiary referral center from January 2015 to July 2016. MRIs and digital cerebral angiograms (DSA) were reviewed to identify MRI characteristics of IIAs. MRI susceptibility weighted imaging (SWI) was performed to collect data on cerebral microbleeds (CMBs) and sulcal SWI lesions. Out of 116 persons, 74 (63.8%) underwent DSA. IIAs were identified in 13 (17.6% of DSA, 11.2% of entire cohort) and 10 patients with aneurysms underwent MRI with SWI sequence. Nine (90%) out of 10 persons with IIAs had CMB >5 mm or sulcal lesions in SWI (9 in sulci, 6 in parenchyma, and 5 in both). Five out of 8 persons who underwent MRI brain with contrast had enhancement within the SWI lesions. In a multivariate logistic regression analysis, both sulcal SWI lesions (p < 0.001, OR 69, 95% CI 7.8-610) and contrast enhancement (p = 0.007, OR 16.5, 95% CI 2.3-121) were found to be significant predictors of the presence of IIAs. In the individuals with IE who underwent DSA and MRI, we found that neuroimaging characteristics, such as sulcal SWI lesion with or without contrast enhancement, are associated with the presence of IIA. © 2017 S. Karger AG, Basel.

Pleural Mass Lesion Containing Calcium Sludge

Directory of Open Access Journals (Sweden)

Can Kurkcuoglu

2012-01-01

Full Text Available   A 30 year-old man was admitted with of chest pain. Had a x-ray and computed tomography showed calcified pleural mass . Lesions in the white-colored, dense mud was the consistency of the material.

MRI of the cystic mass lesions of the pancreas

International Nuclear Information System (INIS)

Ohtomo, Kuni; Itai, Yuji; Yoshikawa, Koki; Kokubo, Takashi; Yashiro, Naofumi; Iio, Masahiro

1987-01-01

Five cystic mass lesions of the pancreas were exemined by MRI. Multiplocular fluid components were demonstrated as areas of various signal intensity in mucinous cystadenoma and cystadenocarcinoma. Gas within the cystic mass was noted in ductectatic mucinous cystadenocarcinoma. Honeycomb pattern and classification were not depicted in serous cystadenoma. Necrotic matter was demonstrated as area of lower signal than liver in pseudocyst. These results were then compared with CT and ultrasound and at present enhanced CT combined with ultrasound is more diagnostic than MRI for cystic mass lesions of the pancreas. (author)

Drip, ship, and grip, then slice and dice: Comprehensive stroke center management of cervical and intracranial emboli.

Directory of Open Access Journals (Sweden)

Jason D Hinman

2013-07-01

Full Text Available BACKGROUND AND PURPOSE: Tandem acute thrombotic emboli in the cervical and intracranial arteries are an unusual case of stroke presenting unique management challenges. In regional systems of acute stroke care anchored by Comprehensive Stroke Centers, combined fibrinolytic, endovascular, and open surgical intervention is a new therapeutic option. SUMMARY OF CASE: A 28 year old male underwent retinal surgery, including post-operative neck compression and the next day presented to a primary stroke center with aphasia and right hemiplegia. Intravenous tissue plasminogen activator therapy was initiated and the patient was transferred to a comprehensive stroke center (CSC for higher level of care (drip and ship. Imaging at the CSC demonstrated tandem thrombi: a near occlusive lesion at the origin of the left cervical internal carotid artery and a total occlusion of the M1 segment of the left middle cerebral artery. Endovascular thrombectomy with the Solitaire stent retriever resulted in intracranial recanalization (grip. Immediately after the endovascular procedure, open carotid thrombectomy was performed to achieve cervical carotid revascularization without systemic heparinization (slice. Both cervical carotid and intracranial thrombi were processed for proteomic analysis via mass spectrometry (dice. CONCLUSION: Combined fibrinolytic, endovascular, and open surgical intervention can yield revascularization and good clinical outcome in cases of tandem lesions.

MRI diagnosis of intracranial tuberculosis (73 cases report)

International Nuclear Information System (INIS)

Zeng Qingyong; Li Xin; He Zhihui; Cheng Chuanhu; Deng Kaijun; Deng Ming

2008-01-01

Objective: To assess the MRI features, classification and diagnostic value for intracranial tuberculosis. Methods MRI findings of 73 patients suffering from intracranial tuberculosis proved by pathology or clinic were analyzed respectively. Among the total 73 patients, 39 cases were tuberculosis meningitis, 12 cases simple intracranial tuberculoma, while 22 cases were tuberculoma combining with meningitis. Results: The MRI features of tuberculous meningitis are cerebral infarction, hydrocephalus, abnormal meningeal and cerebral cistern enhancement. 12 cases mature tuberculoma demon- strated typical features with high or low density on T 2 WI images and ring contrast enhancement; 22 cases non-mature tuberculoma showed focal nodular contrast enhancement with evident cerebral edema. FLAIR is more sensitive to find out focus than T 2 WI. Small lesions could be showed definitively by contrast-enhanced scan. Conclusion: MRI possess typical features in the diagnosis of intracranial tuberculosis. It plays an important role in evaluating location, range, classification of intracranial tuberculosis, and is helpful to clinical treatment. (authors)

High-resolution intracranial vessel wall MRI in an elderly asymptomatic population: comparison of 3T and 7T

Energy Technology Data Exchange (ETDEWEB)

Harteveld, Anita A.; Kolk, Anja G. van der; Dieleman, Nikki; Siero, Jeroen C.W.; Luijten, Peter R.; Zwanenburg, Jaco J.M.; Hendrikse, Jeroen [University Medical Center Utrecht, Department of Radiology, Postbox 85500, Utrecht (Netherlands); Worp, H.B. van der; Frijns, Catharina J.M. [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht (Netherlands); Kuijf, Hugo J. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands)

2017-04-15

Several intracranial vessel wall sequences have been described in recent literature, with either 3-T or 7-T magnetic resonance imaging (MRI). In the current study, we compared 3-T and 7-T MRI in visualising both the intracranial arterial vessel wall and vessel wall lesions. Twenty-one elderly asymptomatic volunteers were scanned by 3-T and 7-T MRI with an intracranial vessel wall sequence, both before and after contrast administration. Two raters scored image quality, and presence and characteristics of vessel wall lesions. Vessel wall visibility was equal or significantly better at 7 T for the studied arterial segments, even though there were more artefacts hampering assessment. The better visualisation of the vessel wall at 7 T was most prominent in the proximal anterior cerebral circulation and the posterior cerebral artery. In the studied elderly asymptomatic population, 48 vessel-wall lesions were identified at 3 T, of which 7 showed enhancement. At 7 T, 79 lesions were identified, of which 29 showed enhancement. Seventy-one percent of all 3-T lesions and 59 % of all 7-T lesions were also seen at the other field strength. Despite the large variability in detected lesions at both field strengths, we believe 7-T MRI has the highest potential to identify the total burden of intracranial vessel wall lesions. (orig.)

A Case Of Ollier′s Disease With Intracranial Enchondroma

Directory of Open Access Journals (Sweden)

Sidharthan Neeraj

2005-01-01

Full Text Available The syndrome of multiple enchondromas is known as Ollier′s disease. Enchondromas are benign tumours of hyaline cartilage arising within the medullary cavity of tubular bones. We are reporting the case of a 16 year old girl with Ollier′s disease who presented with seizures and brainstem compression. A MRI scan of brain showed an intracranial space-occupying lesion in the region of clivus. The intracranial tumour was surgically removed and the histopathology confirmed the diagnosis of enchondroma. Intracranial enchondroma is an extremely rare situation and reported for the first time from south India.

MR Spectroscopy and Perfusion MR Imaging Findings of Intracranial Foreign Body Granuloma: a Case Report

Energy Technology Data Exchange (ETDEWEB)

Jang, Seung Won; Kim, Sang Joon; Kim, Sun Mi; Lee, Jeong Hyun; Choi, Choong Gon; Lee, Deok Hee; Lee, Jung Kyo [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Kim, Eun Ju [Philips Healthcare, Seoul (Korea, Republic of)

2010-06-15

We report a case of intracranial foreign body granuloma that showed features of a high grade tumor on magnetic resonance (MR) imaging. However, the relative cerebral blood volume was not increased in the enhancing mass on perfusion MRI and the choline/creatine ratio only slightly increased on MR spectroscopy. The results suggest that the lesion is benign in nature. Perfusion MRI and MR spectroscopy may be helpful to differentiate a foreign body granuloma from a neoplastic condition

Computed tomography in intracranial hemorrhage in leukemia

International Nuclear Information System (INIS)

Hanyu, Haruo; Katsunuma, Hideyo; Yoshimura, Masahiro; Tomonaga, Masanori.

1984-01-01

In tracranial hemorrhage in leukemia was clinicopathologically studied in 62 cases of autopsy materials, with special attention paid to a morphological comparison of CT images with pathological findings. Intracranial hemorrhage was found in 32 of the 62 leukemic patients (51.6%), and in 13 of these patients (21.0%) it was responsible for death. Leukemic intracranial hemorrhage occurred more often in the acute leukemic type than in the chronic type, and even more often in younger leukemic patinents; it was pathologically characterized by multiple lesions in the white matter of the cerebral hemisphere, prone to combination with SAH or SDH. The hemorrhages could be divided into five types: (1) scattered small hemorrhagic type, (2) hematoma type, (3) fusion type (large hemorrhage composed of assembled small hemorrhages), (4) SAH type, and (5) SDH type. Among these types, the fusion type was considered to be characteristic of leukemia. CT was undertaken in 5 pathologically proven cases, with findings of the scattered small hemorrhagic type in 1, of the SDH type in 3, and of the fusion type in 1. Yet, one case with scattered small hemorrhages and two cases with SDH failed to be detected by CT. However, one case with a typical fusion hemorrhage was found to have multiple, irregular, high-density areas with surrounding edema and a mass effect as well as pathological findings. Therefore, a large-fusion hemorrhage, which is one of the most characteristic types of leukemic intracranial hemorrhage, could be demonstrated as distinctive CT images which reflected neuropathological findings. On the other hand, small parenchymal hemorrhages and relatively thin subdural hemorrhages could not be detected by CT. In conclusion, it seems that CT has value in the diagnosis of intracranial hemorrhage in leukemia. (J.P.N.)

Midline Craniofacial Masses in Children

OpenAIRE

Van Wyhe, Renae D.; Chamata, Edward S.; Hollier, Larry H.

2016-01-01

Nasal dermoids, encephaloceles, and gliomas are rare congenital lesions that result from improper embryologic development. The differentiation between them and a firm understanding of their pathology is necessary to avoid unnecessary complications. In view of their potential intracranial connection, prompt diagnosis and treatment are paramount. The authors review the embryology, diagnoses, radiologic work-up, surgical management, and complications of these midline craniofacial masses in child...

Intracranial Stent Implantation for Drug Resistant Atherosclerotic Stenosis: Results of 52 Cases

International Nuclear Information System (INIS)

Kim, Kuk Seon; Hwang, Dae Hyun; Ko, Young Hwan; Kang, Ik Won; Lee, Eil Seong; Han, You Mie; Kim, In Soo; Hur, Choon Woong

2011-01-01

We evaluated the usefulness of intracranial stent implantation for treatment of drug resistant atherosclerotic stenoses. Between March 2004 and July 2007, we tried intracranial stent implantation in 49 patients with 52 lesions (anterior circulation 48 cases, posterior circulation 4 cases) who had an ischemic stroke with more than 50% of major cerebral artery stenosis. We classified the lesions by their location and morphology, analyzed the results in terms of the success rate, complication rate, and restenosis rate during the follow-up period. Intracranial stent implantation was performed successfully in 43 cases (82.7%). In eight of the nine cases, the stent implantation failure was due to the tortuosity of the target vessel. There was no major periprocedural complication. One patient showed cerebellar infarction after the procedure. Mean residual stenoses decreased from 70.2% to 13.0%. Four cases (9.3%) demonstrated in-stent restenoses and more than 50% during the mean and 25.3/month after the follow-up period. Success rate of intracranial stent implantation may improve on developing technique and more experience. Low rate of complication and restenosis suggest that we can consider intracranial stent implantation for treatment of drug resistant atherosclerotic stenoses.

Surgery for bilateral large intracranial traumatic hematomas: evacuation in a single session.

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Kompheak, Heng; Hwang, Sun-Chul; Kim, Dong-Sung; Shin, Dong-Sung; Kim, Bum-Tae

2014-06-01

Management guidelines for single intracranial hematomas have been established, but the optimal management of multiple hematomas has little known. We present bilateral traumatic supratentorial hematomas that each has enough volume to be evacuated and discuss how to operate effectively it in a single anesthesia. In total, 203 patients underwent evacuation and/or decompressive craniectomies for acute intracranial hematomas over 5 years. Among them, only eight cases (3.9%) underwent operations for bilateral intracranial hematomas in a single session. Injury mechanism, initial Glasgow Coma Scale score, types of intracranial lesions, surgical methods, and Glasgow outcome scale were evaluated. The most common injury mechanism was a fall (four cases). The types of intracranial lesions were epidural hematoma (EDH)/intracerebral hematoma (ICH) in five, EDH/EDH in one, EDH/subdural hematoma (SDH) in one, and ICH/SDH in one. All cases except one had an EDH. The EDH was addressed first in all cases. Then, the evacuation of the ICH was performed through a small craniotomy or burr hole. All patients except one survived. Bilateral intracranial hematomas that should be removed in a single-session operation are rare. Epidural hematomas almost always occur in these cases and should be removed first to prevent the hematoma from growing during the surgery. Then, the other hematoma, contralateral to the EDH, can be evacuated with a small craniotomy.

Concomitant Intracranial and Lumbar Chronic Subdural Hematoma Treated by Fluoroscopic Guided Lumbar Puncture: A Case Report and Literature Review

Science.gov (United States)

ICHINOSE, Daisuke; TOCHIGI, Satoru; TANAKA, Toshihide; SUZUKI, Tomoya; TAKEI, Jun; HATANO, Keisuke; KAJIWARA, Ikki; MARUYAMA, Fumiaki; SAKAMOTO, Hiroki; HASEGAWA, Yuzuru; TANI, Satoshi; MURAYAMA, Yuichi

2018-01-01

A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted. Aspiration of the liquefied spinal subdural hematoma was performed by a lumbar puncture under fluoroscopic guidance. The clinical symptoms were dramatically improved postoperatively. Concomitant intracranial and spinal CSDH is considerably rare so only 23 cases including the present case have been reported in the literature so far. The etiology and therapeutic strategy were discussed with a review of the literature. Therapeutic strategy is not established for these two concomitant lesions. Conservative follow-up was chosen for 14 cases, resulting in a favorable clinical outcome. Although surgical evacuation of lumbosacral CSDH was performed in seven cases, an alteration of cerebrospinal fluid (CSF) pressure following spinal surgery should be reminded because of the intracranial lesion. Since CSDH is well liquefied in both intracranial and spinal lesion, a less invasive approach is recommended not only for an intracranial lesion but also for spinal lesion. Fluoroscopic-guided lumbar puncture for lumbosacral CSDH following burr hole surgery for intracranial CSDH could be a recommended strategy. PMID:29479039

The evaluation of cerebral hemodynamics in patients with intracranial tumors by stable xenon CT; The effect of glycerol administration on regional cerebral blood flow

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Shimoda, Masami; Kawamata, Fumio; Yamamoto, Masahiro; Ohsuga, Hitoshi; Hidaka, Mitsuru; Oda, Shinri; Shibuya, Naoki; Yamamoto, Isao; Sato, Osamu (Tokai Univ., Isehara, Kanagawa (Japan). School of Medicine)

1989-04-01

In evaluating cerebral regional blood flow (rCBF), stable xenon-enhanced tomography (XeCT) study associated with simultaneous blood sampling was applied in 15 cases of intracranial neoplasms. The effect of intravenous glycerol infusion on rCBF was also investigated. The results indicated that intratumoral rCBF values were not only variable and unrelated to their histological types and grades, but also were not correlated with the vascularity of the lesion as demonstrated by angiography. When a tumor mass was enhanced after the injection of iodinated contrast media, it proved to be useful in distinguishing tumor mass and its associated edema that the rCBF of the peritumoral edematous region was predominantly low (10{plus minus}5 ml/100 g/min). The regional cerebral blood flow in remote areas, both ipsilateral and contralateral to the lesion, was low in value, and there was no statistical significance between affected and sound sides. Following glycerol administration, rCBF was increased in the whole intracranial region, but not inside of the neoplasm, particularly when the intracranial pressure (ICP) was increased. It was assumed that the elevated rCBF after glycerol administration was due to the increase in the cerebral perfusion pressure resulting from the ICP reduction, the hemodilution effect, cerebral vessel dilatation after metabolic acidosis, and/or mechanically rectified microcirculation after edema reduction. (author).

Intracranial stenosis in cognitive impairment and dementia.

Science.gov (United States)

Hilal, Saima; Xu, Xin; Ikram, M Kamran; Vrooman, Henri; Venketasubramanian, Narayanaswamy; Chen, Christopher

2017-06-01

Intracranial stenosis is a common vascular lesion observed in Asian and other non-Caucasian stroke populations. However, its role in cognitive impairment and dementia has been under-studied. We, therefore, examined the association of intracranial stenosis with cognitive impairment, dementia and their subtypes in a memory clinic case-control study, where all subjects underwent detailed neuropsychological assessment and 3 T neuroimaging including three-dimensional time-of-flight magnetic resonance angiography. Intracranial stenosis was defined as ≥50% narrowing in any of the intracranial arteries. A total of 424 subjects were recruited of whom 97 were classified as no cognitive impairment, 107 as cognitive impairment no dementia, 70 vascular cognitive impairment no dementia, 121 Alzheimer's Disease, and 30 vascular dementia. Intracranial stenosis was associated with dementia (age/gender/education - adjusted odds ratios (OR): 4.73, 95% confidence interval (CI): 1.93-11.60) and vascular cognitive impairment no dementia (OR: 3.98, 95% CI: 1.59-9.93). These associations were independent of cardiovascular risk factors and MRI markers. However, the association with Alzheimer's Disease and vascular dementia became attenuated in the presence of white matter hyperintensities. Intracranial stenosis is associated with vascular cognitive impairment no dementia independent of MRI markers. In Alzheimer's Disease and vascular dementia, this association is mediated by cerebrovascular disease. Future studies focusing on perfusion and functional markers are needed to determine the pathophysiological mechanism(s) linking intracranial stenosis and cognition so as to identify treatment strategies.

Canine Intracranial Meningioma: Case report

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José Ricardo Gomes de Carvalho

2016-11-01

Full Text Available ABSTRACT. Carvalho J.R.G., Vasconcellos C.H.C., Bastos I. P.B., Trajano F.L.C., Costa T.S. & Fernandes J.I [Canine Intracranial Meningioma: Case report.] Meningioma intracraniano canino: Relato de caso. Revista Brasileira de Medicina Veterinária, 38(supl. 3:1- 7, 2016. Programa de Pós-Graduação em Ciências Veterinária, Universidade Federal Rural do Rio de Janeiro, BR 465 Km 7, Seropédica, RJ 23.897-000, Brasil, E-mail: vetjulio@yahoo.com.br Intracranial neoplasms usually show their signals in a moderate way, revealing a long background of nonspecific signs, making the diagnosis more difficult. The meningioma is the most common intracranial neoplasm in dogs and cats. Along the years, the Veterinary Medicine has experienced important technological improvements, making it possible the diagnosis of a lot of diseases. Therefore, diseases considered not common in the past, started being diagnosed more frequently, for instance, brain lesions. The objective of this research is to report a case of intracranial meningioma in a Boxer dog that arrived at the Veterinary Hospital of the Federal Rural University of Rio de Janeiro, highlighting its clinical improvement, diagnosis and treatment.

Metastatic Breast Lesion to the Falx Detected with PET/CT

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Harrison, Chester; Schuster, David M. [Emory Univ., Atlanta (United States)

2012-06-15

Intracranial dural metastasis is increasingly encountered in imaging. Autopsies conducted on patients with advanced metastatic disease demonstrate dural involvement in 9% of cases, with breast and prostate cancer the most common primaries. Awareness of this entity and imaging appearances is especially important in evaluating malignancies prone to dural metastasis. A 57-year-old woman with a strong family history of breast cancer initially presented after self-detection of a right breast lump. Subsequent mammogram and biopsies yielded a diagnosis of right infiltrating ductal carcinoma with a positive lymph node as well as left invasive lobular carcinoma. Initial staging PET-CT (not shown) at the time of diagnosis demonstrated no abnormal FDG uptake remote from the breast. Neoadjuvant chemotherapy was instituted, and a PET-CT was obtained to evaluate disease response, demonstrating an approximately 1.8 cm hypermetabolic intra-cranial mass, localized to the region of the anterior corpus callosum on axian PET (Fig. 1a), axial fused PET-CT (Fig. 1b), and sagittal fused PET-CT (Fig. 1c) with a maximum SUV of 15.9. There was associated bifrontal vasogenic edema (Fig. 1d) on the CT demonstrated on brain windows. Marked progression of disease was noted elsewhere, including hypermetabolic adenopathy and skeletal disease. A contrast-enhanced MRI of the brain was obtained demonstrating extensive T1 hypointensity, T2, and FLAIR (Fig. 2a) hyperintensity in the bilateral paramedian frontallobes representing vasogenic edema. Post-contrast imaging demonstrated three solidly enhancing masses in the areas of described vasogenic edema, one large extra-axial and two sub-centimeter parenchymal lesions. The large extra-axial and two sub-centimeter parenchymal lesions. The large extra-axial mass demonstrated homogeneous solid enhancement, in the midline anteriorly centered on the falx, just superior to the anterior corpus callosum. This measured 1.7cm transverse x 3.1cm AP x 2.4cm

Anaesthetic management of craniotomy for intracranial lesion in a child with uncorrected Tetrology of Fallot

International Nuclear Information System (INIS)

Rafique, N. B.; Hamid, M.

2013-01-01

The case of a 16 years old female with uncorrected Tetrology of Fallot, who operated for intracranial lesion in parieto frontal area with midline shift is presented. She had right ventricular hypertrophy, clubbing, central and peripheral cyanosis. Patient was anaesthetized keeping all measures required to avoid haemodynamic swings, tachycardia, desaturation, acidosis and dehydration. Pre-operative antibiotic cover was given to prevent bacterial endocarditis. Neurosurgeon, Paediatric cardiologist, Anaesthesiologist and Intensivist were involved in the preoperative planning and management of the patient. Haemodynamics were maintained and managed by monitoring continuous arterial line secured pre-induction and central line after induction. During surgery pain was controlled with fentanyl boluses intra-operatively and post operatively by tramadol infusion. Patient was extubated post operatively in the recovery room fulfilling the extubation criteria. She remained haemodynamically stable throughout the course. She was discharged on 5th post operative day from the hospital on SpO/sub 2/ of 70-80% at room air. (author)

Management of intracranial arteriovenous malformations

International Nuclear Information System (INIS)

Miyamoto, Susumu; Takahashi, Jun C.

2008-01-01

Intracranial arteriovenous malformations (AVMs) are congenital lesions that can cause serious neurological deficits or even death. They can manifest as intracranial hemorrhage, epileptic seizure, or other symptoms such as headache or tinnitus. They are detected by computed tomography or magnetic resonance imaging. Recently there have been significant developments in the management of AVMs. In this paper, the authors represent an overview of the epidemiology of AVMs and the existing treatment strategies. AVMs are ideally excised by standard microsurgical techniques. The grading scale which was proposed by Spetzler and Martin is widely used to estimate the risk of direct surgery. Stereotactic radiosurgery such as that using a gamma knife is very useful for small lesions located in eloquent areas. Technological advances in endovascular surgery have provided new alternatives in the treatment of AVMs. Currently indications for embolization can be divided into presurgical embolization in large AVMs to occlude deep arterial feeding vessels and embolization before stereotactic radiosurgery to reduce the size of the nidus. Palliative embolization can be also applied for patients with large, inoperable AVMs who are suffering from progressive neurological deficits secondary to venous hypertension and/or arterial steal phenomenon. (author)

Management of intracranial arteriovenous malformations

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Miyamoto, Susumu; Takahashi, Jun C [National Cardiovascular Center, Suita, Osaka (Japan)

2008-10-15

Intracranial arteriovenous malformations (AVMs) are congenital lesions that can cause serious neurological deficits or even death. They can manifest as intracranial hemorrhage, epileptic seizure, or other symptoms such as headache or tinnitus. They are detected by computed tomography or magnetic resonance imaging. Recently there have been significant developments in the management of AVMs. In this paper, the authors represent an overview of the epidemiology of AVMs and the existing treatment strategies. AVMs are ideally excised by standard microsurgical techniques. The grading scale which was proposed by Spetzler and Martin is widely used to estimate the risk of direct surgery. Stereotactic radiosurgery such as that using a gamma knife is very useful for small lesions located in eloquent areas. Technological advances in endovascular surgery have provided new alternatives in the treatment of AVMs. Currently indications for embolization can be divided into presurgical embolization in large AVMs to occlude deep arterial feeding vessels and embolization before stereotactic radiosurgery to reduce the size of the nidus. Palliative embolization can be also applied for patients with large, inoperable AVMs who are suffering from progressive neurological deficits secondary to venous hypertension and/or arterial steal phenomenon. (author)

Computed tomographic evaluation of pulmonary mass lesion in chest radiography

International Nuclear Information System (INIS)

Choe, Kyu Ok

1984-01-01

Until recently, solitary coin lesion of pulmonary disease has been a conspicuous problem in radiologic diagnosis. It is now well informed that CT has offered high resolution with its objective CT numbers to provide additional information in terms of anatomic and pathologic changes. Here by the aid of CT, the authors has retrospectively patients with various shape of round masses thus illustrating the advantage of it over conventional X-ray in diagnosis. 1. Total 53 patients, including 34 males and 19 females, aging between 19 to 76 years old with nodule or mass of any size ranging 1 to 13 cm in diameter were observed. 2. On plain chest X-ray they were identified where 50 patients has single round nodular or mass, only one had two masses which were ecchinococcal cysts, and the rest two had invisible lesions, only detected by CT. 3. With philips tomoscan 310, CT scan was taken 12 mm thicken slice during quiet respiration. Using the ROI cursor the average CT number of the central area was calculated 1.0 cm in side the outer border of the mass. 4. As a consequence of their pathologic features, they were itemized to 4 group as 36 solid, 9 cystic, 4 consolidative and 4 cavitary lesions. 5. Correct diagnosis of 3 cystic lesions, 4 diffuse calcification, 1 A-V malformation were available by CT densitometry. 6. By the aid of better resolution and additional cross-sectional orientation of CT, 3 extrapulmonary lesions, 3 segmental consolidations, 2 bronchocele, and 2 solitary metastasis, were helpful in diagnosis. 7. Also helpful in determining the extent of intrathoracic extent of bronchogenic carcinoma for the same reason but given clues were not more than the ordinary. 8. However, the limitation of the CT densitometry led to miss diagnosis of 3 examples of cystic vs.solid lesions, and CT density of noncalcified granuloma together with bronchogenic carcinoma, did not have a clear cut separation in between.

Improved Arousal and Motor Function Using Zolpidem in a Patient With Space-Occupying Intracranial Lesions: A Case Report.

Science.gov (United States)

Bomalaski, Martin Nicholas; Smith, Sean Robinson

2017-08-01

Patients with disorders of consciousness (DOC) have profound functional limitations with few treatment options for improving arousal and quality of life. Zolpidem is a nonbenzodiazepine hypnotic used to treat insomnia that has also been observed to paradoxically improve arousal in those with DOC, such as the vegetative or minimally conscious states. Little information exists on its use in patients with DOC who have intracranial space-occupying lesions. We present a case of a 24-year-old man in a minimally conscious state due to central nervous system lymphoma who was observed to have increased arousal and improved motor function after the administration of zolpidem. V. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Clinical pattern of intracranial space occupying lesions in adult Sudanese patients

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Mustafa, Mustafa Seidahmed [Faculty of Medicine, University of Khartoum, Khartoum (Sudan)

1999-07-01

This study was done in the period between August, 1997 and October, 1998, with the aim to determine the types of SOLs in adult Sudanese patients, also clinical presentation and CT scan changes were studied. The number of patients included in this study was 118, all were seen in Khartoum city hospitals, Khartoum Teaching hospital, Elshaab Teaching Hospital and Ibn Khaldoon Hospital. Intracranial SOLs were found to be more common in males (56.8%), and were more common in the age group>30-40 years (32.2%). The commonest intracranial SOL was meningioma (28.8%), followed by glioma in (26.8%), then abscess in (10.2%), followed by tuberculoma in (8.5%), pituitary adenoma in (6.8%) and other SOLs were found to account for (19.5%).(Author)

Clinical pattern of intracranial space occupying lesions in adult Sudanese patients

International Nuclear Information System (INIS)

Mustafa, Mustafa Seidahmed

1999-01-01

This study was done in the period between August, 1997 and October, 1998, with the aim to determine the types of SOLs in adult Sudanese patients, also clinical presentation and CT scan changes were studied. The number of patients included in this study was 118, all were seen in Khartoum city hospitals, Khartoum Teaching hospital, Elshaab Teaching Hospital and Ibn Khaldoon Hospital. Intracranial SOLs were found to be more common in males (56.8%), and were more common in the age group>30-40 years (32.2%). The commonest intracranial SOL was meningioma (28.8%), followed by glioma in (26.8%), then abscess in (10.2%), followed by tuberculoma in (8.5%), pituitary adenoma in (6.8%) and other SOLs were found to account for (19.5%).(Author)

Intracranial neurenteric cyst: A rare cause of chemical meningitis

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Naseer A Choh

2013-01-01

Full Text Available Intracranial neurenteric cysts are exceedingly rare congenital intracranial lesions that result from disorder of gastrulation. Still, more rarely, the cyst contents may leak into the CSF and give rise to recurrent episodes of chemical meningitis. We present a case of chemical meningitis due to a leaking posterior fossa neurenteric cyst in a young female, with emphasis on its imaging features. The final diagnosis was achieved by sufficiently characteristic imaging features; histopathologic documentation could not be achieved as the patient denied surgery.

Viridans streptococci Intracranial Abscess Masquerading as Metastatic Disease

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Brandon Ruderman

2018-01-01

Full Text Available History of present illness: A 64-year-old woman with a remote history of breast cancer presented to the emergency department with one day of worsening right-sided weakness and headaches. She had been seen two weeks prior for similar symptoms and underwent unenhanced brain computed tomography (CT, which revealed a left parietal mass suspected to represent new metastatic disease. The patient presented on this visit not only with weakness of her right upper and lower extremity, but was found to be febrile, tachycardic and exhibiting lethargy. Peripheral white blood cell count (WBC was 27.1 (x109/L. Given her rapidly declining clinical course and expected time to complete magnetic resonance imaging (MRI of the brain, the decision was made to first perform an emergent contrast-enhanced brain CT to further evaluate the mass. The contrast-enhanced brain CT revealed a large rim-enhancing left parietal lesion (Figures 1 and 2. Significant findings: A non-contrast CT (Figure 1 revealed a large hypoattenuating left parietal lesion. When the CT was enhanced with intravenous contrast (Figure 2, the same lesion showed peripheral rim enhancement, suggestive of a brain abscess. Discussion: Intracranial abscess is a rare yet potentially devastating disease process that can often be difficult to diagnosis, with an incidence of about 0.4-0.9 cases per 100,000 people.1 Mortality rates are about 15% within the past decade, but can increase up to 85% if the abscess ruptures. The most common mechanisms for formation of intracranial abscesses include direct spread from local infections (odontogenic infections or sinusitis, hematogenous spread (congenital heart disease, endocarditis, dental procedures, or intrapulmonary shunting, or penetrating trauma.2 Intracranial abscesses are more likely to occur in severely immunosuppressed patients, after neurosurgical procedures, or in head trauma. About 32%-60% of brain abscesses are polymicrobial, but Viridans streptococci, a

Peri-procedural complications and associated risk factors in wingspan stent-assistant angioplasty of intracranial artery stenosis

International Nuclear Information System (INIS)

Li Zhaoshuo; Li Tianxiao; Wang Ziliang; Bai Weixing; Xue Jiangyu; Zhu Liangfu; Li Li

2013-01-01

Objective: To retrospectively evaluate the cerebrovascular complications from stenting for symptomatic intracranial stenosis and to detect the factors associated with complications. Methods: Medical records of Wingspan stenting were reviewed for 306 cases with symptomatic intracranial stenosis from July 2007 to February 2012, including transient ischemic attack, ischemic stroke, death and intracranial hemorrhage as clinical in-hospital complications. The location of lesions included middle cerebral artery level M1 (114 lesions), intracranial portion of the internal carotid artery (50 lesions), vertebral artery 4 (75 lesions), venebro-basilar artery (14 lesions), basilar artery (76 lesions). Complications were evaluated and analyzed to find out whether they were associated with patient-or stenosis-related risk factors using χ"2 test. Results: The technical success rate was 99% (303/306). Cerebrovascular complications rate was 6.9% (21/303), with 1.6% (14/303) of disabling stroke events and 0.7% (2/303) of deaths. Hemorrhagic events were consisted of procedure-related events (3 cases), hyperperfusion (3 cases), ischemic events of perforator stroke (8 cases), transient ischemic attack (3 cases), embolization (2 cases), thrombosis in stent (2 cases). Hemorrhagic events were associated with significantly higher morbidity and mortality rates (χ"2 = 2.908, P < 0.05) and occurred more frequently after treatment of middle cerebral artery stenosis than other lesions (χ"2 = 1.168, P < 0.05). Perforating branches were detected to be affected mainly in the basilar artery than other locations (χ"2 = 4.263, P < 0.05). Conclusion: The complication rates in the study are preliminary consistent with the previously published data. Hemorrhagic events are prone to occur in the treatment of middle cerebral artery stenosis, while perforating branches are affected mainly in the basilar artery. (authors)

CT and MR imaging features in patients with intracranial dolichoectasia

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Tien, Kuang Lung; Yu, In Kyu; Yoon, Sook Ja; Yoon, Yong Kyu [Eulji College of Medicine, Eulji Hospital, Seoul (Korea, Republic of)

2000-02-01

To describe the CT and MR imaging features in patients with intracranial dolichoectasia. The CT (n=3D21), MR (n=3D20) and MRA (n=3D11) imaging features seen in 28 patients (M:F=3D12:16 aged between 65 and 82 (mean, 65) years) with intracranial dolichoectasia were retrospectively reviewed with regard to involved sites, arterial changes (maximum diameter, wall calcification, high signal intensity in the involved artery, as seen on T1-weighted MR images), infarction, hemorrhagic lesion, compression of brain parenchyma or cranial nerves, hydrocephalus and brain atrophy. Involved sites were classified as either type 1 (involvement of only the posterior circulation), type 2 (only the anterior circulation), or type 3 (both). In order of frequency, involved sites were type 1 (43%), type 3 (36%) and type 2 (22%). Dolichoectasia was more frequently seen in the posterior circulation (79%) than in the anterior (57%). Arterial changes as seen on T1-weighted MR images, included dolichoectasia (mean maximum diameter 7.4 mm in the distal internal carotid artery, and 6.7 mm in the basilar artery), wall calcification (100% in involved arteries) and high signal intensity in involved. Cerebral infarction in the territory of the involved artery was found in all patients, and a moderate degree of infarct was 87%. Hemorrhagic lesions were found in 19 patients (68%); these were either lobar (53%), petechial (37%), or subarachnoid (16%), and three patients showed intracranial aneurysms, including one case of dissecting aneurysm. In 19 patients (68%), lesions were compressed lesions by the dolichoectatic arteries, and were found-in order of descending frequency-in the medulla, pons, thalamus, and cerebellopontine angle cistern. Obstructive hydrocephalus was found in two patients (7%), and 23 (82%) showed a moderate degree of brain atrophy. In patients with intracranial dolichoectasia, moderate degrees of cerebral infarction and brain atrophy in the territory of involved arteries, as well as

Paraganglioma with intracranial metastasis: a case report and review of the literature.

Science.gov (United States)

Cai, Peihao; Mahta, Ali; Kim, Ryan Y; Kesari, Santosh

2012-10-01

Paragangliomas are rare neuroendocrine tumors of neural crest origin. They are mostly benign, however; malignant tumors with aggressive behavior and distant metastasis can also occur. Intracranial involvement is extremely rare and has been sporadically reported in the literature. Here we report a case who presented with progressive neurologic deficits due to multiple intracranial lesions found to be metastasis from an occult retroperitoneal malignant paraganglioma.

The value of diffusion weighted imaging in differentiating intracranial tuberculomas from high-grade astrocytomas and metastases

International Nuclear Information System (INIS)

Peng Juan; Luo Tianyou; Lv Fajin; Fang Weidong; Wu Jingquan; Ouyang Yu; Li Yongmei

2007-01-01

Objective: To explore the value of diffusion weighted imaging (DWI) in differentiating intracranial tuberculomas from high-grade astrocytomas and metastases. Methods: The conventional MR imaging and DWI were performed in 50 eases (14 cases with intracranial tuberculomas, 15 cases with high- grade astrocytomas, and 21 cases with metastases) before treatment or operation. The mean apparent diffusion coefficient (ADC) values and relative apparent diffusion coefficient (rADC) values were calculated from the mass as well as from the peripheral edema regions of intracranial lesions. Results: The mean ADC values and rADC values were (1.2±0.2) x 10 -3 mm 2 ·s -1 and 1.6±0.3 in the mass of intracranial tuberculomas respectively; (0.8±0.1) x 10 -3 mm 2 ·s -1 and 1.1±0.1 in the parenehyma of high-grade astrocytomas; (0.8±0.1) x 10 -3 mm 2 ·s -1 and 1.0±0.2 in the parenchyma of metastases. There was significant difference of the mean ADC values (F=33.57, P -3 mm 2 ·s -1 and 2.5±0.2 in the peripheral edema regions of intracranial tuberculomas respectively; (1.4±0.2) x 10 -3 mm 2 ·s -1 and 1.8±0.3 in the peripheral edema regions of high-grade astrocytomas; and (1.9±0.2) x 10 -3 mm 2 ·s -1 and 2.3±0.5 in the peripheral edema regions of metastases. There was also significant difference in the mean ADC values (F23.17, P<0.01) or rADC values (F=5.94, P<0.01) among the peripheral edema regions of the three groups. Conclusion: The ADC values and rADC values are quite effective in differentiating intracranial tuberculoma from high-grade astrocytoma and metastasis. (authors)

CT evaluation of mass lesions in the parotid region

International Nuclear Information System (INIS)

Matsumoto, Shunichi; Kishikawa, Takashi; Kudo, Sho; Miyaji, Hiroshi; Kuwano, Haruo; Kaneko, Kuniyuki; Ohuchida, Toshiyuki

1988-01-01

CT findings of 35 patients with proven 31 parotid gland mass lesions (23 benign tumors, 5 malignant tumors, 3 inflammatory diseases) and 4 infraauricular lymphadenopathy (2 inflammatory nodes, 2 neoplastic nodes) were reviewed. CT accurately diagnosed the parotid origin in 29 of 31 parotid gland diseases. In all four patients with infraauricular lymphadenopathy, differentiation from parotid tumor was difficult. CT differentiation between superficial and deep lobe tumors agreed with surgical findings in 18 of 21 parotid gland tumors. Twenty out of 23 benign parotid gland tumors appeared as discrete masses with smooth margins. All five malignant parotid gland tumors appeared as poorly defined masses. It is concluded that when a tumor is located in the superficial lobe and appears as a sharply circumscribed mass on plain CT, it should be diagnosed as a benign lesion and contrast CT is not required. Secondly, contrast CT would be beneficial when a tumor is indistinct, or located in the deep portion of the parotid gland on plain CT. Finally, CT-sialography is considered unnecessary in the diagnosis of parotid masses. (author)

Intracranial neurenteric cyst traversing the brainstem

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Jasmit Singh

2015-01-01

Full Text Available Neurenteric cysts (NECs, also called enterogenous cysts, are rare benign endodermal lesions of the central nervous system that probably result from separation failure of the notochord and upper gastrointestinal tract. Most frequently they are found in the lower cervical spine or the upper thoracic spine. Intracranial occurrence is rare and mostly confined to infratentorial compartment, in prepontine region [51%]. Other common locations are fourth ventricle and cerebellopontine angle. There are few reports of NEC in medulla or the cerebellum. Because of the rarity of the disease and common radiological findings, they are misinterpreted as arachnoid or simple cysts until the histopathological confirmation, unless suspected preoperatively. We herein report a rare yet interesting case of intracranial NEC traversing across the brainstem.

Exposure parameters of mammograms with and without mass lesions from a South African breast care centre

International Nuclear Information System (INIS)

Acho, Sussan N.; Boonzaier, Willem P. E.; Nel, Ina F.

2017-01-01

In South African breast care centres, full-field digital mammography units provide breast imaging services to symptomatic and asymptomatic women simultaneously. This study evaluated the technical exposure parameters of 800 mammograms of which 100 mammograms had obvious mass lesions in the fibro-glandular tissue. The average breast compression force of mammograms with mass lesions in the fibro-glandular tissue was 18.4% less than the average breast compression force of mammograms without mass lesions. The average mean glandular dose (MGD), tube potential (kV p ) and compressed breast thickness (CBT) values were 2.14 mGy, 30.5 kV p and 63.9 mm, respectively, for mammograms with mass lesions, and 1.45 mGy, 29.6 kV p and 56.9 mm, respectively, for mammograms without mass lesions. Overall, the average MGD and mean CBT of mammograms with mass lesion were significantly higher compared to those without mass lesions (p < 0.05), although there was no significant difference in their tube potentials (p > 0.05). (authors)

Importance of contrast-enhanced fluid-attenuated inversion reconvery magnetic resonance imaging in various intracranial pathologic conditions

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Lee, Eun Kyoung; Lee, Eun Ja; Kim, Sung Won; Lee, Yong Seok [Dept. of Radiology, Dongguk University Ilsan Hospital, Goyang(Korea, Republic of)

2016-02-15

Intracranial lesions may show contrast enhancement through various mechanisms that are closely associated with the disease process. The preferred magnetic resonance sequence in contrast imaging is T1-weighted imaging (T1WI) at most institutions. However, lesion enhancement is occasionally inconspicuous on T1WI. Although fluid-attenuated inversion recovery (FLAIR) sequences are commonly considered as T2-weighted imaging with dark cerebrospinal fluid, they also show mild T1-weighted contrast, which is responsible for the contrast enhancement. For several years, FLAIR imaging has been successfully incorporated as a routine sequence at our institution for contrast-enhanced (CE) brain imaging in detecting various intracranial diseases. In this pictorial essay, we describe and illustrate the diagnostic importance of CE-FLAIR imaging in various intracranial pathologic conditions.

Idiopathic intracranial hypertension: case report

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Iacob G.

2015-12-01

Full Text Available Idiopathic intracranial hypertension - IIH (synonymous old terms: benign intracranial hypertension - BIH, pseudotumor-cerebri - PTC it’s a syndrome, related to elevated intracranial pressure, of unknown cause, sometimes cerebral emergency, occuring in all age groups, especially in children and young obese womans, in the absence of an underlying expansive intracranial lesion, despite extensive investigations. Although initial symptoms can resolve, IIH displays a high risk of recurrence several months or years later, even if initial symptoms resolved. Results: A 20-year-old male, obese since two years (body mass index 30, 9, was admitted for three months intense headache, vomiting, diplopia, progressive visual acuity loss. Neurologic examination confirmed diplopia by left abducens nerve palsy, papilledema right > left. At admission, cerebral CT scan and cerebral MRI with angio MRI 3DTOF and 2D venous TOF was normal. Despite treatment with acetazolamide (Diamox, corticosteroid, antidepressants (Amitriptyline, anticonvulsivants (Topiramate three weeks later headache, diplopia persist and vision become worse, confirmed by visual field assessment, visual evoked potential (VEP. A cerebral arteriography demonstrate filling defect of the superior sagittal sinus in the 1/3 proximal part and very week filling of the transverse right sinus on venous time. Trombophylic profile has revealed a heterozygote V factor Leyden mutation, a homozygote MTHFR and PAI mutation justifying an anticoagulant treatment initiated to the patient. The MRI showed a superior sagittal sinus, right transverse and sigmoid sinus thrombosis, dilatation and buckling of the optic nerve sheaths with increased perineural fluid especially retrobulbar, discrete flattening of the posterior segment of the eyeballs, spinal MRI showed posterior epidural space with dilated venous branches, with mass effect on the spinal cord, that occurs pushed anterior on sagittal T1/T2 sequences cervical and

Germinoma with Involvement of Midline and Off-Midline Intracranial Structures

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Monica Graciela Loto

2014-01-01

Full Text Available Germinomas are malignant intracranial germ tumors, usually found in suprasellar regions. Less than 10% are localized in off-middle structures, and synchronous involvement of both structures has only exceptionally been published. A case of an 18-year-old male patient with progressive right-sided hemiparesis and panhypopituitarism was reviewed. Brain MRI showed a solid mass involving pituitary and hypothalamus with thickening of pituitary stalk, high intensity lesions on T2-weighted imaging in left internal capsule, caudate nucleus, globus pallidus, and mild atrophy of the left internal capsule and cerebral peduncle. Nonadenomatous lesions were considered in the differential diagnosis. Alfa-fetoprotein (AFP levels were negative in both serum and cerebrospinal fluid (CSF, while β-human chorionic gonadotrophin (β-HCG levels were slightly increased in CSF. A transsphenoidal biopsy identified a germinoma. Four cycles of chemotherapy with bleomicine, etoposide, and cysplatin were given, followed by radiotherapy, but patients died due to a recidiva. Conclusion. Germinoma must be considered in patients with insipidus diabetes with a sellar mass with thickening of pituitary stalk; and ectopic germinoma must be suspected in patients with slowly progressive hemiparesis with cerebral hemiatrophy. Even with a rare condition, colocalization of midline and off-midline germinoma must be suspected in the presence of these typical signs of both localizations.

Clinical application of MR susceptibility weighted imaging in intracranial hemorrhage

International Nuclear Information System (INIS)

Shen Baozhong; Wang Dan; Sun Xilin; Shen Hao; Liu Fang

2009-01-01

Objective: To assess the value of susceptibility weighted imaging (SWI) in the diagnosis of intracranial hemorrhage. Methods: Forty patients with intracranial hemorrhage underwent MRI scanning (GE Signa HDe 1.5 T), which included T 2 WI, T 1 WI, T 2 * WI and SWI. Of them, DWI was conducted in 37 eases and enhanced MRI was conducted in 10 cases additionally. After post processing on the workstation, both magnitude and phase images of SWI were acquired for further analysis. The images of all sequences were scored from 1 to 3, according to their ability of depicting the lesions. Statistical analysis was conducted to compare the scores among these sequences. Results: On SWI, the scores in detecting the lesions, their margin and adjacent veins were 2.8, 2.8, and 2.8 respectively. The scores of those were 1.8, 1.7, and 0.0 on T 1 WI, 2.3, 2.0 and 0.0 on T 2 WI, 2.0, 2.1 and 0.2 on T 2 * WI, respectively. There was statistical difference between the scores on SWI and those on T 1 WI, T 2 WI and T 2 * WI (P 1 WI, T 2 WI, DWI and T 2 * WI were 402, 55, 61, 84 and 188 respectively. There was statistical difference in showing micro hemorrhagic lesions between SWI and T 1 WI, T 2 WI, DWI, T 2 * WI (P 2 * WI in detecting intracranial hemorrhage, especially cerebral microbleeding. According to the features of the paramagnetic and diamagnetic lesions, radiologists can differentiate hemorrhage and calcification with phase images. (authors)

Intracranial hemorrhage: principles of CT and MRI interpretation

International Nuclear Information System (INIS)

Parizel, P.M.; Makkat, S.; Miert, E. van; Goethem, J.W. van; Hauwe, L. van den; Schepper, A.M. de

2001-01-01

Accurate diagnosis of intracranial hemorrhage represents a frequent challenge for the practicing radiologist. The purpose of this article is to provide the reader with a synoptic overview of the imaging characteristics of intracranial hemorrhage, using text, tables, and figures to illustrate time-dependent changes. We examine the underlying physical, biological, and biochemical factors of evolving hematoma and correlate them with the aspect on cross-sectional imaging techniques. On CT scanning, the appearance of intracranial blood is determined by density changes which occur over time, reflecting clot formation, clot retraction, clot lysis and, eventually, tissue loss. However, MRI has become the technique of choice for assessing the age of an intracranial hemorrhage. On MRI the signal intensity of intracranial hemorrhage is much more complex and is influenced by multiple variables including: (a) age, location, and size of the lesion; (b) technical factors (e.g., sequence type and parameters, field strength); and (c) biological factors (e.g., pO2, arterial vs venous origin, tissue pH, protein concentration, presence of a blood-brain barrier, condition of the patient). We discuss the intrinsic magnetic properties of sequential hemoglobin degradation products. The differences in evolution between extra- and intracerebral hemorrhages are addressed and illustrated. (orig.)

MO-AB-BRA-04: Correct Identification of Low-Attenuation Intracranial Hemorrhage and Calcification Using Dual-Energy Computed Tomography in a Phantom System

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Nute, J; Jacobsen, M; Popnoe, D [UT MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX (United States); UT Graduate School of Biomedical Sciences at Houston, Houston, TX (United States); Wei, W [UT MD Anderson Cancer Center, Department of Biostatistics, Houston, TX (United States); Baiu, C [Gammex Inc., Middleton, WI (United States); Schellingerhout, D [MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX (United States); Cody, D [UT MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX (United States)

2015-06-15

Purpose: Intracranial hemorrhage and calcification with Single-Energy CT (SECT) attenuation below 100HU cannot be reliably identified using currently clinically available means. Calcification is typically benign but hemorrhage can carry a risk of intracranial bleeding and contraindicate use of anticoagulant therapies. A biologically-relevant phantom was used to investigate identification of unknown intracranial lesions using dual-energy CT (DECT) as a verification of prior lesion differentiation results. Methods: Prior phantom work investigating calcification and hemorrhage differentiation resulted in 3D-DECT raw data (water density, calcium density, 68keV) for a range of DECT protocol variations: image thicknesses (1.25, 2.5, 3.75, 5mm), CTDIvol (36.7 to 132.6mGy) and reconstruction algorithms (Soft, Standard, Detail). Acquisition-specific raw data were used to create a plane of optimal differentiation based on the geometric bisector of 3D-linear regression of the two lesion distributions. Verification hemorrhage and calcification lesions, ranging in size from 0.5 to 1.5cm, were created at varying attenuation from 50 to 100HU. Lesions were inserted into a biologically-relevant brain phantom and scanned using SECT (3.75mm images, Standard, 67mGy) and a range of DECT protocols (3.75mm images, Standard, [67, 105.6, 132.6mGy]). 3D-DECT data were collected and blinded for analysis. The 3D-DECT distribution of the lesion was then compared to the acquisition-matched geometric bisector plane and the mean lesion value’s position relative to the plane, indicating lesion identity, and the percentage of voxels on the identified side of the plane, indicating identification confidence, were derived. Results: 98% of the 120 lesions investigated were identified correctly as hemorrhage or calcification. 74% were identified with greater than 80% confidence. Increases in CTDIvol and lesion diameter were associated with increased identification confidence. Conclusion: Intracranial

MRI findings of primary intracranial lymphoma on immunologically normal patients

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Kim, Ho Chul; Chang, Kee Hyun; Han, Moon Hee; Choi, Choong Gon [Seoul National University College of Medicine, Seoul (Korea, Republic of); Cha, Sang Hoon [Chonbuk National University College of Medicine, Chungju (Korea, Republic of)

1993-07-15

Magnetic resonance (MR) images of 14 consecutive patients with pathologically proven primary intracranial lymphoma were reviewed. All patients had a brain MR imaging before any treatment and were immunologically competent. MR images were acquired using 2.0 T (n=6) or 0.5 T (n=8) machine. The MR images were reviewed regarding the location, multiplicity, size, signal intensity, margin, shape, and the extent of surrounding edema of the lesions. Seven patients had multi lesions, 2 to 4 in number. A total of 26 lesions was found; 25 were parenchymal lesions and one was dural lesion. The location of tumor was either central (n=11) or peripheral (n=14). The size of tumor was variable raging from 0.6 cm to 6.0 cm in its maximal diameter. The tumors were isointense (n=19) or hypointense (n=7) relative to gray matter om T1-weighted images, isointense (n=24) or hypointense (n=2) on proton-density weighted images, and isointense (n=21) or hypointense (n=5) on T2-weighted images. On gadolinium-enhanced T1- weighted images of 13 patients, strong enhancement was seen in 22 of 23 lesion. Nineteen lesions showed smooth, well-defined margin, whereas remaining 7 lesions showed irregular, ill-defined margin. The shape of the tumor was diverse; round of ovoid (n=15), lobulated (n=9), or short linear (n=2). These results suggest that one should consider the diagnosis of CNS lymphoma in case with single or multiple masses that abut CSF space and show iso- or similar intensity to gray matter with strong enhancement on MR images.

Epilepsy in primary intracranial tumors in a neurosurgical hospital in ...

African Journals Online (AJOL)

Background: Seizures may be manifestation of intracranial tumor (IT) and demand thorough neurological evaluation. This paper examines epidemiology, lesion characteristics and outcome of seizures associated with primary IT. Methods: Retrospective analysis of medical records, computed tomography and magnetic ...

Analysis of Factors Related to Hypopituitarism in Patients with Nonsellar Intracranial Tumor.

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Lu, Song-Song; Gu, Jian-Jun; Luo, Xiao-Hong; Zhang, Jian-He; Wang, Shou-Sen

2017-09-01

Previous studies have suggested that postoperative hypopituitarism in patients with nonsellar intracranial tumors is caused by traumatic surgery. However, with development of minimally invasive and precise neurosurgical techniques, the degree of injury to brain tissue has been reduced significantly, especially for parenchymal tumors. Therefore, understanding preexisting hypopituitarism and related risk factors can improve perioperative management for patients with nonsellar intracranial tumors. Chart data were collected retrospectively from 83 patients with nonsellar intracranial tumors admitted to our hospital from May 2014 to April 2015. Pituitary function of each subject was determined based on results of preoperative serum pituitary hormone analysis. Univariate and multivariate logistic regression methods were used to analyze relationships between preoperative hypopituitarism and factors including age, sex, history of hypertension and secondary epilepsy, course of disease, tumor mass effect, site of tumor, intracranial pressure (ICP), cerebrospinal fluid content, and pituitary morphology. A total of 30 patients (36.14%) presented with preoperative hypopituitarism in either 1 axis or multiple axes; 23 (27.71%) were affected in 1 axis, and 7 (8.43%) were affected in multiple axes. Univariate analysis showed that risk factors for preoperative hypopituitarism in patients with a nonsellar intracranial tumor include an acute or subacute course (≤3 months), intracranial hypertension (ICP >200 mm H 2 O), and mass effect (P hypopituitarism in patients with nonsellar intracranial tumors (P hypopituitarism is high in patients with nonsellar intracranial tumors. The occurrence of hypopituitarism is correlated with factors including an acute or subacute course (≤3 months), intracranial hypertension (ICP >200 mm H 2 O), and mass effect (P hypopituitarism. Copyright © 2017 Elsevier Inc. All rights reserved.

Onyx combined with coiling embolization for endovascular treatment of complex intracranial ruptured aneurysms

International Nuclear Information System (INIS)

Wu Yongfa; Huang Qinghai; Yang Pengfei; Zhang Lei; Li Qiang; Liu Jianmin

2011-01-01

Objective: To study the therapeutic effect of Onyx combined with stent-assisted coiling in embolizing complex intracranial ruptured aneurysms. Methods: Onyx combined with stent-assisted coiling embolization was conducted in two patients with complex intracranial ruptured aneurysms. The clinical data were retrospectively analyzed. The related literature concerning intracranial complex aneurysm treated with Onyx was reviewed. Results: Two intracranial complex aneurysms were embolized with Onyx together with coils. The lesions were located at internal carotid arterial bifurcation (n=1) and at the anterior wall of internal carotid artery (n=1). Complete embolization of the aneurysms was achieved immediately after the procedure while the parent arteries remained patent. Conclusion: For the treatment of complex intracranial ruptured aneurysms Onyx combined with coiling embolization is safe, effective and feasible. This technique can improve the degree of embolization. To make the evaluation of the long-term efficacy further study is needed. (authors)

Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma

International Nuclear Information System (INIS)

Lee, K.-W.; McLeary, M.S.; Zuppan, C.W.; Won, D.J.

2000-01-01

An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma. (orig.)

Significance of computed tomography in the diagnosis of the mediastinal mass lesions

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Kimura, Masanori; Takashima, Tsutomu; Suzuki, Masayuki; Itoh, Hiroshi; Hirose, Jinichiro; Choto, Shuichi (Kanazawa Univ. (Japan). School of Medicine)

1983-08-01

Thirty cases of the mediastinal mass lesions were examined by computed tomography and diagnostic ability of CT was retrospectively evaluated. We devided them into two major groups: cystic and solid lesions. Cysts and cystic teratomas were differentiated on the thickness of their wall. Pericardial cysts were typically present at the cardiophrenic angle. In the solid mediastinal lesions, the presence of calcific and/or fatty components, the presence of necrosis, the irregularity of the margin and the obliteration of the surrounding fat layer were the clues to differential diagnosis and of evaluation for their invasiveness. Although differential diagnosis of the solid anterior mediastinal tumors was often difficult, teratomas with calcific and fatty componets were easily diagnosed. Invasiveness of the malignant thymoma and other malignant lesions were successfully evaluated to some extent. Neurogenic posterior mediastinal tumors were easily diagnosed because of the presence of the spine deformity and typical dumbbell shaped appearance. We stress that our diagnostic approach is useful to differentiate the mediastinal mass lesions.

Significance of computed tomography in the diagnosis of the mediastinal mass lesions

International Nuclear Information System (INIS)

Kimura, Masanori; Takashima, Tsutomu; Suzuki, Masayuki; Itoh, Hiroshi; Hirose, Jinichiro; Choto, Shuichi

1983-01-01

Thirty cases of the mediastinal mass lesions were examined by computed tomography and diagnostic ability of CT was retrospectively evaluated. We devided them into two major groups: cystic and solid lesions. Cysts and cystic teratomas were differentiated on the thickness of their wall. Pericardial cysts were typically present at the cardiophrenic angle. In the solid mediastinal lesions, the presence of calcific and/or fatty components, the presence of necrosis, the irregularity of the margin and the obliteration of the surrounding fat layer were the clues to differential diagnosis and of evaluation for their invasiveness. Although differential diagnosis of the solid anterior mediastinal tumors was often difficult, teratomas with calcific and fatty componets were easily diagnosed. Invasiveness of the malignant thymoma and other malignant lesions were successfully evaluated to some extent. Neurogenic posterior mediastinal tumors were easily diagnosed because of the presence of the spine deformity and typical dumbbell shaped appearance. We stress that our diagnostic approach is useful to differentiate the mediastinal mass lesions. (author)

MRI findings of intracranial cystic meningiomas

International Nuclear Information System (INIS)

Zhang, D.; Hu, L.-B.; Zhen, J.W.; Zou, L.-G.; Feng, X.-Y.; Wang, W.-X.; Wen, L.

2009-01-01

Aim: To report the magnetic resonance imaging (MRI) features of intracranial cystic meningiomas and compare these features in intra- and peritumoural cyst groups. Materials and methods: Fourteen cases of peritumoural cystic meningiomas were compared with 18 cases of intratumoural cystic meningiomas. All patients were examined using non-enhanced and contrast-enhanced MRI. Tumour location, tumour size, signal intensity, enhancement characteristics, and cystic changes were assessed. The MRI features were compared between the intra- and peritumoural cyst groups. Results: Most cystic meningiomas comprised two or more cysts. The solid parts of the tumours showed moderate or marked enhancement after the injection of contrast material. An enhanced cyst wall was found in six out of 14 cases in the peritumoural cyst group, but not in the intratumoural cyst group. Peritumoural cystic meningiomas were predominately located in the cerebral falx, whereas the intratumoural cystic meningiomas were predominantly found in frontal convexity (X 2 = 7.434, p = 0.024). The cysts were larger in the peritumoural cyst group than in the intratumoural cyst group (t = 5.274, p = 0.0258). Peritumoural oedema was more commonly found in the intratumoural cyst group (X 2 = 6.863, p = 0.008). Cystic meningiomas with solid parts located inside the cyst are reported for the first time. Conclusion: Cystic meningiomas, although uncommon, should be differentiated from other cystic intracranial lesions. Peri- and intratumoural cystic meningiomas have distinct MRI features. The present study provides the first report of two lesions with solid parts located inside the cyst, as well as one lesion with a calcified solid nodule and haemorrhage within the cyst.

Primary Intracranial Sarcoma Presenting as Chronic Subdural Fluid Collections in a Child.

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Glenn, Chad A; Fung, Kar-Ming; Tullos, Hurtis J; McNall-Knapp, Rene Y; Gunda, Divya; Mapstone, Timothy B

2016-02-01

Chronic subdural hematoma in the pediatric population often results from trauma. Asymptomatic and benign-appearing subdural collections are generally managed conservatively without operative intervention. Primary intracranial sarcomas are uncommon entities. Diagnosis of sarcoma can be difficult because these lesions often manifest as apparent hematoma. Presented is the case of a primary intracranial mucoid spindle cell sarcoma that arose in a child with a history of benign-appearing bilateral subdural fluid collections in the setting of nonaccidental trauma. The patient was initially managed conservatively because her neurological examination result was normal and her subdural collections decreased in size on repeated imaging. The collections did not resolve completely. Years later, she exhibited weakness, seizure, and an increase in the size of her subdural fluid collection. Subdural drainage was attempted without significant effect. Cytologic assessment of fluid was negative for malignant cells. Magnetic resonance imaging revealed multiple enhancing masses along the subdural collection. The patient eventually underwent craniotomy in which a diagnosis of sarcoma was obtained. Pathological and radiographic findings as well as oncological management are reviewed. The authors also review the natural history and treatment of primary intracranial sarcoma in the pediatric population. Early contrasted magnetic resonance imaging should be obtained in patients with subdural fluid collections that appear asymmetric or do not resolve in the expected time course, despite having a normal neurologic examination result. Negative cytologic assessment does not exclude sarcoma diagnosis. Copyright © 2016 Elsevier Inc. All rights reserved.

Monitoring of Intracranial Pressure During Intracranial Endoscopy

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Rajeev Kumar

2013-08-01

Full Text Available Background: Intracranial endoscopy is a minimum invasive procedure, which reduces trauma to the brain, is cost-effective, and carries a shortened hospital stay with an improved postoperative outcome. Objective: To monitor intracranial pressure changes during intracranial endoscopy among children and adults under general anesthesia/sedation, and to compare the intracranial pressure changes between children and adults receiving general anesthesia and among adults receiving general anesthesia and sedation. Methods: The present cross-sectional study was conducted in one of the tertiary care hospitals of Lucknow. This was carried out in the department of neurosurgery from January 2008 to December 2008. Patients who were not fit for general anesthesia received local anesthesia under sedation. Patients participating in the study were divided into three groups. Intracranial pressure was recorded at specific intervals. Parametric data were subjected to statistical analysis using a student\\s t test. Result: A total of 70 patients were undergoing intracranial endoscopy under general anesthesia during the study period. In both groups A and B, intracranial pressure increases the maximum during inflation of the balloon. In group C, all the variations in ICP were found to be statistically significant. In the comparison of intracranial pressure changes between groups A and B, no significant difference was found. All correlations in the comparison of groups B and C were found to be statistically significant (p< 0.001. Conclusion: There is a need for continuous intraoperative monitoring of ICP intracranial endoscopy, because ICP increases in various stages of the procedure, which can be detrimental to the perfusion of the brain. [Arch Clin Exp Surg 2013; 2(4.000: 240-245

Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma

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Lee, K.-W. [Department of Pediatrics, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); McLeary, M.S. [Div. of Pediatric Radiology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Zuppan, C.W. [Dept. of Pathology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Won, D.J. [Div. of Pediatric Neurosurgery, Loma Linda University Children' s Hospital, Loma Linda, CA (United States)

2000-05-01

An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma. (orig.)

MR study of intracranial disease with three-dimensional FLASH

International Nuclear Information System (INIS)

Runge, V.M.; Wood, M.L.; Kaufman, D.M.; Nelson, K.L.; Traill, M.R.; Wolpert, S.M.

1987-01-01

A three-dimensional FLASH technique was used to study 36 patients with intracranial disease at 1 T (Siemens Magnetom). This included 15 cases of intracranial neoplastic disease, four with the application of intravenous Gd-DTPA. Contiguous thin sections (1-2 mm thick) were acquired of the entire intracranial contents using one acquisition (scan time of 5-15 minutes). A MIPRON (KONTRON Instruments) image processing work station was used for rapid image display and 3D reconstruction. 3D FLASH was found to be superior to spin-echo imaging at 1 T for the detection of hemorrhage. 3D acquisition also provided superior localization of neoplastic disease. The T1 contrast achieved was comparable to spin-echo technique with a repetition time/echo time of .6/17. The advantages in terms of lesion localization and thin-section imaging with high spatial resolution of the entire brain may lead to use of 3D FLASH in place of conventional spin-echo imaging

Diagnostic Accuracy of CT in Paediatric Intracranial Neoplastic Lesions - Radiologic and Pathologic Correlation

International Nuclear Information System (INIS)

Qureshi, A.

2011-01-01

The frequency of paediatric tumours in developing countries could be attributed to the increased percentage (39% of total population of children) in the overall population. Therefore, extensive researches should be under taken in the field of Paediatric Oncology in the third world. Objective: This study was conducted to determine the diagnostic accuracy of CT by comparing the pre-operative radiological findings of paediatric brain tumours with post-operative histopathological findings on the basis of characteristic radiological features of various tumours. Materials and Methods: This was a hospital based prospective, cross-sectional and descriptive study carried out in Radiology Dept, KEMU / Mayo Hospital, Lahore. Study was conducted over a period of 3 years from June 2005 till June 2008 and comprised of 100 cases of paediatric brain tumours up to 12 years of age. Cases were also collected from Mayo and Children Hospital, Lahore. Results: Topographically, supratentorial tumours were found more than infratentorial 55 : 45. Low grade were more common than high grade 73 : 27. The most common tumour was astrocytoma with 52 cases. Medulloblastoma ranked the second with 16 cases followed by craniopharyngioma with 12 cases. Conclusion: The diagnostic accuracy of CT scan was found to be 83% when correlated with histopathology. CT proved fairly accurate in detection of paediatric intracranial neoplastic lesions. As CT is relatively commonly available inexpensive modality than MRI so it can be used as non invasive imaging modality. (author)

Dolichoectasia and dissection of the intracranial vertebrobasilar artery

International Nuclear Information System (INIS)

Stoyanov, D.; Boshnjakovich, P.; Zivkovic, M.

2001-01-01

The purpose is to determine the clinical neuro-radiological features of dolichoectatic intracranial vertebrobasilar artery dissection. The clinical features native and post-contrast CT scans of five patients (4 men and 1 woman; age ranged from 25 to 68 years) with dolichoectatic intracranial vertebrobasilar artery dissection were analysed retrospectively for a period of 3 years. Diagnosis was confirmed by vertebral angiography. Clinical symptoms due to ischemic cerebellar and/or brain stem lesion were present in 4 patient, 2 of them had Wallenberg syndrome. Occipital and/or posterior neck pains were found in 4 patients. Subarachnoid hemorrhage was shown in 1 patient. The incidence of previously documented hypertension was 60% (3 of 5 patients). The prognosis was relatively good. Dolichoectasia was detected by native, post-contrast CT scans and reconstructions in all patients. Intimal flap was visualized with post contrast CT scans in 1 patients. Extension of the basilar artery tip into the third ventricle was detected in 3 patients. Ischemic low-density lesions were detected in 3 patients and subarachnoid hemorrhage in 1 patient. Vertebral angiography disclosed elongation and dilatation of the vertebral and basilar arteries, double lumen sign - the presence of a true and false lumen and an intimal flap, double density and retention of contrast medium. Ischemic symptoms and head and/or neck pain were the most common clinical findings. The double lumen sign considered as the only pathognomonic angiographic finding of arterial dissection, was found in all patients. Angiography is still considered the 'gold standard' for diagnosis of intracranial vertebrobasilar artery dissection. (author)

Intracranial subdural hematoma coexisting with improvement in spontaneous intracranial hypotension after an epidural blood patch

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Cheng-Hsi Chang

2012-11-01

Full Text Available A 36-year-old male had spontaneous intracranial hypotension (SIH presenting with refractory headache for 4 months. Multiple epidural blood patches (EBPs yielded relief of symptoms, but the course was complicated, with asymptomatic intracranial subdural hematoma (SDH. Except for SDH, other radiological diagnostic signs of SIH were resolved and the patient’s headaches improved after EBP. Owing to a mass effect and persistent cerebrospinal fluid (CSF leakage, surgical repair of the spinal leakage was performed, but no cranial procedures were carried out. Postoperatively, the SDH completely resolved, but there was still CSF leakage at the level where surgery was performed. The patient has remained free of headache or other events for 3 years. It was reduction rather than elimination of the spinal CSF leak that yielded remission of SIH. In summary, intracranial SDH can be a complication of inadequately treated SIH (i.e. persistent minor CSF leakage. Management of SDH should focus on correction of the underlying SIH rather than craniotomy for hematoma evacuation.

Intracranial extramedullary hematopoiesis in patients with thalassemia: a case report and review of the literature.

Science.gov (United States)

Eskazan, Ahmet Emre; Ar, Muhlis Cem; Baslar, Zafer

2012-08-01

Extramedullary hematopoiesis (EH) is a compensatory phenomenon that results in the production of blood cell precursors outside the marrow in patients with chronic hemolytic anemia and ineffective erythropoiesis. EH usually involves the liver, spleen, and lymph nodes. It can also be found at paravertebral, intrathoracic, or pelvic locations. Intracranial EH is a rare entity and often asymptomatic but can sometimes lead to symptomatic tumor-like masses. Treatment options are controversial and include hypertransfusion, surgical excision, radiotherapy, and hydroxyurea (HU). Successful treatment of an intracranial EH mass with HU and blood transfusions in a beta-thalassemia major patient was discussed along with a review of the published literature on intracranial EH in thalassemia. In our patient, the extramedullary hematopoietic mass in the interhemispheric fissure showed a marked improvement after 6 months of HU and hypertransfusion therapy. In the English literature, there are a few cases with intracranial EH and thalassemia, which were treated with different treatment modalities, with different outcomes. There is no standard treatment approach in patients with symptomatic EH. HU with hypertransfusion regimen is a reasonable first-choice modality in treating intracranial EH masses. © 2012 American Association of Blood Banks.

CT-assisted localisation of intracranial processes

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Luft, C.; Trenkler, J.; Hammer, B.; Valencak, E.

1986-01-01

With the software developed for the SOMATOM DRH computerized tomograph it is possible to mix a ROI into the digital radiogram (topogram) for projection of a lesion, such as a tumor, onto the topogram plane; the software also allows an image reconstruction taking the topogram as a reference image (topogram-initiated reconstruction). Combining these two relatively simple methods, and adding distance measurements in two planes, the neurosurgeon has at his disposal an objective CT-assisted means of precisely localising intracranial processes before surgery.

MRI of intracranial germ cell tumours

International Nuclear Information System (INIS)

Sumida, M.; Uozumi, T.; Kiya, K.; Mukada, K.; Arita, K.; Kurisu, K.; Sugiyama, K.; Onda, J.; Satoh, H.; Ikawa, F.; Migita, K.

1995-01-01

We reviewed MRI findings in proven intracranial germ cell tumours in 22 cases, 12 of whom received Gd-DTPA. On T1-weighted images, the signal intensity of the tumour parenchyma was moderately low in 19 cases and isointense in 3; on T2-weighted images, it was high in all cases. Regions of different intensity thought to be cysts were found in 17 (77 %): 7 of 12 patients with germinoma (58 %) and in all other cases. Of the 13 patients with pineal lesions T1-weighted sagittal images showed the aqueduct to be obstructed in 5, stenotic in 7 and normal in 1. Strong contrast enhancement was observed in all 12 cases. Of the 14 patients with suprasellar lesions, 5 were found to have an intrasellar extension, and in 3 of these, the normal pituitary gland, which could be distinguished from the tumour, was displaced anteriorly. Ten patients (45 %) had multiple lesions. (orig.)

Low density lesion in solid mass on CT: Pathologic change and housfield number

International Nuclear Information System (INIS)

Han, Tae Il; Lim, Joo Won; Ryu, Kyung Nam; Ko, Young Tae; Song, Mi Jin; Lee, Dong Ho; Lee, Ju Hie

1994-01-01

We retrospectively reviewed the pathologic changes and housfield unit of the low density lesion in solid mass on CT. Pathologically proved solid mass was evaluated in regard to the shape and margin of the low density in the mass on the CT scans of 23 patient. The CT number of the low density lesion was correlated with the pathologic changes. Pathologic changes of the low density lesions were; necrosis (n=17), hemorrhage (n=13), cyst (n=4), myxoid degeneration (n=2), hyaline degeneration (n=1), fibrosis (n=1), and mixed cellularity (n=1). In 14 cases, more than 2 pathologic changes were seen. In 11 cases, necrosis was associated with hemorrhage. The CT number ranged from 11.5 to 44.9 Housfield unit(HU) (mean, 25.2 HU). The average CT number was 26.9 HU in hemorrhage and necrosis, 17.2 HU in cystic change, 20.9 HU in myxoid degeneration, 35.7 HU in hyaline de generation, 22.3 HU in fibrosis, and 21.4 HU in mixed cellularity. The hemorrhage and necrosis in 17 cases showed irregular margin, amorphous shape, and showed centrifugal distribution. The cystic change in 4 cases showed well defined margin, round shape, and peripheral location in solid mass. The low density lesions in solid mass on CT represented variable pathologic changes; necrosis, hemorrhage, cyst, myxoid degeneration, hyaline degeneration, fibrosis, and mixed cellularity. Pathologic changes would not be differentiated on the basis of CT number

Temporal lobe epilepsy due to meningoencephaloceles into the greater sphenoid wing. A consequence of idiopathic intracranial hypertension?

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Urbach, H.; Jamneala, G.; Mader, I.; Egger, K.; Yang, S. [Medical Center - Freiburg Univ. (Germany). Dept. of Neuroradiology; Altenmueller, D. [Medical Center - Freiburg Univ. (Germany). Dept. of Epileptology

2018-01-15

Antero-inferior temporal lobe meningoencephaloceles are a rare, but increasingly recognized cause of drug-resistant temporal lobe epilepsy (TLE). In order to evaluate whether these lesions are related to idiopathic intracranial hypertension (IIH), we analyzed clinical and MRI findings of a cohort of patients undergoing presurgical work-up. Seizure onset in the anterior temporal lobe was proven by EEG electrodes in 22 patients, and in 21 patients, anterior temporal lobectomy (mostly with sparing of the hippocampus) was performed. MRI signs of IIH (in particular empty sella) and the volumes of the ventricles and external CSF spaces were determined and related to the body mass index (BMI) and clinical outcome. Six of seven obese (BMI > 30 kg/m{sup 2}) compared to four of 15 non-obese patients had partial empty or empty sella (p = 0.007). Bilateral lesions were found in all obese and 11 patients. Seizure freedom (Engel class 1A) was achieved in 12 of 21 patients (5 obese compared to 7 non-obese patients). BMI was related to the volume of the external CSF spaces (r = 0.467), and age at seizure onset was higher in obese patients. Roughly a third of patients with temporal lobe epilepsy due to antero-inferior meningoencephaloceles is obese and has MRI signs of idiopathic intracranial hypertension. (orig.)

Targeting Accuracy of Image-Guided Radiosurgery for Intracranial Lesions: A Comparison Across Multiple Linear Accelerator Platforms.

Science.gov (United States)

Huang, Yimei; Zhao, Bo; Chetty, Indrin J; Brown, Stephen; Gordon, James; Wen, Ning

2016-04-01

To evaluate the overall positioning accuracy of image-guided intracranial radiosurgery across multiple linear accelerator platforms. A computed tomography scan with a slice thickness of 1.0 mm was acquired of an anthropomorphic head phantom in a BrainLAB U-frame mask. The phantom was embedded with three 5-mm diameter tungsten ball bearings, simulating a central, a left, and an anterior cranial lesion. The ball bearings were positioned to radiation isocenter under ExacTrac X-ray or cone-beam computed tomography image guidance on 3 Linacs: (1) ExacTrac X-ray localization on a Novalis Tx; (2) cone-beam computed tomography localization on the Novalis Tx; (3) cone-beam computed tomography localization on a TrueBeam; and (4) cone-beam computed tomography localization on an Edge. Each ball bearing was positioned 5 times to the radiation isocenter with different initial setup error following the 4 image guidance procedures on the 3 Linacs, and the mean (µ) and one standard deviation (σ) of the residual error were compared. Averaged overall 3 ball bearing locations, the vector length of the residual setup error in mm (µ ± σ) was 0.6 ± 0.2, 1.0 ± 0.5, 0.2 ± 0.1, and 0.3 ± 0.1 on ExacTrac X-ray localization on a Novalis Tx, cone-beam computed tomography localization on the Novalis Tx, cone-beam computed tomography localization on a TrueBeam, and cone-beam computed tomography localization on an Edge, with their range in mm being 0.4 to 1.1, 0.4 to 1.9, 0.1 to 0.5, and 0.2 to 0.6, respectively. The congruence between imaging and radiation isocenters in mm was 0.6 ± 0.1, 0.7 ± 0.1, 0.3 ± 0.1, and 0.2 ± 0.1, for the 4 systems, respectively. Targeting accuracy comparable to frame-based stereotactic radiosurgery can be achieved with image-guided intracranial stereotactic radiosurgery treatment. © The Author(s) 2015.

Intracranial germinoma: a clinical analysis of 33 cases

International Nuclear Information System (INIS)

Zhao Xiangfei; Kang Jingbo; Nie Qing; Zhang Jun; Jia Haiwei

2012-01-01

Objective: To analyze the characteristics of clinical symptoms, examinations, and treatments in patients with intracranial germinoma. Methods: Medical records of 33 cases with intracranial germinoma between January 2000 and January 2011 were retrospectively reviewed. Results: The study population consisted of 26 males and 7 females. Eighteen patients had a single tumor and 15 patients had multiple tumor. Twelve (36.4% ) were in the sellar region, 13 (39.4% ) in the pineal region, 5 cases (15.2% ) in basal ganglia and 9 cases in the periventricular region. Clinical manifestations: 21 patients (63.7% ) had headache, nausea and vomiting; 10 (30.3% ) had blurred vision and visual field damage; 11 (33.3% ) patients had diabetes insipidus and 7 patients (21.2% ) had limb weakness. Image study: MRI examination showed long T1, T2 or abnormal T1, T2 in MRI, which were enhanced equally by contrast medium. Diagnostic methods: 17 cases were confirmed by pathological diagnosis and 16 cases by diagnostic radiotherapy. Treatment: 3 cases underwent resection; 4 cases with obstructive hydrocephalus underwent ventriculoperitoneal shunt, and 10 patients underwent stereotactic surgery. All the patients underwent radiotherapy combined with chemotherapy. Symptoms were relieved obviously, but 2 patients had spinal cord metastasis. Conclusion: The increased intracranial pressure, polyuria, diplopia are the most common clinical symptoms of intracranial germ cell tumors. Common locations of lesions are the saddle area and pineal region. The whole brain + local radiotherapy combined with chemotherapy treatment is a common and effective modality for intracranial germinoma. Most patients have clinical symptoms remission and long survival. (authors)

On the CT-diagnosis of optic nerve lesions. Differential diagnostic criteria

International Nuclear Information System (INIS)

Unsoeld, R.

1982-01-01

Computed tomograms of 166 optic nerve lesions were analyzed: 97 were mainly orbital and 69 mainly intracranial. The criteria were clinical course, size, density and delineation of the optic nerve shadow, orbital and cerebral soft tissue abnormalities, and bony changes in the optic canal. Characteristic CT features are described of individual disease entities such as optic gliomas, optic nerve sheath meningiomas, neoplastic and inflammatory infiltrations. The differential diagnostic importance of individual CT criteria is evaluated and discussed. Simultaneous visualization of orbital and intracranial soft tissue changes as well as bony changes in the optic canal allow the location and identification of the majority of optic nerve lesions based on the criteria mentioned above, and optic nerve tumors can be differentiated. In 9 patients with optic neuritis due to clinically proven encephalitis and in 17 patients with total optic atrophy, no changes in the size of the optic nerve could be found. CT evaluation of the intraorbital portion of the optic nerve requires special examination techniques. Oblique computer reformations through the optic canal provide excellent visualization of bony changes in the optic canal. The exclusion of intracranial causes of optic nerve lesions requires intravenous injection of contrast material. (orig.) [de

Can a Morel-Lavallée lesion be misdiagnosed as a mass like lesion?

Science.gov (United States)

Lee, Yoon Jae; Kim, Jun Hyeok; Kim, Ji Young; Han, Hyun Ho

2017-12-01

The Morel-Lavallée lesion (MLL) is a post-traumatic closed soft tissue degloving injury. Common complaints of MLL patients are a haematoma or fluid collection on the trunk or the lower extremity. However, the authors introduce unique cases of MLL that present an atypical appearance. The fluid collection was not apparent, and the capsule formation was not detected on preoperative image study. The main complaint of patients was the uncomfortable mass-like lesion that was regarded as a simple benign lump. The purpose of this case study is to introduce the atypical cases of MLL and to help other physicians make accurate diagnosis based on trial and error of our cases. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Factors influencing local control and survival for patients undergoing stereotactic radiosurgery for intracranial metastases

International Nuclear Information System (INIS)

Suh, John H.; Barnett, Gene H.; Sohn, Jason W.; Fernandez-Vicioso, Eduardo; Kupelian, Patrick A.

1996-01-01

PURPOSE: To identify factors affecting local control and survival for patients undergoing stereotactic radiosurgery for intracranial metastases. MATERIALS AND METHODS: From 3/90-10/95, 99 patients (median age 58, range 29-83; 44 women, 55 men) with asymptomatic or mildly symptomatic intracranial metastases measuring < 4 cm in diameter and ≥ 1 cm from optic chiasm and Karnofsky Performance Status (KPS) ≥ 70 underwent modified linear accelerator-based stereotactic radiosurgery (SRS). Patients characteristics included 20 with recurrent disease, 66 with solitary lesions, and 42 with systemic disease. Forty six patients underwent surgical resection prior to SRS (16 biopsy, 3 subtotal resection (STR), and 21 gross total resection (GTR)). Eighty of 99 patients underwent whole brain radiation treatments (median 4005 cGy/15 fx, range 2200-6000 cGy). A total of 154 lesions were treated with 143 being evaluable on follow-up CT or MRI scans. Radiosurgery parameters (median) were the following: volume 2.8 cc (range 0.1-38 cc) and a peripheral dose of 1700 cGy (range 500-2400 cGy) with normalization to the 80% line (range 50-90%). Survival was measured from the date of SRS. Local control was defined as stabilization or decrease in size of the intracranial lesion(s). RESULTS: The following factors were analyzed with respect to local control and survival: 1) solitary vs. multiple lesions, 2) Age < or ≥ 60, 3) sex, 4) radiosensitive vs. radioresistant (renal cell and melanoma) histologies, 5) recurrent vs. newly diagnosed lesions, 6) KPS (70-80 vs. 90-100), 7) extent of surgery (biopsy vs. STR/GTR), 8) use of whole brain radiation treatments, 9) absence or presence of systemic disease, 10) dose (< or ≥ 1500 cGy) and 11) volume (< or ≥ 3 cc). On univariate analysis, survival was significantly influenced by female sex, presence of solitary lesion, absence of systemic disease, and extent of surgery. On multivariate analysis, female sex (p=0.0037), absence of systemic disease

Magnetic resonance imaging (MRI) of intracranial chordomas

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Fukuda, Teruo; Inoue, Yuichi; Shakudo, Miyuki and others

1988-03-01

MR images of 5 patients with intracranial chordoma were evaluated and compared with those of other clival lesions (1 clival osteomyelitis, 1 metastatic clival tumor, 3 clival meningiomas). The MR examination was performed using a 0.5 T superconductive magnet, with approximately 10 mm section thickness, one average and a 256 x 256 matrix. T1 weighted images were obtainned by inversion recovery (IR) with TR 2100 - 2500 msec, TI 600 msec and TE 40 msec. T2 weighted images were obtained by spin echo pulse sequence with TR 1800 - 2500 msec and TE 120 msec (long SE). In several cases, the spin echo pulse sequences with TR 1000 msec and TE 40 msec (short SE) were also done. Multiplaned images were obtained. Four of 5 intracranial chordomas were low in intensity compared to cerebral gray matter on T1 weighted images, and all of 5 chordomas were as high in intensity as cerebrospinal fluid or higher than that of cerebrospinal fluid on T2 weighted images. Clival fatty marrow is high intensity on T1 weighted images. Clival involvement by a tumor was a clearly demonstrated as disappearance of this high intensity in all cases. In two cases, the tumor extended to the retropharyngeal space and this was detected clearly on short SE image. Although clival fatty marrow was disappeared, osteomyelitis and metastatic tumor in clivus were iso-intense to cerebral gray matter on both T1 and T2 weighted images. All of 3 clival meningiomas showed iso-intensity to cerebral gray matter on T1 weighted images and slightly high intensity to brain on T2 weighted images, and clival fatty marrow was normal in all 3 cases. Although our experiences are limited in number, intracranial chordoma appeared to be differentiated from other clival lesions.

Holographic observation of magnetic resonance image CT of intracranial tumors

International Nuclear Information System (INIS)

Iwata, Kinjiro; Watanabe, Saburo; Yuasa, Hiromi; Yamada, Takahisa; Hoshino, Daisaku; Suzuki, Masane; Saito, Takayuki.

1987-01-01

In 1975, we developed a new method of 3-dimensional observation of CT pictures using Gabor's holography principle. In this study, we are reporting our experience with the multi-tomogram holography using magnetic resonance image CT in order to reconstruct 3-dimensional viewing of the central nervous system and intracranial lesions. (J.P.N.)

CT-assisted localisation of intracranial processes

International Nuclear Information System (INIS)

Luft, C.; Trenkler, J.; Hammer, B.; Valencak, E.

1986-01-01

With the software developed for the SOMATOM DRH computerized tomograph it is possible to mix a ROI into the digital radiogram (topogram) for projection of a lesion, such as a tumor, onto the topogram plane; the software also allows an image reconstruction taking the topogram as a reference image (topogram-initiated reconstruction). Combining these two relatively simple methods, and adding distance measurements in two planes, the neurosurgeon has at his disposal an objective CT-assisted means of precisely localising intracranial processes before surgery. (orig.) [de

Epidemiology and genetics of intracranial aneurysms

International Nuclear Information System (INIS)

Caranci, F.; Briganti, F.; Cirillo, L.; Leonardi, M.; Muto, M.

2013-01-01

Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

Epidemiology and genetics of intracranial aneurysms

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Caranci, F., E-mail: ferdinandocaranci@libero.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Briganti, F., E-mail: frabriga@unina.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Cirillo, L.; Leonardi, M. [Neuroradiology service, Bellaria Hospital, Bologna (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Service Cardarelli Hospital Naples (Italy)

2013-10-01

Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

Management strategies for neoplastic and vascular brain lesions presenting during pregnancy: A series of 29 patients

OpenAIRE

Celestino Esteves Pereira; Jose Carlos Lynch

2017-01-01

Background: The occurrence of a brain tumor or intracranial vascular lesion during pregnancy is a rare event, but when it happens, it jeopardizes the lives of both the mother and infant. It also creates challenges of a neurosurgical, obstetric, and ethical nature. A multidisciplinary approach should be used for their care. Methods: Between 1986 and 2015, 12 pregnant women diagnosed with brain tumors and 17 women with intracranial vascular lesion underwent treatment at the Neurosurgery Departm...

Magnetic resonance imaging of primary intracranial tumors: a review

International Nuclear Information System (INIS)

Holland, B.A.; Brant-Zawadzki, M.; Norman, D.; Newton, T.H.

1985-01-01

The experience in magnetic resonance (MR) imaging of primary intracranial neoplasia at University of California, San Francisco is reviewed. Seventy patients have been evaluated by MR and computerized tomography (CT). MR scans were performed using a multi-slice spin echo technique with a long pulse repetition time (TR = 2000 msec), and long echo sampling delay (TE = 56 msec). This method was most sensitive in differentiating normal gray and white matter and in detecting both cerebral edema and abnormal tissue with prolonged T 2 characteristics. More sensitive to slight alterations in normal tissue, MR may detect a focal lesion in cases in which CT shows only mass effect. Moreover, MR may demonstrate more thoroughly the extent of tumor infiltration and broaden the characterization of abnormal tissue. Posterior fossa and brainstem anatomy are invariably better depicted by MR. The major limitations of MR include its inability to detect foci of tumor calcification, demonstrate the severity of bone destruction, or reliably distinguish tumor nidus from surrounding edema

Hemorrhagic intracranial inflammatory pseudotumor originating from the trigeminal nerve: a case report.

Science.gov (United States)

Jung, Tae-Young; Jung, Shin; Lee, Min-Cheol; Moon, Kyung-Sub; Kim, In-Young; Kang, Sam-Suk; Kim, Soo-Han

2006-01-01

We report here on a case of intracranial inflammatory pseudotumor arising from the trigeminal nerve. A 52-year-old man presented with sudden onset severe headache. He had had facial numbness several months earlier and no signs indicating infection. On the computerized tomography scan, intracranial hemorrhage was detected at the cerebellopontine angle. Magnetic resonance imaging demonstrated a 2.7-cm-sized, homogenously enhancing mass. A provisional diagnosis of trigeminal schwannoma was made, and suboccipital craniotomy was then performed. The mass was encapsulated and had multiple capsular veins. There was a evidence of intratumoral bleeding. It originated from the trigeminal root and was adhered to the 4th cranial nerve. Pathologic examination showed fibrovascular tissue with dense infiltrates of plasma cells and lymphocytes, some histiocytes, and occasional neutrophils and eosinophils. It showed immunopositivity for leukocyte common antigen (LCA) and immunonegativity for S-100 and lysozyme. It was also immunopositive for EBV antigen. Intracranial inflammatory pseudotumors mostly arise from dural/meningeal structures in the intracranial location. This case is the first to describe an intracranial inflammatory pseudotumor originating from a cranial nerve. The pathologic examination supported the postinfection hypothesis out of several possible pathologic mechanisms.

Large Morel-Lavallée lesion presenting as fungating mass with skin ulceration.

Science.gov (United States)

Ryan, Christine E; Wachtel, Sarah; Leef, George; Ozdalga, Errol

2016-01-01

A Morel-Lavallée lesion, a type of soft tissue degloving injury that has also been referred to as a chronic expanding hematoma, is a relatively rare condition that usually develops following traumatic injury. Here, we present a case of a 60-year-old male with a Morel-Lavallée lesion diagnosed over 5 years after a traumatic injury of the hip. He presented with a large fungating mass and overlying skin ulceration, which was highly suspicious for sarcoma. However, lack of other systemic findings and constitutional complaints, as well as negative imaging studies, did not support a diagnosis of malignancy. This information, combined with the history of remote trauma to the affected area, instead led us to suspect the alternative diagnosis of a Morel-Lavallée lesion. The diagnosis was later confirmed by pathology showing a chronic expanding hematoma. To our knowledge, a Morel-Lavallée lesion presenting as a fungating mass has not been previously described.

Unfavorable surgical outcomes in partial epilepsy with secondary bilateral synchrony: Intracranial electroencephalography study.

Science.gov (United States)

Sunwoo, Jun-Sang; Byun, Jung-Ick; Moon, Jangsup; Lim, Jung-Ah; Kim, Tae-Joon; Lee, Soon-Tae; Jung, Keun-Hwa; Park, Kyung-Il; Chu, Kon; Kim, Manho; Chung, Chun-Kee; Jung, Ki-Young; Lee, Sang Kun

2016-05-01

Secondary bilateral synchrony (SBS) indicates bilaterally synchronous epileptiform discharges arising from a focal cortical origin. The present study aims to investigate SBS in partial epilepsy with regard to surgical outcomes and intracranial EEG findings. We retrospectively reviewed consecutive patients who underwent epilepsy surgery following extraoperative intracranial electroencephalography (EEG) study from 2008 to 2012. The presence of SBS was determined based upon the results of scalp EEG monitoring performed for presurgical evaluations. We reviewed scalp EEG, neuroimaging, intracranial EEG findings, and surgical outcomes in patients with SBS. We found 12 patients with SBS who were surgically treated for intractable partial epilepsy. Nine (75%) patients had lateralized ictal semiology and only two (16.6%) patients showed localized ictal onset in scalp EEG. Brain MRI showed epileptogenic lesion in three (25%) patients. Intracranial EEG demonstrated that ictal onset zone was widespread or non-localized in six (50%) patients. Low-voltage fast activity was the most common ictal onset EEG pattern. Rapid propagation of ictal onset was noted in 10 (83.3%) patients. Eleven patients underwent resective epilepsy surgery and only two patients (18.2%) achieved seizure-freedom (median follow-up 56 months). MRI-visible brain lesions were associated with favorable outcomes (p=0.024). Patients with SBS, compared to frontal lobe epilepsy without SBS, showed lesser localization in ictal onset EEG (p=0.029) and more rapid propagation during evolution of ictal rhythm (p=0.015). The present results suggested that resective surgery for partial epilepsy with SBS should be decided carefully, especially in case of nonlesional epilepsy. Poor localization and rapid spread of ictal onset were prominent in intracranial EEG, which might contribute to incomplete resection of the epileptogenic zone and poor surgical outcomes. Copyright © 2016 Elsevier B.V. All rights reserved.

CT findings of skull tumors forming subcutaneous masses

International Nuclear Information System (INIS)

Niida, Hirohito; Takeda, Norio; Onda, Kiyoshi; Tanaka, Ryuichi

1991-01-01

Some characteristics of CT findings in 27 patients with skull tumors forming subcutaneous tumors were studied. There were sixteen metastatic skull tumors, six primary skull tumors, and five meningiomas. A CT scan was found to be helpful in the diagnosis of the lesions. Especially, bone-window CT images proved very sensitive in the detection of destructive and permeative lesions of the skull. In 19 of the 27 cases, some lytic lesions were observed. In all cases with skull metastasis from carcinomas, a complete osteolytic change of the skull was observed. Furthermore, all of the metastatic tumors from thyroid carcinoma showed well circumscribed and homogeneously enhanced lesions, in contrast with the other metastatic carcinomas, which usually showed heterogeneously enhanced lesions with irregular margins. Osteoblastic changes were characteristically observed in all cases of meningiomas, osteosarcoma, and chondrosarcoma. Meningiomas were located mainly in the intracranial region and extended extracranially. In one case of malignant lymphoma, one of a neuroblastoma, and one of leukemia, there was little or no gross cortical bone change, despite a large mass. (author)

Primary intracranial leiomyoma: case report

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Lai, P.H.; Yang, C.F.; Yeh, L.R.; Pan, H.B. [Department of Radiology, Veterans General Hospital-Kaohsiung, National Yang Ming University, National Defence Medical Centre, 386 Ta-Chung First Rd., Kaohsiung 813, Taiwan (Taiwan, Province of China); Huang, C.H. [Department of Neurosurgery, Veterans General Hospital-Kashsiung, National Yang Ming University, National Defence Medical Centre, Kashsiung, Taiwan (Taiwan, Province of China); Lin, S.L. [Department of Pathology, Veterans General Hospital-Kaohsiung, National Yang Ming University, National Defence Medical Centre, Taiwan (Taiwan, Province of China)

1998-04-01

We present a case of intracranial parenchymal leiomyoma in a 20-year-old woman with a chief complaint of numbness and a painful sensation over the right limbs for several years. CT and MRI revealed an intensely enhancing calcified mass. The patient was well, without recurrence, 2 years after surgery. (orig.) With 2 figs., 13 refs.

Localized pulmonary crystal-storing histiocytosis complicating pulmonary mucosa-associated lymphoid tissue lymphoma presenting with multiple mass lesions.

Science.gov (United States)

Kokuho, Nariaki; Terasaki, Yasuhiro; Kunugi, Shinobu; Onda, Naomi; Urushiyama, Hirokazu; Terasaki, Mika; Hino, Mitsunori; Gemma, Akihiko; Hatori, Tsutomu; Shimizu, Akira

2017-07-01

Crystal-storing histiocytosis (CSH) is an uncommon finding in lymphoplasmacytic disorders that presents histiocytes with abnormal intralysosomal accumulations of immunoglobulin light chains as crystals of unknown etiology. A 38-year-old woman with antiphospholipid syndrome had a surgical lung biopsy because of multiple lung mass lesions. In a right middle lobe lesion, lymphoplasmacytic cells had a monocytoid appearance, destructive lymphoepithelial lesions, and positive immunoglobulin heavy chain (IGH) gene rearrangements. A right upper lobe lesion manifested proliferating rounded histiocytes with abundant, deeply eosinophilic cytoplasm and negative IGH gene rearrangements. Electron microscopy and mass spectrometry revealed a case of pulmonary CSH: abnormal proliferation of the immunoglobulin κ chain of a variable region that may be crystallized within plasma cells and histiocytes. We report a rare case of localized pulmonary CSH complicating pulmonary mucosa-associated lymphoid tissue lymphoma with multiple mass lesions. We demonstrate advances in the understanding of the pathogenesis of CSH by various analyses of these lesions. Copyright © 2017 Elsevier Inc. All rights reserved.

Extracranial-intracranial bypass in medial sphenoid ridge meningioma associated with severe stenosis of the intracranial segments of the internal carotid artery: A case report.

Science.gov (United States)

Huang, Yabo; Wang, Zhong; Han, Qingdong

2018-06-01

Tumor resection and extracranial-intracranial bypass concerning medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery (ICA) of intracranial segments has been rarely presented. Effective treatment as to the complex lesions may be complicated. Tumor resection and cerebrovascular protection should be both taken into consideration. We presented one case of medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery of intracranial segments. The patient suffered hyperthyroidism, mirror-image dextrocardia and congenital heart disease atrial septal defect simultaneously. Before the neurosurgical treatment , the colleagues of department of cardiac surgery, anesthesiology and respiratory medicine agreed on our plan of resecting the tumor following the comprehensive evaluation of basal clinical conditions in the patient. For reducing the bleeding intraoperatively, the interventional branch performed digital subtraction angiography(DSA) and found collateral anastomosis between the supplying vessels of left middle meningeal arteries and anterior choroid arteries. No preoperative interventional embolization was determined considering the risk of cerebral ischemia. The following subtotal resection of medial sphenoid ridge meningioma and left extracranial-intracranial bypass were carried out. Additionally, ipsilateral decompressive craniectomy was done. Post-operative imaging Computed tomography (CT), Computed tomography angiography (CTA) and Transcranial Doppler (TCD) indicated subtotal resection of tumor and bypass patency. The patient was discharged with the right limbs of muscle strength of grade IV. The muscle strength of the patient returned to grade V after 6 months of follow-up. Comprehensive treatment of tumor resection and extracranial-intracranial bypass concerning medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery of intracranial segments is

Primary brain tumor presenting as intracranial hemorrhage

International Nuclear Information System (INIS)

Tsunoda, Shigeru; Sakaki, Toshisuke; Miyamoto, Seiji; Kyoi, Kikuo; Utsumi, Shozaburo; Kamada, Kitaro; Inui, Shoji; Masuda, Akio.

1989-01-01

Ten cases of primary brain tumor presenting as intracranial hemorrhage were studied in terms of the radiological and histological findings. The cases having hemorrhage in the tumor, as established through CT or histologically, were excluded if their onsets were not sudden due to intracranial hemorrhages. The results obtained may be summarized as follows: 1) From an anatomical point of view, cerebral subcortical hemorrhages account for 80%; hemorrhages in the cerebellopontine angle, 10%, and hemorrhages in the basal ganglia, 10%. 2) Plain CT findings showed perifocal low-density areas within 24 hours after onset in all 10 cases. 3) Enhanced CT findings showed enhanced areas in 4 or 6 cases. 4) Angiographic findings revealed abnormalities besides the mass effect in 5 of the 10 cases. 4) Angiographic findings revealed abnormalities besides the mass effect in 5 of the 10 cases. 5) From a histological point of view, glioblastomas account for 30%; malignant astrocytomas, 20%; astrocytomas, 20%; malignant ependymomas, 10%; hemangioblastoma, 10%, and transitional meningiomas, 10%. In conclusion, a perifocal low-density area on CT within 24 hours after onset is the most meaningful indication of intracranial hemorrhage originating from a brain tumor. A histological 'perinuclear halo' in an astrocytoma as an artifact due to hemorrhage may often be misleading in diagnosing mixed oligo-astrocytomas. (author)

Computed tomographic spectrum of intracranial mycosis: correlation with histopathology

International Nuclear Information System (INIS)

Whelan, M.A.; Stern, J.; deNapoli, R.A.

1981-01-01

Four cases of intracerebral fungal infection are reviewed. The clinical course is outlined, and the computed tomographic (CT) characteristics are analyzed in light of known pathological data. The CT appearance of intracranial mycosis is dependent on the type of fungus as well as the dominant infecting form, i.e., yeast or hyphae. The hyphal form leads predominantly to a CT pattern consistent with vascular occlusion and secondary abscess formation; the yeast form generally results in noncaseating granulomas, which appear on CT scan as nodular enhancing lesions. If the patient survives the acute infective process, these fungal lesions undergo a prolonged subacute phase, and may eventually calcify

Pittsburgh compound B (PiB) PET imaging of meningioma and other intracranial tumors.

Science.gov (United States)

Johnson, Derek R; Hunt, Christopher H; Nathan, Mark A; Parisi, Joseph E; Boeve, Bradley F; Murray, Melissa E; Knopman, David S; Jack, Clifford R; Petersen, Ronald C; Lowe, Val J; Johnson, Geoffrey B

2018-01-01

Meningiomas are the most common intracranial tumors. Diagnosis by MRI is generally straightforward, but lack of imaging specificity can present a diagnostic dilemma, particularly in patients with cancer. We report our experience with meningioma identification on Pittsburgh compound B (PiB) PET/CT. Patients who underwent PiB PET/CT from 2006 to 2015 were reviewed to identify those with intracranial tumors. Tumor types were classified by MR appearance, or by pathology when available. Maximum standardized uptake value (SUVmax) measurements of tumor PiB activity were compared across tumor types. 2472 patients underwent PiB PET/CT in the period of interest; 45 patients (1.8%) had probable or definite intracranial tumor. Tumor types were meningioma (29/45, 64%), vestibular schwannoma (7/45, 16%), pituitary macroadenoma (4/45, 9%), metastatic disease (2/45, 4%), and others (3/45, 7%). In patients with meningioma, the mean lesion SUVmax was 2.05 (SD 1.37), versus 1.00 (SD 0.42) in patients with non-meningioma tumors (p < 0.01). A receiver operating curve was created for lesion:cerebellum SUVmax ratio, with an area under the curve of 0.91 for a value of 1.68. At or above this ratio, specificity for meningioma was 100% (95% CI 79-100%) and sensitivity was 76% (95% CI 57-90%). PiB PET activity within an intracranial tumor is a highly specific and reasonably sensitive marker of meningioma. Further prospective evaluation is warranted to validate this result as well as to assess the performance of commercially available beta-amyloid radiotracers in meningioma identification.

Brugada-like Precordial ST Elevation on ECG by Anterior Mediastinal Infective Mass Lesion

Directory of Open Access Journals (Sweden)

Yuji Nakazato

2003-07-01

Full Text Available Several causes are known to induce the right precordial ST elevation mimicking Brugada syndrome. Right ventricular outflow area is assumed to be responsible for such ECG changes. We experienced a case of anterior mediastinal infective mass lesion with a Brugada-like ECG. A 52-year-old female, who has pulmonary stenosis and recurrent episodes of right ventricular heart failure, complained of high fever, abdominal discomfort, and edema. On physical examination, jugular vein dilation, hepatomegaly, and facial and leg edema were noted. Leucocytosis was also noted on blood examination. An ECG showed right ventricular hypertrophy, incomplete right bundle branch block pattern and marked ST elevation on precordial leads mimicking Brugada syndrome. Magnetic resonance imaging revealed an abnormal mass shadow located on the anterior mediastinum and compressing the right ventricle (Figure 1A. Trans-thoracic echocardiography also showed the high echogenic mass lesion at the anterior side of right ventricle and the vicinity of pulmonary valve. After treatment with antibiotics, the mass lesion gradually shrunk. Concomitantly, the ST elevation disappeared with improvement of inflammatory markers (Figure 1B. The symptoms suggesting right ventricular failure were also ameliorated. The mechanism of Brugada-like ST elevation in this patient was considered to be compression, by the abnormal infective mass, of the right ventricular outflow tract with/without focal pericardial inflammation.

Correlation of proton MR spectroscopy of primary intracranial tumours and histopathological findings: preliminarily findings

International Nuclear Information System (INIS)

Mandel, C.; Birchall, D.; Ellison, D.; Crawford, P.J.

2002-01-01

Full text: Proton MR spectroscopy is becoming more widely available in the clinical setting, and is increasingly used for the analysis of focal intracranial mass lesions. Several papers have indicated that MR spectroscopy can be applied not only to the differentiation of tumour from non-neoplastic pathologies, but that it may also have a role in the grading of differing histological grades of tumour. MR spectroscopy has therefore been proposed as a means of non-invasive biopsy, but its validation in this context is a necessary prerequisite for its use in this manner. Currently at our centre, all patients undergoing surgical biopsy for intracranial tumour are being imaged preoperatively with proton MR spectroscopy, and comparison made with the histopathological findings. To date, 20 patients (12 male, 8 female, age range 24-72) with primary intracranial tumour have been included in the study. Patients were imaged with conventional MR scanning and proton MR spectroscopy on a Philips Intera 1.5T scanner. Chemical shift spectroscopy was performed in each case (TR 2000 msec, TE 272 msec, slice thickness 20mm, acquisition time 15:53) in an axial plane at the level of tumour. Voxels were chosen within the lesion and within remote normal appearing white matter, and the corresponding spectra were interrogated. The heights of the peaks corresponding to choline (Cho), creatine (Cr), N-acetyl aspartate (NAA) and lactate / lipid (Lip) were measured using a semi-quantitative scale. Cho:NAA, Cho:Cr, Cho: Chonormal, Cho:Crnormal, Lip:Crnormal, Chonormal:NAAnormal and Chonormal:Crnormal ratios were calculated. Biopsy was performed by the neurosurgical team, and histopathological analysis performed by a single consultant neuropathologist. Histological analysis demonstrated 10 glioblastomas, 4 anaplastic astrocytomas and 6 low grade gliomas. Spectral analysis demonstrated a mean Cho:NAA and Cho:Cr of 0.3 and 0.8 respectively for normal white matter. Cho:NAA and Cho:Cr were

A case of multiple intracranial tuberculomas accompanied by tuberculous meningitis

International Nuclear Information System (INIS)

Fukabori, Takashi; Takamatsu, Hajime; Nakanishi, Yasuhiro

1986-01-01

A 63-year-old man was admitted for headache and progressive drowsiness. In spite of negative results from cerebrospinal fluid (CSF) stains and cultures of tuberculosis and other bacteria, CSF findings and tuberculosis-positive sputum culture led to a tentative diagnosis of tuberculous meningitis. Symptoms and neurological test results both improved remarkably during antituberculous chemotherapy. Although the brain CT scan taken on admission showed no abnormal findings, one taken two months later revealed multiple high-density areas after enhancement with a contrast medium, suggesting multiple intracranial tuberculomas accompanied by tuberculous meningitis. The size of the multiple high-density areas gradually decreased during antituberculous chemotherapy. The CT scan can clearly locate lesions, detect complications, and evaluate the effects of treatment in patients with intracranial tuberculosis. (author)

A facial lesion … the face of cutaneous tuberculosis

African Journals Online (AJOL)

Lesions of the facial skin can be difficult to diagnose in the absence ... Treatment. The Standard WHO regimen was started with rifampicin, isoniazid, pyrazinamide and ethambutol for .... evidence of midline shift or of signs of raised intracranial.

Quantitative magnetic resonance techniques in the evaluation of intracranial tuberculomas

International Nuclear Information System (INIS)

Vasudev, M.K.; Jayakumar, P.N.; Srikanth, S.G.; Nagarajan, K.; Mohanty, A.

2007-01-01

Purpose: To evaluate intracranial tuberculomas using quantitative magnetic resonance (MR) techniques such as T2 relaxometry, magnetization transfer (MT), and diffusion-weighted imaging (DWI). Material and Methods: Thirty-three patients with intracranial tuberculomas (histologically confirmed in 22) were evaluated using proton density/T2-weighted, T1-weighted (with and without MT), and echo-planar diffusion-weighted imaging sequences. T2 relaxation times, MT ratios (MTR), and apparent diffusion coefficient (ADC) values were calculated from the center of the lesion, the periphery, perilesional edema, and contralateral normal white matter. The mean and standard deviation values of each variable were calculated and correlated using Pearson's test (P = 0.05). Results: The measured mean values of T2 relaxation time, MTR, and ADC in the center of lesions were 155.5 ms, 14.1, and 1.27x10-3 mm 2 /s, respectively, compared to 117 ms, 23.72, and 0.74x10-3 mm 2 /s in normal white matter, and a T2 relaxation time of 187.45 ms in normal gray matter. Significant inverse correlations were noted between T2 relaxation values and MTR (P<0.001) and between MTR and ADC (P = 0.046). Significant positive correlation was seen between T2 relaxation and ADC values (P = 0.03). Conclusion: Intracranial tuberculomas are characterized by relatively short T2 relaxation times (compared to normal gray matter), decreased MTR, and mostly no restriction of diffusion. A combination of these quantitative parameters could be of help in the noninvasive diagnosis of tuberculomas

Lesões expansivas do plexo coróide Choroid plexus mass lesions

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Ernesto Lima Araújo Melo

2003-12-01

Full Text Available As lesões expansivas do plexo coróide constituem um grupo bastante amplo e heterogêneo de doenças e seus simuladores. Tumores, infecções, anomalias congênitas, hemorragias, cistos e fenômenos degenerativos são alguns dos exemplos de causas de lesões expansivas do plexo coróide. No presente trabalho fizemos revisão da literatura pertinente, descrevendo os achados de imagem e ilustrando-os com alguns casos do nosso serviço. Apesar de não existir na literatura descrição de sinais patognomônicos, a avaliação criteriosa e sistemática das características das lesões pode sugerir determinada etiologia.Choroid plexus mass lesions encompass a broad and heterogeneous group of diseases and their simulators. Tumors, infections, congenital anomalies, hemorrhage, cysts and degenerative diseases are some examples of mass lesions affecting the choroid plexus. In this article we review the current literature, describing the imaging findings and illustrating choroid plexus mass lesions with some cases diagnosed at our facility. Despite the inexistence of pathognomonic signs, a careful and systematic evaluation of the imaging characteristics may suggest many etiologies.

A whole-body mathematical model for intracranial pressure dynamics.

Science.gov (United States)

Lakin, William D; Stevens, Scott A; Tranmer, Bruce I; Penar, Paul L

2003-04-01

Most attempts to study intracranial pressure using lumped-parameter models have adopted the classical "Kellie-Monro Doctrine," which considers the intracranial space to be a closed system that is confined within the nearly-rigid skull, conserves mass, and has equal inflow and outflow. The present work revokes this Doctrine and develops a mathematical model for the dynamics of intracranial pressures, volumes, and flows that embeds the intracranial system in extensive whole-body physiology. The new model consistently introduces compartments representing the tissues and vasculature of the extradural portions of the body, including both the thoracic region and the lower extremities. In addition to vascular connections, a spinal-subarachnoid cerebrospinal fluid (CSF) compartment bridges intracranial and extracranial physiology allowing explict buffering of intracranial pressure fluctuations by the spinal theca. The model contains cerebrovascular autoregulation, regulation of systemic vascular pressures by the sympathetic nervous system, regulation of CSF production in the choroid plexus, a lymphatic system, colloid osmotic pressure effects, and realistic descriptions of cardiac output. To validate the model in situations involving normal physiology, the model's response to a realistic pulsatile cardiac output is examined. A well-known experimentally-derived intracranial pressure-volume relationship is recovered by using the model to simulate CSF infusion tests, and the effect on cerebral blood flow of a change in body position is also examined. Cardiac arrest and hemorrhagic shock are simulated to demonstrate the predictive capabilities of the model in pathological conditions.

18F-fluorodeoxyglucose positron emission tomography and magnetic resonance imaging findings of primary intracranial histiocytic sarcoma in a dog

International Nuclear Information System (INIS)

Kang, B.T.; Park, C.; Yoo, J.H.; Gu, S.H.; Jang, D.P.; Kim, Y.B.; Woo, E.J.; Kim, D.Y.; Cho, Z.H.; Park, H.M.

2009-01-01

A 10-year-old, neutered male, Maltese dog presented with a three week history of intention tremor, right hind limb rigidity, poor coordination, and occasional circling to the left. On magnetic resonance imaging (MRI) of the brain, a mass was identified in the right occipital lobe and cerebellum. Three weeks after the initial MRI scan, we performed an sup(18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) of the brain. The FDG-PET demonstrated areas of hypermetabolism in the right occipital lobe, cerebellum, pons, and medulla oblongata. When the standardized uptake value was calculated, the hypermetabolic lesion was higher than the gray matter values. The anatomical location of the hypermetabolic lesion was more precisely identified by the PET-MRI fusion images. The dog was definitively diagnosed as a primary histiocytic sarcoma of the brain. This is the first report of PET findings of an intracranial histiocytic sarcoma in a dog

Disappearance of Intracranial Extradural Hematomas: Role of Diastatic Cranial Fracture and Intracranial Pressure - An Institutional Experience

Science.gov (United States)

Bhat, Abdul Rashid; Kirmani, Altaf Rehman; Wani, Mohammed Afzal

2018-01-01

Context: The intracranial extradural hematoma (EDH) occupies space and creates a mass effect on the brain but the tenacious-adhesions of dura to the inner table of skull counters this effect. The intracranial pressure also pushes the hematoma back while it is held by dural tensile-force. Aims: The exploitation of a diastatic fracture, overlying an EDH, by the intracranial pressures to decompress a hematoma out of extradural space into subgaleal/subperiosteal space without surgical intervention. Settings and Design: In a period of 15 years, a group of 11 patients among 729 EDHs were managed conservatively. Materials and Methods: The retrospective study of 11 EDH patients was conducted in the Department of Neurosurgery from January 2000 to December 2014 in 15 years. Statistical Analysis Used: The statistical law of variance was used as applicable. Results: Analysis of spontaneous disappearance of intracranial EDH among 11 patients revealed that only 1.5% (11/729) EDHs resolved conservatively. The most cases (63.6%) were children and the youngest being 9 months old. All the patients had a diastatic fracture overlying-EDH and were fully conscious. The cause of head injury in most was the fall from height. The hospital stay ranged from 2 to 4 days. All the patients had a good recovery at the time of discharging. Conclusion: The trial of the conservative or spontaneous disappearance of an EDH through a diastatic fracture into the subgaleal space is similar to burr-hole drainage without surgical intervention but depends upon the neurological status, the intracranial pressure of the patient, and the availability of all the modern neurosurgical gadgets. PMID:29682037

Primary intracranial malignant lymphoma

International Nuclear Information System (INIS)

Matsumoto, Mikiro; Ohtsuka, Takatsugu; Kuroki, Takao; Shibata, Iekado; Terao, Hideo; Kudo, Motoshige

1988-01-01

Nine cases of primary intracranial malignant lymphoma, which accounts for 3.3 % of all intracranial tumors seen in the authors' institution, were studied in terms of diagnostic computed tomographic (CT) features, the tumors' histologic appearance, treatment, post-treatment blood immunologic and cerebrospinal fluid (CSF) characteristics, and outcome. The patients were seven males and two females aged 42 to 67 years. Their chief signs and symptoms on admission were intracranial hypertension, focal signs, and disturbance of consciousness. CT, which proved the most useful preoperative diagnostic technique, demonstrated multiple lesions in seven cases and, in all cases, regions of isodensity or slight high density that were enhanced by contrast medium. According to the patterns of enhancement, the tumors were classed as diffuse (three cases) or nodular (six cases). The former is considered typical of malignant lymphoma, whereas the latter type was sometimes indistinguishable from metastatic tumor and meningioma. At surgery, one patient underwent radical tumor excision, two partial removal, and six biopsy only. Histologic examination revealed one tumor to be of the diffuse small cell type, three of the medium cell type, and five of the large cell type (Lymphoma Study Group classification). Of seven tumors in which lymphocytes were examined by peroxidase-antiperoxidase staining, four were of the B cell type. Postoperatively, whole brain irradiation with 29 to 46 Gy was followed by local irradiation with 15 to 50 Gy. If the tumor persisted, one of three chemotherapies was administered. In one case, methotrexate was given intrathecally. Seven patients were divided into two groups: long remission (three) and recurrence (four). These two groups were compared in terms of serum immunoglobulin levels, T and B cell ratios, CSF characteristics, CT features, tumor cell type, and treatment. No clear differences were found. (author)

Progressive subcortical calcifications secondary to venous hypertension in an intracranial dural arteriovenous fistula.

Science.gov (United States)

Pascoe, Heather M; Lui, Elaine H; Mitchell, Peter; Gaillard, Frank

2017-05-01

Intracranial dural arteriovenous fistulas (dAVF) are acquired lesions, with the most commonly reported findings on CT haemorrhage or focal oedema. We describe a case of progressive subcortical calcification on CT secondary to venous hypertension from a high grade dAVF. Copyright © 2017 Elsevier Ltd. All rights reserved.

Bright intracranial lesions on diffusion-weighted images: a pictorial review

International Nuclear Information System (INIS)

Choi, Dae Seob

2006-01-01

Diffusion-weighted imaging (DWI) is a MR sequence that is used to evaluate the rate of microscopic water diffusion within the tissues. The ability to measure the rate of water diffusion is important because this is frequently altered in various disease processes. Generally, the lesions with restricted water diffusion show bright intensity on DWI, but the lesions without restricted water diffusion can also show bright intensity on DWI, which is called the 'T2 shine through effect'. With DWI, we can sensitively detect hyperacute infarction (within 6 hours after symptom onset), and this is difficult to detect with using CT and the conventional MR sequenced. The acute and subacute lesions of hypoxic-ischemic encephalopathy and carbon monoxide intoxication also show bright intensity on the DWI. The other diseases that can show bright intensity on the DWI include acute and subacute diffuse axonal injury lesion, hyperacute and late subacute hematomas, cerebral abscess, subdural empyema, acute herpes encephalitis, various tumors and such degenerative and demyelinating diseases as multiple sclerosis, posterior reversible encephalopathy syndrome, Wilson's disease and Wernicke's encephalopathy

Bright intracranial lesions on diffusion-weighted images: a pictorial review

Energy Technology Data Exchange (ETDEWEB)

Choi, Dae Seob [Gyeongsang National University College of Medicine, Jinju (Korea, Republic of)

2006-06-15

Diffusion-weighted imaging (DWI) is a MR sequence that is used to evaluate the rate of microscopic water diffusion within the tissues. The ability to measure the rate of water diffusion is important because this is frequently altered in various disease processes. Generally, the lesions with restricted water diffusion show bright intensity on DWI, but the lesions without restricted water diffusion can also show bright intensity on DWI, which is called the 'T2 shine through effect'. With DWI, we can sensitively detect hyperacute infarction (within 6 hours after symptom onset), and this is difficult to detect with using CT and the conventional MR sequenced. The acute and subacute lesions of hypoxic-ischemic encephalopathy and carbon monoxide intoxication also show bright intensity on the DWI. The other diseases that can show bright intensity on the DWI include acute and subacute diffuse axonal injury lesion, hyperacute and late subacute hematomas, cerebral abscess, subdural empyema, acute herpes encephalitis, various tumors and such degenerative and demyelinating diseases as multiple sclerosis, posterior reversible encephalopathy syndrome, Wilson's disease and Wernicke's encephalopathy.

Parapharyngeal meningioma extending from the intracranial space

International Nuclear Information System (INIS)

Uchibori, M.; Odake, G.; Ueda, S.; Yasuda, N.; Hisa, I.

1990-01-01

A 50-year old woman with a giant parapharyngeal meningioma extending from the intracranial cavity was admitted to our hospital. The parapharyngeal tumor was biopsied using the transoral approach, and a histological section diagnosis suggested meningioma. Thereafter, further examination by magnetic resonance images (MRI) and contrast enhanced CT scans revealed a diffuse meningioma en plaque in the posterior fossa. Invasion extended from the clival dura to the right sigmoid sinus. The extracranial extension of a meningioma is very rare but a few cases have been reported. In almost all of the reported cases, a large intracranial meningioma was simultaneously or previously verified by CT scans. Our case was special in that the intracranial mass was not voluminous but showed en plaque extension, and also because the pathway of the extracranial extension through the jugular foramen was clearly visualized by CT and MRI. Obliteration and invasion of the right sigmoid sinus and the internal jugular vein by tumor were also demonstrated. (orig.)

Preliminary experience with fetal MRI for evaluation of intracranial abnormalities

International Nuclear Information System (INIS)

Penev, L.; Georgieva-Kosarova, G.

2015-01-01

Full text: Modern MRI technologies allow the preparation of a multi-planar images as well as images showing the movement of the fetus for less than 1 sec. the methodology is particularly useful as a rendering intracranial lesions (at ventriculomegaly, lesions in the posterior cranial fossa, corpus callosum abnormalities, myelination, migration and sulcation) and in the body lesions of the fetus (diaphragmatic hernia, congenital cystic abnormalities, renal cystic lesions spinal anomalies) and the abdomen of the mother. We set a goal to prove the usefulness of MRI research in prenatal diagnosis of congenital malformations of the central nervous system. For a period of 24 months in City Clinic Hospital Sofia were studied 12 pregnant women and 13 fetuses in which there was doubt about intracranial fetal malformations. All studies were conducted as a supplementary diagnostic technique after ultrasound in the third trimester of pregnancy when the fetus is large enough and organogenesis is completed. MRI is held superconductive 3.0t magnet using single-shot fast-spin echo and half-Fourier acquisition turbo spin echo (HASTE) with a duration of under one minute scan, MRI study therefore does not require preparation of the mother. Does not require use of contrast. None reported harm to the fetus and the mother. Although ultrasound due to its low price and its wide accessibility as well as of its non-invasiveness and low time in some cases results were insufficient to determine condition and course of pregnancy. We believe that the MRI examination in the case of ambiguous results of the ultrasound has an important role to refine abnormalities prenatal and postnatal treatment planning

Monteris AXiiiS Stereotactic Miniframe for Intracranial Biopsy: Precision, Feasibility, and Ease of Use.

Science.gov (United States)

Manjila, Sunil; Knudson, Kathleen E; Johnson, Carleton; Sloan, Andrew E

2016-06-01

Stereotactic biopsy is an important and minimally invasive technique used for a variety of indications in neurosurgery. Initially, this technique required a frame, but recently there have been a number of newer, less cumbersome approaches to biopsy including robotic arms, fixed arms, and, more recently, skull-mounted miniframes. Miniframes are attractive because they are disposable and low profile. However, the relatively limited degree of freedom offered by currently available devices necessitates a preplanned burr hole, which in turn limits flexibility and multiple trajectories. The AXiiiS device is a skull-mounted, magnetic resonance imaging-compatible miniframe that provides a similar degree of freedom with a frame while maintaining a low-profile, disposable platform. To assess the image-guided trajectory alignment accuracy using AXiiiS stereotactic miniframe biopsy of intracranial lesions. The accuracy of the AXiiiS device is compared with the Navigus Trajectory Guide as platforms. After approval by our institutional review board, medical records of 10 neurosurgical patients with intracranial pathologies were chosen for AXiiiS stereotactic miniframe biopsy, and histological correlation was obtained. Ten reported cases demonstrate the precision and ease of using the AXiiiS stereotactic miniframe for biopsy of intracranial lesions in conjunction with preoperative magnetic resonance imaging. Multiple trajectories and angles have been used with precision and safety. The AXiiiS stereotactic miniframe is a feasible, safe, and disposable platform for multitrajectory intracranial biopsies. Compared with existing platforms, this novel device provides a more stable base and wider limits of trajectory angles with comparable accuracy and precision.

Usefulness of {sup 99m}Tc-HMPAO SPECT in Patients with Subarachnoid Hemorrhage due to Ruptured Intracranial Aneurysm

Energy Technology Data Exchange (ETDEWEB)

Choi, C. W.; Lee, K. H.; Kim, J. H.; Kwark, C. E.; Lee, D. S.; Chung, J. K.; Lee, M. C.; Han, D. H.; Koh, C. S. [Seoul National University Hospital, Seoul (Korea, Republic of)

1993-07-15

We evaluated the usefulness of {sup 99m}Tc-HMPAO SPECT in 21 Patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm and in 3 patients with unruptured intracranial aneurysm. SPECT study could detect the bilaterally hypoperfused cases in 10 patients(48%), but CT/MRI showed the bilateral abnormalities in only 3 patients(14%). The number of abnormal lesions were 56 in SPECT and 25 in CT/MRI. The lesions found in SPECT were well correlated with the neurological signs of the patients such as aphasia or hemiplegia. SPECT study during Matas test was helpful in evaluating the risk for carotid artery occlusion therapy. We thought that {sup 99m}Tc-HMPAO brain SPECT is helpful in evaluating the functional changes in patients with subarachnoid hemorrhage.

Intracranial arteries in individuals with the elastin gene hemideletion of Williams syndrome.

Science.gov (United States)

Wint, D P; Butman, J A; Masdeu, J C; Meyer-Lindenberg, A; Mervis, C B; Sarpal, D; Morris, C A; Berman, K F

2014-01-01

Williams syndrome, a rare genetic disorder with a striking neurobehavioral profile characterized by extreme sociability and impaired visuospatial construction abilities, is caused by a hemideletion that includes the elastin gene, resulting in frequent supravavular aortic stenosis and other stenotic arterial lesions. Strokes have been reported in Williams syndrome. Although the extracranial carotid artery has been studied in a sample of patients with Williams syndrome, proximal intracranial arteries have not. Using MRA, we studied the intracranial vessels in 27 participants: 14 patients with Williams syndrome (age range, 18-44 years; mean age, 27.3 ± 9.1; 43% women) and 13 healthy control participants with similar age and sex distribution (age range, 22-52 years; mean age, 33.4 ± 7.6; 46% women). All participants with Williams syndrome had hemideletions of the elastin gene. Blinded to group allocation or to any other clinical data, a neuroradiologist determined the presence of intracranial vascular changes in the 2 groups. The Williams syndrome group and the healthy control group had similar patency of the proximal intracranial arteries, including the internal carotid and vertebral arteries; basilar artery; and stem and proximal branches of the anterior cerebral artery, MCA, and posterior cerebral arteries. The postcommunicating segment of the anterior cerebral artery was longer in the Williams syndrome group. Despite the elastin haploinsufficiency, the proximal intracranial arteries in Williams syndrome preserve normal patency.

Intracranial melanocytic meningeal tumours and melanosis oculi: case report and literature review

International Nuclear Information System (INIS)

Doglietto, Francesco; Colosimo, Cesare; Lauriola, Libero; Balducci, Mario; De Bonis, Pasquale; Montano, Nicola; Zadeh, Gelareh; Maira, Giulio; Pallini, Roberto

2012-01-01

Melanocytic meningeal tumours are rare extra-axial neoplasms of the nervous system, with only three reported cases in the cavernous sinus. Herein we describe for the first time the association of ocular melanosis and multiple intracranial melanocytic meningeal tumours, with the presenting lesion being in the cavernous sinus. The importance of this association is discussed together with the diagnostic and therapeutic challenges of the case. A 20-year-old man presented with a left sixth cranial nerve deficit; general examination documented only congenital melanosis of the homolateral eye. MRI examination showed a space occupying lesion in the left cavernous sinus, which was followed conservatively for 2 years, until a new space occupying lesion was evident at the level of the right frontal convexity: both lesions presented with neuroradiological characteristics suggestive of melanin content. The frontal convexity lesion was removed: intraoperatively the dura was markedly and diffusely melanotic. Histological examination documented a melanocytic meningeal tumour, with a proliferative index of 3 %. The patient underwent 3D-Conformal Radiation Therapy on the lesion of the cavernous sinus (total dose 5040 cGy), with initial tumour reduction. Three years later, due to a symptomatic growth, he underwent partial removal of the lesion in the cavernous sinus. Histological examination was unchanged. He then received adjuvant Temozolomide with Low Dose Fractionated Radiation Therapy (LD-FRT). Due to further disease progression cisplatin plus fotemustine were administered, concomitant with LD-FRT: after two cycles MRI documented significant disease regression. After a period of apparent disease control, the patient presented with persistent cough and evidence of multiple thoracic metastases, which lead to his death, seven years after presentation. Intracranial melanocytic meningeal tumours are challenging lesions, both from a diagnostic and therapeutic point of view; though rare

Computerized detection of mass lesions in digital mammograms

International Nuclear Information System (INIS)

Yin, F.F.; Giger, M.L.; Doi, K.; Metz, C.E.; Vyborny, C.J.; Schmidt, R.A.

1989-01-01

Early detection of breast cancer from the periodic screening of asymptomatic women could reduce breast cancer mortality by at least 40%. The authors are developing a computerized scheme for the detection of mass lesions in digital mammograms as an aid to radiologists in such high volume screening programs. Based on left-right architectural symmetry and gray-level histogram analysis, bilateral subtraction of left and right breast images is performed. False-positive detections included in bilateral-difference images are reduced with various images feature-extraction techniques. The database involves clinical film mammograms digitized by a TV camera and analyzed on a Micro-VAX workstation. Among five different bilateral subtraction techniques investigated, a nonlinear approach provided superior lesion enhancement. Feature-extraction techniques reduced substantially the remaining false-positives. Preliminary results, for 32 pairs of clinical mammograms, yielded a true-positive rate of approximately 95% with a false-positive rate of about 2 per image

DSA volumetric 3D reconstructions of intracranial aneurysms: A pictorial essay

Science.gov (United States)

Cieściński, Jakub; Serafin, Zbigniew; Strześniewski, Piotr; Lasek, Władysław; Beuth, Wojciech

2012-01-01

Summary A gold standard of cerebral vessel imaging remains the digital subtraction angiography (DSA) performed in three projections. However, in specific clinical cases, many additional projections are required, or a complete visualization of a lesion may even be impossible with 2D angiography. Three-dimensional (3D) reconstructions of rotational angiography were reported to improve the performance of DSA significantly. In this pictorial essay, specific applications of this technique are presented in the management of intracranial aneurysms, including: preoperative aneurysm evaluation, intraoperative imaging, and follow-up. Volumetric reconstructions of 3D DSA are a valuable tool for cerebral vessels imaging. They play a vital role in the assessment of intracranial aneurysms, especially in evaluation of the aneurysm neck and the aneurysm recanalization. PMID:22844309

The effectiveness of FDG PET/CT for evaluation of intracardiac mass and pericardiac lesions

International Nuclear Information System (INIS)

Hwang, H. S; Yun, M. J.; Lee, J. D

2004-01-01

Fluorodeoxyglucose positron emission tomography has been known to be useful in diagnosis and staging of malignancy. FDG PET has high sensitivity and easily detects malignant lesions that are missed and overlooked in anatomic imaging modality. We assessed the impact of FDG PET/CT compared to echocardiogram and enhanced CT scan. Five patients of intra- and pericardiac lesions were included in this study. All patients underwent PET/CT(GE Discovery ST), enhanced CT scan and echocardiogram. Two patients were non-small cell lung cancer, one of RV metastatic mass, the other of pericardial metastasis in RV region. One of melanoma with systemic metastases, had RA malignant masses. One of suspicious lung cancer and intracardiac mass, has proved to benign LA thrombosis. One of lymphoma showed suspicious cardiac mass, but revealed no abnormality in echocardiogram. FDG PET/CT is sensitive and useful method to detect intra- and pericardiac mass in patients with suspected malignancy. All patients except lymphoma were correctly diagnosed using FDG PET/ICT

Intracranial Pressure

DEFF Research Database (Denmark)

Hvedstrup, Jeppe; Radojicic, Aleksandra; Moudrous, Walid

2018-01-01

OBJECTIVE: To compare a new method of noninvasive intracranial pressure (nICP) measurement with conventional lumbar puncture (LP) opening pressure. METHODS: In a prospective multicenter study, patients undergoing LP for diagnostic purposes underwent intracranial pressure measurements with HeadSen...

Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension: A case series and systematic review.

Science.gov (United States)

Safaee, Michael; Oh, Taemin; Sun, Matthew Z; Parsa, Andrew T; McDermott, Michael W; El-Sayed, Ivan H; Bloch, Orin

2015-08-01

Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder of the synovial membrane. PVNS generally affects large joints but occasionally involves the temporomandibular joint (TMJ), with occasional extension into the middle cranial fossa. The purpose of this study was to report our experience with PVNS along with a focused literature review. Patients with PVNS of the TMJ treated at the University of California - San Francisco from 2007 to 2013 were reviewed. A PubMed search was performed to identify additional cases. Five patients underwent surgical resection, with 1 recurrence at 61 months. A literature review identified 58 patients, 19 of which had intracranial involvement. Interestingly, intracranial extension was more common in men. Intracranial extension was not associated with an increased rate of recurrence. PVNS of the TMJ is a rare entity associated with excellent outcomes, even with intracranial extension. Management should consist of maximal resection, with radiotherapy reserved for extensive or recurrent lesions. © 2014 Wiley Periodicals, Inc.

MRI and CT findings of intracranial neurosyphilis

International Nuclear Information System (INIS)

Suh, Hong Kil; Shim, Ya Seong; Kim, Seon Bok; Kim, Uk Jung; Lee, Shin Ho; Jung, Hae Kyuong; Lee, Eil Seong; Kang, Ik Won; Cho, Hyeun Cha

1999-01-01

To evaluate the CT and MRI findings of neurosyphilis. We retrospectively reviewed the CT and MR imaging findings in five patients with intracranial neurosyphilis confirmed by CSF, VDRL, TPHA, and clinical follow-up. MR imaging was performed in all five cases, and CT in two. The MRI and CT findings of intracranial neurosyphilis included infarction (n=3), focal inflammation (n=1) and encephalopathy (n=1). There was a total of ten infaretions : three of the basal ganglia, two each of the frontal lobe, watershed zone, and cerebellum, and one of the occipital lobe. Intaretion was most common in MCA territory (n=9; 50%), followed by the watershed zone (16.6%), posterior cerebral artery territory (16.6%), and posterior inferior cerebellar artery territory (11.1%). The size of the lesion varied from 1cm to larger than one lobe. One patient showed diffuse high signal intensity in the left temporal lobe, but on follow-up MRI, this had resolved. The most common finding of neurosyphilis, as seen on MRI and CT, was infarction in middle cerebral arterial territory

MRI and CT findings of intracranial neurosyphilis

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Suh, Hong Kil; Shim, Ya Seong; Kim, Seon Bok; Kim, Uk Jung; Lee, Shin Ho; Jung, Hae Kyuong; Lee, Eil Seong; Kang, Ik Won [Hallym University College of Medicine, Seoul (Korea, Republic of); Cho, Hyeun Cha [Sungkyunkwan University College of Medicine, Seoul (Korea, Republic of)

1999-02-01

To evaluate the CT and MRI findings of neurosyphilis. We retrospectively reviewed the CT and MR imaging findings in five patients with intracranial neurosyphilis confirmed by CSF, VDRL, TPHA, and clinical follow-up. MR imaging was performed in all five cases, and CT in two. The MRI and CT findings of intracranial neurosyphilis included infarction (n=3), focal inflammation (n=1) and encephalopathy (n=1). There was a total of ten infaretions : three of the basal ganglia, two each of the frontal lobe, watershed zone, and cerebellum, and one of the occipital lobe. Intaretion was most common in MCA territory (n=9; 50%), followed by the watershed zone (16.6%), posterior cerebral artery territory (16.6%), and posterior inferior cerebellar artery territory (11.1%). The size of the lesion varied from 1cm to larger than one lobe. One patient showed diffuse high signal intensity in the left temporal lobe, but on follow-up MRI, this had resolved. The most common finding of neurosyphilis, as seen on MRI and CT, was infarction in middle cerebral arterial territory.

Primary giant myxoma of the temporal bone with major intracranial extension: presenting with hearing impairment and ear polyp

Directory of Open Access Journals (Sweden)

Satyarthee Guru Dutta

2016-12-01

Full Text Available Myxomas are mesenchymal origin, benign tumor, constituting approximately half of the benign cardiac tumors. Occasionally, it may also occurs at other locations, though the intracranial location of a myxoma is considered exceptionally rare. Only isolated few cases of intracranial myxoma are reported in the literature, almost all were locally confined within the originating bone. The extensive Pubmed and Medline search yielded only eight cases of primary myxoma arising in the temporal bone with extension into intracranial compartment. However intracranial extension is limited as early detection, however, Osterdock et al reported a case also arising from temporal bone with extensive intracranial extension. Author report an interesting case of intracranial myxoma in 27- year- old- male, involving the temporal bone associated with extensive bony erosion and also extending into infratemporal fossa, mastoid, and frontoparietal region and a polypoidal mass protruding into external ear. To the best of knowledge of authors, temporal myxoma presenting with external ear polypoidal mass, which underwent successful surgical excision is not reported and represent first case in the world literature.

Early detection of breast cancer mass lesions by mammogram segmentation images based on texture features

International Nuclear Information System (INIS)

Mahmood, F.H.

2012-01-01

Mammography is at present one of the available method for early detection of masses or abnormalities which is related to breast cancer.The calcifications. The challenge lies in early and accurate detection to overcome the development of breast cancer that affects more and more women throughout the world. Breast cancer is diagnosed at advanced stages with the help of the digital mammogram images. Masses appear in a mammogram as fine, granular clusters, which are often difficult to identify in a raw mammogram. The incidence of breast cancer in women has increased significantly in recent years. This paper proposes a computer aided diagnostic system for the extraction of features like mass lesions in mammograms for early detection of breast cancer. The proposed technique is based on a four-step procedure: (a) the preprocessing of the image is done, (b) regions of interest (ROI) specification, (c) supervised segmentation method includes two to stages performed using the minimum distance (M D) criterion, and (d) feature extraction based on Gray level Co-occurrence matrices GLC M for the identification of mass lesions. The method suggested for the detection of mass lesions from mammogram image segmentation and analysis was tested over several images taken from A L-llwiya Hospital in Baghdad, Iraq.The proposed technique shows better results.

Intracranial Hypertension Research Foundation

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... PARTNERSHIPS Meet our Fundraising Partners Tweet Welcome Intracranial hypertension (IH) is the general term for the neurological ... high. (Old names for IH include Benign Intracranial Hypertension and Pseudotumor Cerebri). The Intracranial Hypertension Research Foundation ...

Intracranial cavernous hemangiomas: a case report and bibliographic review

International Nuclear Information System (INIS)

Shiguihara, L.C.M.; Granero, P.C.; Gianotti, I.A.; Lederman, H.M.; Seixas, M.T.

1992-01-01

This is a case report of intracranial cavernous hemangioma that presented with macrocrania. A large, spontaneously hyperdense area with mass effect on CT was seen. This is a rare vascular malformation evolving the CNS in pediatrics. (author)

A case of intracranial teratoma

International Nuclear Information System (INIS)

Shiota, Madoka; Ando, Yukinori; Takashima, Sachio; Hori, Tomokatsu; Hiramoto, Shinsuke.

1985-01-01

A case of neonatal intracranial teratoma was examined on ultrasonography (US), computed tomography (CT) and tumor markers in serum, CSF and tumor tissue. This 27-day-old male infant was pointed out a head enlargement by prenatal sonography at 39 weeks' gestation. He admitted to our hospital at the age of one day after cesarean section. His birth weight was 4430 g and head circumstance 47.5 cm. On admission, physical and neurological examinations reveled big head, weak crying, twiching and sun set phenomenon. The optic fundi were normal. The CT scan at 1 day demonstrated the marked enlargement of lateral ventricles and the supratentorial large polycystic mass with calcifications at midline area. Transfontanelle sonography also delineated the polycystic mass and enlarged ventricle. Ventricular tap showed bloody CSF. Alpha-Fetoprotein and carcinoembryonic antigen level in CSF was higher than those in serum. Postmortam tumor necropsy revealed a teratoma including mature squamous epithelium, muscle, cartilage, bone, lymphoid and nervous tissue. There were immature mesenchymal cells in some parts. The immune histochemical method showed positive staining to AFP in intestinal and respiratory epithelium, and to CEA in intestinal epithelium and immature mesenchymal cells. In summary, these characteristic findings of US, CT and tumor marker in CSF have a diagnostic value of intracranial teratoma. (author)

Emergency Medicine Myths: Computed Tomography of the Head Prior to Lumbar Puncture in Adults with Suspected Bacterial Meningitis - Due Diligence or Antiquated Practice?

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April, Michael D; Long, Brit; Koyfman, Alex

2017-09-01

Various sources purport an association between lumbar puncture and brainstem herniation in patients with intracranial mass effect lesions. Several organizations and texts recommend head computed tomography (CT) prior to lumbar puncture in selected patients. To review the evidence regarding the utility of obtaining head CT prior to lumbar puncture in adults with suspected bacterial meningitis. Observational studies report a risk of post-lumbar puncture brainstem herniation in the presence of intracranial mass effect (1.5%) that is significantly lower than that reported among all patients with bacterial meningitis (up to 13.3%). It is unclear from existing literature whether identifying patients with intracranial mass effect decreases herniation risk. Up to 80% of patients with bacterial meningitis experiencing herniation have no CT abnormalities, and approximately half of patients with intracranial mass effect not undergoing lumbar puncture herniate. Decision rules to selectively perform CT on only those individuals most likely to have intracranial mass effect lesions have not undergone validation. Despite recommendations for immediate antimicrobial therapy prior to imaging, data indicate an association between pre-lumbar puncture CT and antibiotic delays. Recent data demonstrate shortened door-to-antibiotic times and lower mortality from bacterial meningitis after implementation of new national guidelines, which restricted generally accepted CT indications by removing impaired mental status as imaging criterion. Data supporting routine head CT prior to lumbar puncture are limited. Physicians should consider selective CT for those patients at risk for intracranial mass effect lesions based on decision rules or clinical gestalt. Patients undergoing head CT must receive immediate antibiotic therapy. Published by Elsevier Inc.

Software-triggered contrast-enhanced three-dimensional MR angiography of the intracranial arteries.

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Isoda, H; Takehara, Y; Isogai, S; Takeda, H; Tanaka, T; Takahashi, M; Nozaki, A; Sun, Y

2000-02-01

We investigated the effectiveness of software-triggered contrast-enhanced three-dimensional (3D) MR angiography in evaluating intracranial arteries. We studied 38 patients with suspected brain lesions. Imaging was performed using a 1.5-T superconducting MR system with a commercially available head coil. To monitor signal intensity changes we used software to place a tracker volume at the basilar artery or the internal carotid artery. A 20-ml bolus of gadodiamide hydrate was administered through the antecubital vein at a rate of 2-4 ml/sec, followed by a saline flush. Three-dimensional MR angiography using a spoiled gradient-echo sequence with centric K-space ordering was triggered by the arrival of the contrast bolus in the tracker volume. Imaging times ranged from 12 to 20 sec. We used MR images to assess the effectiveness of contrast-enhanced 3D MR angiography in revealing intracranial arteries with minimal venous overlap. The software triggered imaging on the arrival of the contrast bolus in 81.6% of examinations. In 77.6% of examinations, the resulting MR angiograms revealed intracranial arteries with minimal venous overlap. Software-triggered contrast-enhanced 3D MR angiography with centric K-space ordering is a promising technique for viewing intracranial arteries.

Affection of blood supply of focal hepatic mass on apparent diffusion coefficient of the lesions

International Nuclear Information System (INIS)

Chen Zaizhi; Wu Yulin; Xu Zhongfei; Yang Zhenghan; Chen Min; Zhou Cheng; Xie Jingxia

2002-01-01

Objective: To investigate the affection of lesion blood supply on apparent diffusion coefficient (ADC) of focal hepatic mass. Methods: Diffusion-weighted imaging (DWI) with different b values was performed in 87 patients with 159 focal hepatic lesions. ADCs of lesion, liver, spleen, gallbladder were measured in every case. Results: On DWI with small b value and small b value remainder, ADCs were affected by blood perfusion of tissues or lesions. The mean ADC of hypervascular lesions was significantly higher than that of hypovascular lesions on DWI with small b value, and hemoangiomas got the highest mean ADC. The mean ADC of hepatic cysts was not affected by b value. Conclusion: Blood perfusion affects ADC of tissue or focal hepatic lesion, particularly on DWI with small b value, and to some degree, DWI and ADC can reflect the blood supply of focal hepatic lesion

Diagnostic value of somatostatin receptor scintigraphy in patients with intracranial tumours

International Nuclear Information System (INIS)

Luyken, C.; Hildebrandt, G.; Scheidhauer, K.; Kirsch, B.

1993-01-01

The aim of the study was to detect the SR binding sites in intracranial tumours and to evaluate the benefit of SRS in pre- and postoperative diagnostics. 86 patients with 94 intracranial tumours (39 meningiomas, 18 pituitary adenomas, 11 gliomas grade 3 or 4, 8 gliomas grade 2, 5 neurinomas, 5 intracranial metastases, 4 tumours of the orbit, 2 neurofibromas, 1 brain abscess and 1 cystic lesion) were examined. 111 In-octreotide was injected i.v. as 10 μg or 20 μg bolus, corresponding to 110 or 220 MBq (3 or 6 mCi). Gamma-camera images and SPECT were obtained 3-6 h and 24 h post injection. The scintigraphic evaluation was performed without knowledge of CT and MRI results. The histological classification corresponded to the WHO grading system. Somatostatin binding sites were detected in vito using somatostatin-gold conjugates. All patients with meningiomas showed a high focal tracer uptake corresponding to SR binding sites in vitro, whereas only in 50% of the pituitary adenomas SRS was positive. Neurinomas did not show any tracer uptake. In patients with gliomas with disturbed blood-brain-barrier positive tracer uptake was detected, while none of the gliomas with intact blood-brain-barrier could be visualized by SRS but showed somatostatin binding sites in vitro. In intracranial metastases a local tracer uptake was detected in vivo. In vitro 3 of 4 cases showed somatostatin binding sites. In 2 cases extracranial tracer uptake showed the primary tumour and metastases of the lymphnodes. Somatostatin receptor scintigraphy can help to detect or to exclude meningiomas especially in the cerebellopontine angle or in the orbit. In intracranial metastases SRS may point to the primary tumour or other metastases. In all other intracranial tumours receptor scintigraphy provides no clinical relevant information. (orig./MG) [de

Mass lesions in chronic pancreatitis: benign or malignant? An "evidence-based practice" approach.

LENUS (Irish Health Repository)

Gerstenmaier, Jan F

2012-02-01

The diagnosis of a pancreatic mass lesion in the presence of chronic pancreatitis can be extremely challenging. At the same time, a high level of certainty about the diagnosis is necessary for appropriate management planning. The aim of this study was to establish current best evidence about which imaging methods reliably differentiate a benign from a malignant lesion, and show how that evidence is best applied. A diagnostic algorithm based on Bayesian analysis is proposed.

Canine histiocytic sarcoma presenting as a target lesion on brain magnetic resonance imaging and as a solitary pulmonary mass.

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Hicks, Jill; Barber, Renee; Childs, Bronwen; Kirejczyk, Shannon Gm; Uhl, Elizabeth W

2017-04-17

A 6-year-old spayed female miniature schnauzer presented with generalized seizures and progressive multifocal intracranial neurologic disease. Thoracic radiographs and computed tomography (CT) revealed a large solitary pulmonary mass within the right cranial lung lobe. On brain magnetic resonance imaging (MRI), a solitary intraparenchymal mass within the left piriform lobe had a "target" appearance on both pre- and postcontrast sequences. Cerebrospinal fluid was unremarkable and histopathology indicated both masses represented histiocytic sarcoma. This case represents an uncommonly reported MRI appearance of histiocytic sarcoma in the canine brain and a large, solitary-appearing pulmonary histiocytic sarcoma in the same dog. © 2017 American College of Veterinary Radiology.

20 year old lady with a paraspinal mass.

LENUS (Irish Health Repository)

O'Toole, Orna

2010-05-01

A 20 year old female presented with a 4 month history of right upper limb pain and paraesthesias. She had no systemic symptoms and no prior medical or family history of note. MRI revealed a right-sided intradural extramedullary mass extending from C7-T1 and displacing the spinal cord. While awaiting surgery her symptoms progressed to involve the right lower limb. She was re-imaged and the lesion now extended from C5 to T3 with spinal cord compression at C7-T1. The radiological features and recent rapid growth were felt to be in keeping with a large plexiform neurofibroma. The patient underwent emergency resection of the lesion and pathology revealed Hodgkin\\'s Lymphoma (HL)-mixed cellularity type. A mediastinal mass was identified on further imaging and biopsy confirmed the diagnosis of HL-stage IV. The patient is currently undergoing treatment with ABVD chemotherapy. CNS-HL is extremely rare and may occur de novo or in association with systemic disease. Lesions may be parenchymal or dural based and are usually intracranial with an increased risk of CNS involvement in HL-mixed-cellularity type as in our patient. This is the first report in the literature of CNS-HL radiologically mimicking a paraspinal plexiform neurofibroma.

Dual energy CT intracranial angiography: image quality, radiation dose and initial application results

International Nuclear Information System (INIS)

Chai Xue; Zhang Longjiang; Lu Guangming; Zhou Changsheng

2009-01-01

Objective: To assess the clinical value of dual-energy intracranial CT angiography (CTA). Methods: Forty-one patients suspected of intracranial vascular diseases underwent dual-energy intracranial CT angiography, and 41 patients who underwent conventional subtraction CT were enrolled as the control group. Image quality of intracranial and skull base vessels and radiation dose between dual-energy CTA and conventional subtraction CTA were compared using two independent sample nonparametric test and independent-samples t test, respectively. Prevalence and size of lesions detected by dual-energy CTA and digital subtraction CTA were compared using paired-samples t test and Spearman correlative analysis. Results: The percentage of image quality scored 5 was 70.7% (29/41) for dual-energy CTA and 75.6% (31/41) for conventional subtraction CTA. There was no significant difference between the two groups (Z= -0.455, P=0.650). Image quality of vessels at the skull base in conventional subtraction CTA was superior to that in dual-energy CTA, especially for the petrosal and syphon segment (Z=-4.087, P=0.000). Radiation exposure of dual energy CTA and conventional CTA were (396.54±17.43) and (1090.95±114.29) mGy·cm respectively. Radiation exposure was decreased by 64% (t=-38.52, P=0.000) by dual energy CTA compared with conventional subtraction CTA. Out of the 41 patients, 19 patients were diagnosed as intracranial aneurysm, 2 patients as arteriovenous malformation (AVM), 3 patients with Moya-moya's disease, and the remaining 17 patients with negative results. Nine patients with intracranial aneurysm, 2 patients with AVM, 3 patients with Moya-moya's disease, and 2 patients with negative findings underwent DSA or operation, with concordant findings from both techniques. Diameter of aneurysm neck, long axis and minor axis by dual-energy CTA was (2.90±1.61), (5.23±1.68) and (3.83±1.69) mm, respectively; Diameter of aneurysm neck, long axis and minor axis by DSA was (2.95±1

MR appearances of intracranial tumors with a low tesla (0.064 T) permanent MR system

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Kim, Hee Jin; Lim, Sun Kyung; Kwon, Dae Ik; Kim, Byung Young; Lee, Jong Gil [Fatima Hospital, Taegu (Korea, Republic of)

1993-09-15

In this report we describe twenty-two cases of intracranial tumors studied with an MR imager operating at a field strength of 0.064 T for evaluation of the clinical utility of low tesla MRI. The confirmed diagnoses were meningioma(9 cases), astrocytoma(4 cases), glioblastoma multiforme (1 case), craniopharyngioma(2 cases), intracranial metastasis(1 cases), pituitary microadenomal(1 cases), hemangioblastoma(1 cases), and trigerminal neurilemmoma(1 cases). Meningiomas appeared as well-marginated, homogeneous signal intensity masses (67%) in most cases. Most meningiomas showed iso-signal intensity(78%) on T1-weighted images, and high signal intensity on T2-weighted images. After Gd-DTPA enhancement, diffuse homogeneous contrast enhancement(75%) was well seen. The mutiple hemorrhage foci within the glioblastoma multiforme were identified, which showed high signal intensity on T1-weighted images and low signal intensity on T2-weighted images(intracellular methemoglobin) or high signal intensity on both T1 and T2-weighted images(extracellular methemoglobin). One case of cerebellar hemangioblastoma was a well- defined cystic mass with contrast enhanced mural nodule but no identification of characteristic signal void vessels. The remaining tumors showed low signal intensity on T1-weighted images, and high signal intensity on T2-weighted images. Gd-DTPA enhancement was helpful in separating the lesion from the surrounding edema or normal tissue, but had limited diagnostic value in characterizing the nature of the mass. The advantage of low tesla MRI are as follows: on requirement of cooling water or electricity, open design, shorter T1 relaxation time compared with high tesla unit that increases the difference of T1-relaxation time between tissues, ease of installation, and cost effectiveness. In conclusion, The low tesla MRI is useful for the detection and evaluation of the brain tumors.

MR appearances of intracranial tumors with a low tesla (0.064 T) permanent MR system

International Nuclear Information System (INIS)

Kim, Hee Jin; Lim, Sun Kyung; Kwon, Dae Ik; Kim, Byung Young; Lee, Jong Gil

1993-01-01

In this report we describe twenty-two cases of intracranial tumors studied with an MR imager operating at a field strength of 0.064 T for evaluation of the clinical utility of low tesla MRI. The confirmed diagnoses were meningioma(9 cases), astrocytoma(4 cases), glioblastoma multiforme (1 case), craniopharyngioma(2 cases), intracranial metastasis(1 cases), pituitary microadenomal(1 cases), hemangioblastoma(1 cases), and trigerminal neurilemmoma(1 cases). Meningiomas appeared as well-marginated, homogeneous signal intensity masses (67%) in most cases. Most meningiomas showed iso-signal intensity(78%) on T1-weighted images, and high signal intensity on T2-weighted images. After Gd-DTPA enhancement, diffuse homogeneous contrast enhancement(75%) was well seen. The mutiple hemorrhage foci within the glioblastoma multiforme were identified, which showed high signal intensity on T1-weighted images and low signal intensity on T2-weighted images(intracellular methemoglobin) or high signal intensity on both T1 and T2-weighted images(extracellular methemoglobin). One case of cerebellar hemangioblastoma was a well- defined cystic mass with contrast enhanced mural nodule but no identification of characteristic signal void vessels. The remaining tumors showed low signal intensity on T1-weighted images, and high signal intensity on T2-weighted images. Gd-DTPA enhancement was helpful in separating the lesion from the surrounding edema or normal tissue, but had limited diagnostic value in characterizing the nature of the mass. The advantage of low tesla MRI are as follows: on requirement of cooling water or electricity, open design, shorter T1 relaxation time compared with high tesla unit that increases the difference of T1-relaxation time between tissues, ease of installation, and cost effectiveness. In conclusion, The low tesla MRI is useful for the detection and evaluation of the brain tumors

CT-verified intracranial calcifications and contrast enhancement in acute disseminated encephalomyelitis: a case report

International Nuclear Information System (INIS)

Ipsen, P.

1998-01-01

Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease which follows viral infection or vaccination. We report the CT findings in a 13-year-old boy with ADEM after infection with Epstein-Barr virus. After 11 days, the patient developed intracranial calcifications in addition to demyelinating lesions. This is a rare finding in ADEM. (orig.)

Canine Choroid Plexus Tumor with Intracranial Dissemination Presenting as Multiple Cystic Lesions

Directory of Open Access Journals (Sweden)

Trisha J. Oura

2013-01-01

Full Text Available A Miniature Pinscher developed acute blindness and behavioral changes. On magnetic resonance imaging (MRI, there were multiple small intra-axial cystic lesions, and primary differential diagnoses included primary or metastatic neoplasia and neurocysticercosis. These cystic lesions were subsequently diagnosed histopathologically as disseminated choroid plexus carcinoma. This is only the second documented description of this diagnosis in a dog, but both patients had very similar MRI findings. This patient adds to the literature about the MRI characteristics of choroid plexus tumors and indicates that choroid plexus tumor should be considered as a possible cause of small multifocal intra-axial cystic brain lesions in dogs, regardless of whether a primary intraventricular lesion is visible.

[Isolated lesion of the Edinger-Westphal nucleus in topographical relation with a post-traumatic mesencephalic hematoma].

Science.gov (United States)

Guerrero, A L; Onzáin, J I; Martín, J A; Blanco, A; Moreta, J A

1996-08-01

From the relevant literature, it would seem that the commonest single cause of lesion of the third cranial nerves is indirect, accompanying intracranial traumas. From multiple clinical observations however, it seems that many of these cases may be due to lesions of the mesencephalum which nevertheless have rarely been identified by current imaging techniques. Clinical case. We describe the clinical observation of isolated pupil involvement, attributed to a lesion of the Edinger-Westphal nucleus as a consequence of a mesencephalic haematoma in the context of closed craneo-encephalic trauma. In our review of the literature, we have not found any other such case. We briefly review the most frequently involved mechanisms implicated in the genesis of lesions of the third cranial nerves at different sites and the different changes seen in the pupil in each case, together with the characteristics and pathogenesis of the lesions produced in the mesencephalum as a consequence of intracranial trauma. We emphasize the importance of our case as being the first time an isolated lesion of the Edinger-Westphal nucleus has been described in topographic relation to a mesencephalic haematoma.

Acute Stroke and Obstruction of the Extracranial Carotid Artery Combined with Intracranial Tandem Occlusion: Results of Interventional Revascularization

International Nuclear Information System (INIS)

Lescher, Stephanie; Czeppan, Katja; Porto, Luciana; Singer, Oliver C.; Berkefeld, Joachim

2015-01-01

PurposeDue to high thrombus load, acute stroke patients with tandem obstructions of the extra- and intracranial carotid arteries or the middle cerebral artery show a very limited response to systemic thrombolysis. Interventional treatment with mechanical thrombectomy—often in combination with acute stenting of underlying atherosclerotic stenosis or dissection—is increasingly used. It has been shown that such complex interventions are technically feasible. The lack of optimal management strategies and clinical data encouraged us to review our acute stroke interventions in patient with anterior circulation tandem lesions to determine lesion patterns, interventional approaches, and angiographic or clinical outcomes.Patients and MethodsWe retrospectively analyzed a series of 39 consecutive patients with intracranial vessel occlusion of the anterior circulation simultaneously presenting with high-grade cervical internal carotid artery (ICA) stenosis or occlusion.ResultsEmergency ICA stent implantation was technically feasible in all patients, and intracranial recanalization with TICI ≥ 2b was reached in a large number of patients (64 %). Good clinical outcomes (mRS ≤ 2 at 3 months) were achieved in one third of the patients (36 %). Symptomatic hemorrhages occurred in four patients (10 %). Mortality was 10 %.ConclusionEndovascular recanalization of acute cervical carotid artery occlusion was technically feasible in all patients, and resulted in high extra- and intracranial revascularization rates. A trend for favorable clinical outcome was seen in a higher TICI score, younger age, good collateral status, and combined IV rTPA and endovascular therapy

Post Traumatic Cerebral Oedema in Severe Head Injury is Related to Intracranial Pressure and Cerebral Perfusion Pressure but not to Cerebral Compliance

Directory of Open Access Journals (Sweden)

U Nujaimin

2009-07-01

Full Text Available This was a prospective cohort study, carried out in the Neuro Intensive Care Unit, Department of Neurosciences, Hospital Universiti Sains Malaysia, Kubang Kerian Kelantan. The study was approved by the local ethics committee and was conducted between November 2005 and September 2007 with a total of 30 patients included in the study. In our study, univariate analysis showed a statistically significant relationship between mean intracranial pressure (ICP as well as cerebral perfusion pressure (CPP with both states of basal cistern and the degree of diffuse injury and oedema based on the Marshall classification system. The ICP was higher while CPP and compliance were lower whenever the basal cisterns were effaced in cases of cerebral oedema with Marshall III and IV. In comparison, the study revealed lower ICP, higher mean CPP and better mean cerebral compliance if the basal cisterns were opened or the post operative CT brain scan showed Marshall I and II. These findings suggested the surgical evacuation of clots to reduce the mass volume and restoration of brain anatomy may reduce vascular engorgement and cerebral oedema, therefore preventing intracranial hypertension, and improving cerebral perfusion pressure and cerebral compliance. Nevertheless the study did not find any significant relationship between midline shifts and mean ICP, CPP or cerebral compliance even though lower ICP, higher CPP and compliance were frequently observed when the midline shift was less than 0.5 cm. As the majority of our patients had multiple and diffuse brain injuries, the absence of midline shift did not necessarily mean lower ICP as the pathology was bilateral and even when after excluding the multiple lesions, the result remained insignificant. We assumed that the CT brain scan obtained after evacuation of the mass lesion to assess the state basal cistern and classify the diffuse oedema may prognosticate the intracranial pressure and cerebral perfusion pressure

A nested mechanistic sub-study into the effect of tranexamic acid versus placebo on intracranial haemorrhage and cerebral ischaemia in isolated traumatic brain injury: study protocol for a randomised controlled trial (CRASH-3 Trial Intracranial Bleeding Mechanistic Sub-Study [CRASH-3 IBMS]).

Science.gov (United States)

Mahmood, Abda; Roberts, Ian; Shakur, Haleema

2017-07-17

Tranexamic acid prevents blood clots from breaking down and reduces bleeding. However, it is uncertain whether tranexamic acid is effective in traumatic brain injury. The CRASH-3 trial is a randomised controlled trial that will examine the effect of tranexamic acid (versus placebo) on death and disability in 13,000 patients with traumatic brain injury. The CRASH-3 trial hypothesizes that tranexamic acid will reduce intracranial haemorrhage, which will reduce the risk of death. Although it is possible that tranexamic acid will reduce intracranial bleeding, there is also a potential for harm. In particular, tranexamic acid may increase the risk of cerebral thrombosis and ischaemia. The protocol detailed here is for a mechanistic sub-study nested within the CRASH-3 trial. This mechanistic sub-study aims to examine the effect of tranexamic acid (versus placebo) on intracranial bleeding and cerebral ischaemia. The CRASH-3 Intracranial Bleeding Mechanistic Sub-Study (CRASH-3 IBMS) is nested within a prospective, double-blind, multi-centre, parallel-arm randomised trial called the CRASH-3 trial. The CRASH-3 IBMS will be conducted in a cohort of approximately 1000 isolated traumatic brain injury patients enrolled in the CRASH-3 trial. In the CRASH-3 IBMS, brain scans acquired before and after randomisation are examined, using validated methods, for evidence of intracranial bleeding and cerebral ischaemia. The primary outcome is the total volume of intracranial bleeding measured on computed tomography after randomisation, adjusting for baseline bleeding volume. Secondary outcomes include progression of intracranial haemorrhage (from pre- to post-randomisation scans), new intracranial haemorrhage (seen on post- but not pre-randomisation scans), intracranial haemorrhage following neurosurgery, and new focal ischaemic lesions (seen on post-but not pre-randomisation scans). A linear regression model will examine whether receipt of the trial treatment can predict haemorrhage

Transethmoidal encephalocele after reduction of high intracranial pressure in aqueductal stenosis.

Science.gov (United States)

Sharifi, Guive; Alavi, Ehsan; Jalessi, Maryam; Haddadian, Karim; Faramarzi, Faezeh

2014-01-01

Acquired non-traumatic transethmoidal encephaloceles are very infrequent lesions that are generally caused by a tumor or hydrocephalus. As far as we know, there is no reported case of encephalocele after CSF diversion in the literature. We present a 25-year-old woman with hydrocephalus due to aquiductal stenosis who was treated with endoscopic third ventriculostomy. Nine months later, she had developed rhinorrhea and on imaging she had a transethmoidal encephalocele. She underwent endonasal endoscopic repair of the defect and removal of herniated parenchyma. CSF diversion to parasellar cisterns is not a known iatrogenic cause of basal encephalocele and is not noted elsewhere as a complication of third ventriculostomy. However, as third ventriculostomy is performed usually for intracranial hypertension treatment and intracranial hypertension itself is a known but rare cause of lacunar skull defect and encephalocele, this co-incidence may occur.

Intracranial dermoid cysts: variations of radiological and clinical features

International Nuclear Information System (INIS)

Orakcioglu, B.; Halatsch, M.-E.; Unterberg, A.; Fortunati, M.; Yonekawa, Y.

2008-01-01

Intracranial dermoid cysts are uncommon, and their clinical features as well as surgical management differ from patient to patient. Dermoids are generally benign lesions, but may cause spontaneous complications such as meningitis and/or hydrocephalus due to rupture and epileptic seizures depending on their location. Little has been reported about characteristic imaging findings with resulting therapeutic considerations, and only a few reports exist about associated hydrocephalus. Imaging modalities have changed and can facilitate differential diagnosis and follow-up if applied correctly. In this paper, we attempt to contribute our clinical experience with the management of dermoid cysts. The charts of five men and two women with intracranial dermoid cysts were retrospectively reviewed. The patients were treated between September 1993 and September 2006. Selected patients are presented in detail. Tumour location, size and radiographic characteristics varied in each patient. Clinical presentations comprised focal neurological deficits as well as epileptic seizures, persistent headache, mental changes and psycho-organic syndromes. One patient underwent delayed ventriculo-peritoneal shunting after ruptured fatty particles caused obstructive hydrocephalus. Despite dermoid rupture into the subarachnoid space, three patients never developed hydrocephalus. Diffuse vascular supra-tentorial lesions were seen in one patient as a result of aseptic meningitis. Diffusion-weighted imaging (DWI) hyperintensity in dermoids is related to decrease of water proton diffusion and should be used for both the diagnosis and follow-up of this lesion. Although dermoid cysts are known to be benign entities per se, their rupture can cause a wide range of symptoms including aseptic meningitis and/or hydrocephalus. This may be due to intraventricular obstruction and/or paraventricular compression. While rupture does not necessarily bring about hydrocephalus, radical removal of the tumor and

CT-verified intracranial calcifications and contrast enhancement in acute disseminated encephalomyelitis: a case report

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Ipsen, P. [Department of Neuroradiology, Aarhus University Hospital (Denmark)

1998-08-01

Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease which follows viral infection or vaccination. We report the CT findings in a 13-year-old boy with ADEM after infection with Epstein-Barr virus. After 11 days, the patient developed intracranial calcifications in addition to demyelinating lesions. This is a rare finding in ADEM. (orig.) With 4 figs., 15 refs.

Intracranial solitary fibrous tumor: Imaging findings

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Clarencon, Frederic, E-mail: fredclare5@msn.com [Department of Neuroradiology, Pitie-Salpetriere Hospital, APHP, 75013 Paris (France); Bonneville, Fabrice [Department of Neuroradiology, Hopital Rangueil, Toulouse University Hospital, 31000 Toulouse (France); Rousseau, Audrey [Department of Neuropathology, Pitie-Salpetriere Hospital (France); Galanaud, Damien [Department of Neuroradiology, Pitie-Salpetriere Hospital, APHP, 75013 Paris (France); Kujas, Michele [Department of Neuropathology, Pitie-Salpetriere Hospital (France); Naggara, Olivier [Department of Neuroradiology, St Anne Hospital, 75014 Paris (France); Cornu, Philippe [Department of Neurosurgery, Pitie-Salpetriere Hospital (France); Chiras, Jacques [Department of Neuroradiology, Pitie-Salpetriere Hospital, APHP, 75013 Paris (France)

2011-11-15

Objective: To study the neuroimaging features of intracranial solitary fibrous tumors (ISFTs). Materials and methods: Retrospective study of neuroimaging features of 9 consecutive histopathologically proven ISFT cases. Location, size, shape, density, signal intensity and gadolinium uptake were studied at CT and MRI. Data collected from diffusion-weighted imaging (DWI) (3 patients), perfusion imaging and MR spectroscopy (2 patients), and DSA (4 patients) were also analyzed. Results: The tumors most frequently arose from the intracranial meninges (7/9), while the other lesions were intraventricular. Tumor size ranged from 2.5 to 10 cm (mean = 6.6 cm). They presented multilobular shape in 6/9 patients. Most ISFTs were heterogeneous (7/9) with areas of low T2 signal intensity that strongly enhanced after gadolinium administration (6/8). Erosion of the skull was present in about half of the cases (4/9). Components with decreased apparent diffusion coefficient were seen in 2/3 ISFTs on DWI. Spectroscopy revealed elevated peaks of choline and myo-inositol. MR perfusion showed features of hyperperfusion. Conclusion: ISFT should be considered in cases of extra-axial, supratentorial, heterogeneous, hypervascular tumor. Areas of low T2 signal intensity that strongly enhance after gadolinium injection are suggestive of this diagnosis. Restricted diffusion and elevated peak of myo-inositol may be additional valuable features.

Medial frontal cortex and response conflict: Evidence from human intracranial EEG and medial frontal cortex lesion

NARCIS (Netherlands)

Cohen, M.X.; Ridderinkhof, K.R.; Haupt, S.; Elger, C.E.; Fell, J.

2008-01-01

The medial frontal cortex (MFC) has been implicated in the monitoring and selection of actions in the face of competing alternatives, but much remains unknown about its functional properties, including electrophysiological oscillations, during response conflict tasks. Here, we recorded intracranial

Intracranial non-Langerhans cell histiocytosis presenting as an isolated intraparenchymal lesion

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Rajaram, Smitha; Shackley, Fiona; Raghavan, Ashok [Western Bank, Sheffield Children' s Hospital, Sheffield (United Kingdom); Wharton, Stephen B. [University of Sheffield, Department of Neurosciences, Sheffield (United Kingdom); Connolly, Daniel J.A. [Western Bank, Sheffield Children' s Hospital, Sheffield (United Kingdom); University of Sheffield, Academic Radiology, Sheffield (United Kingdom)

2010-12-15

Non-Langerhans cell histiocytosis in the absence of cutaneous or other organ involvement is very rare. A Caucasian boy age 3 years 11 months presented with episodes of recurrent right-side seizures over 2 weeks. Brain CT and MR imaging showed a single enhancing left frontal lobe lesion. Stereotactic biopsy was performed and histological examination showed diffuse infiltrate of macrophages with foamy cytoplasm. Four months later there was recurrence of seizure activity despite anti-epileptic medication and a repeat MR scan showed a persistent enhancing lesion in the left frontal lobe. Histological examination of the resection specimen resembled juvenile xanthogranuloma (JXG) involving the central nervous system. In the absence of skin lesions a diagnosis of non-Langerhans cell histiocytosis was made. The child made a full recovery following surgery with resolution of his symptoms. (orig.)

Investigation of intracranial peripheral dose arising from the treatment of large lesions with Leksell GammaKnife Perfexion.

Science.gov (United States)

Ruschin, Mark; Nordström, Håkan; Kjäll, Per; Cho, Young-Bin; Jaffray, David

2009-06-01

This investigation involves quantifying the extent of intracranial peripheral dose arising from simulated targets situated in the skull-base or upper-spine region using the Leksell GammaKnife Perfexion treatment unit. For each of three spherical target volumes--denoted as Vs (4 cm3), VM (18 cm3), and VL (60 cm3)--three treatment plans were manually generated, one for each of the three collimator sizes--4, 8, and 16 mm. Each of the plans was delivered to a spherical dosimetry phantom with an insert containing EBT Gafchromic film. The total dose at 70 mm from the targets' edges, %D(70 mm), was measured as a function of elevation angle and expressed as a percentage of the prescription dose. The film insert was placed centered in the median sagittal plane (Leksell X = 100) and %D(70 mm) was measured for the angular range from 0 degree (superior/along Z axis) to 90 degrees (anterior/along Y axis). For a given collimator i, the irradiation time ti to treat a spherical target of volume V using the 50% isodose line was observed to follow a power-law relationship of the form ti = Ai(V/ Vi)n where Ai was the maximum dose divided by collimator dose rate and Vi was the volume encompassed by the 50% isodose line for a single shot. The mean value of n was 0.61 (range: 0.61-0.62). Along the superior (Z) direction (angle=0 degree) and up to angles of around 30 degrees, the %D(70 mm) was always highest for the 4 mm plans, followed by the 8 mm, followed by the 16 mm. In this angular range, the maximum measured %D(70 mm) was 1.7% of the prescription dose. The intracranial peripheral dose along the superior direction (combined scatter and leakage dose) resulting from irradiation of upper-spine or base-of-skull lesions is measured to be less than 2% of the prescription dose, even for very large (60 cm3) targets. The results of this study indicate that, for a given target volume, treatment plans consisting of only 4 mm shots yield larger peripheral dose in the superior direction than 8

Intracranial ring enhancing lesions in dogs: a correlative CT scanning and neuropathologic study

International Nuclear Information System (INIS)

Wolf, Michael; Pedroia, Vince; Higgins, Robert J.; Koblik, Philip D.; Turrel, Jane M.; Owens, Jerry M.

1995-01-01

This retrospective analysis of 15 dogs with postcontrast ring enhancing brain lesions, each detected by a single Computed Tomography (CT) examination, searched for any association between their CT appearance and the pathologic diagnosis. In a subgroup of these dogs (n = 71) necropsied within 2 days of the last CT scan, we evaluated whether there was any anatomic correlation between the ring zone and the histopathologic features of the lesions. Our study consisted of eight dogs with primary brain tumors (3 meningiomas, 3 astrocytomas, 1 mixed glioma, 1 oligodendroglioma), 4 with metastatic brain tumors (2 fibrosarcomas, 1 mammary carcinoma, 1 melanoma) and 3 with non-neoplastic brain lesions (2 intraparenchymal hemorrhages, 1 pyogranulomatous meningoencephalitis). The overall size and shape of the contrast enhancing CT lesions, as well as the thickness, surface texture and degree of enhancement of the ring were subjectively evaluated. No association was found between the CT lesion characteristics and the pathologic diagnosis. In the sub-group of dogs euthanatized within 2 days of the CT examination, distinct histologic features which anatomically correlated with the zone of ring enhancement were found in 3 of 7 lesions. The findings of this study are consistent with those of ring-enhancing lesions in people, and indicates that CT ring enhancement is a nonspecific phenomenon which can occur in a variety of neoplastic and non-neoplastic lesions in the dog

Apparent Diffusion Coefficient Maps of Pediatric Mass Lesions with Free-Breathing Diffusion-Weighted Magnetic Resonance: Feasibility Study

International Nuclear Information System (INIS)

Olsen, Oe.E.; Sebire, N.J.

2006-01-01

Purpose: To assess the technical feasibility of apparent diffusion coefficient (ADC) mapping based on free-breathing diffusion-weighted magnetic resonance (DW-MR) outside the CNS in children. Material and Methods: Twelve children with mass lesions of varied histopathology were scanned with short-tau inversion recovery (STIR), contrast-enhanced T1-weighted (CE-T1W), and diffusion-weighted (b = 0, 500 and 1,000 s/mm 2 ) sequences. ADC maps were calculated. Lesion-to-background signal intensity ratios were measured and compared between STIR/CE-T1W/ADC overall (Friedman test) and between viable embryonal tumors and other lesions (Kruskal-Wallis test). Results: ADC maps clearly depicted all lesions. Lesion-to-background signal intensity ratios of STIR (median 3.7), CE-T1W (median 1.4), and ADC (median 1.6) showed no overall difference (chi-square = 3.846; P = 0.146), and there was no difference between viable embryonal tumors and other lesions within STIR/CE-T1W/ADC (chi-square 1.118/0.669/<0.001; P = 0.290/0.414/1.000, respectively). Conclusion: ADC mapping is feasible in free-breathing imaging of pediatric mass lesions outside the CNS using standard clinical equipment. Keywords: Diffusion-weighted magnetic resonance imaging; infants and children; neoplasms

Pleomorphic adenocarcinoma of the lacrimal gland with multiple intracranial and spinal metastases

Directory of Open Access Journals (Sweden)

Kim Se

2007-03-01

Full Text Available Abstract Background Pleomorphic adenoma of the lacrimal gland is known to undergo malignant transformation when incompletely excised. Even if such a malignant change occurs, intracranial direct invasion and leptomeningeal seeding are seldom encountered. Case presentation A 50-year-old woman presented with malignant transformation associated with both intracranial invasion and multiple intracranial and spinal disseminations in the third recurrence of pleomorphic adenoma of the lacrimal gland, 6 years after initial treatment. MRI demonstrated increased extent of orbital mass, extending to the cavernous sinus. The patient underwent intensity-modulated radiation therapy (IMRT and Gamma Knife radiosurgery. Follow-up MRI showed multiple leptomeningeal disseminations to the intracranium and spine. Conclusion It is important to recognize that leptomeningeal intracranial and spinal disseminations of pleomorphic adenocarcinoma can occur, although it is extremely rare. To our knowledge, we report the first case of pleomorphic adenocarcinoma of the lacrimal gland presumably metastasizing to the intracranium and spine.

Ring-shaped lesions in the CT scan

International Nuclear Information System (INIS)

Kazner, E.; Steinhoff, H.; Wende, S.; Mauersberger, W.

1978-01-01

Computerised tomography has really opened new dimensions for the diagnosis of various intracranial space-occupying lesions. However, during the last years we had to learn how difficult it can be to evaluate a certain CT finding correctly. Especially the group of ring-type lesions still pose some unsolved problems even if clinical information available in the individual case is considered. The ring blush is a nonspecific finding which occurs in primary and metastatic neoplasms, abscess, infarction, certain stages of intracerebral hematomas and even after neurosurgical operations. The ring blush is caused partly by breakdown of the blood brain barrier, partly by hypervascular pathologic tissue or by both factors. (orig.) [de

The syndrome of pseudotumour cerebri and idiopathic intracranial hypertension.

Science.gov (United States)

Fraser, Clare; Plant, Gordon T

2011-02-01

Idiopathic intracranial hypertension (IIH) is a condition in which raised intracranial pressure is associated with a high body mass index, and in those societies in which the prevalence of obesity is increasing the disorder is of increasing importance. It is one cause of the syndrome of pseudotumour cerebri but the cause and the link with a rise in body weight are not understood. Furthermore the treatment of the more severe, sight-threatening cases is controversial. A major theme in recent years has been an attempt to identify the underlying mechanism of IIH. Some theories - such as the dural sinus stenosis theory - seem to ignore the relationship with weight gain; others have proposed a direct link between obesity and raised intracranial pressure through a specific fat distribution in the body; others through the production of lipokines; and yet others have suggested a converse causation with raised intracranial pressure giving rise to obesity. Uncontrolled case series continue to demonstrate the success of interventions such as cerebrospinal fluid diversion procedures, venous sinus stenting and bariatric surgery but there are no level 1 clinical trials. Interest in IIH is increasing and currently generating numerous studies but there is no consensus view on either cause or management.

Intracranial ganglioglioma: clinicopathological and MRI findings in 16 patients

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Zhang, D. [Department of Radiology, XinQiao Hospital, Third Military Medical University, ChongQing 400037 (China); Henning, T.D. [UCSF, Department of Radiology, Contrast Media Laboratory, San Francisco, CA, 94107 (United States); Zou, L.-G. [Department of Radiology, XinQiao Hospital, Third Military Medical University, ChongQing 400037 (China); Hu, L.-B. [Department of Radiology, The Second Hospital of ChongQing, ChongQing 400000 (China); Wen, L. [Department of Radiology, XinQiao Hospital, Third Military Medical University, ChongQing 400037 (China)], E-mail: cqzdwl@yahoo.com.cn; Feng, X.-Y. [Department of Radiology, HuaShan Hospital, Medical Center of FuDan University, ShangHai 200040 (China); Dai, S.-H.; Wang, W.-X.; Sun, Q.-R. [Department of Radiology, XinQiao Hospital, Third Military Medical University, ChongQing 400037 (China); Zhang, Z.-G. [Department of Pathology, XinQiao Hosptial, Third Military Medical University, ChongQing 400037 (China)

2008-01-15

Aim: To record the clinical findings and magnetic resonance imaging (MRI) characteristics of intracranial gangliogliomas in 16 patients. Materials and methods: Sixteen patients were imaged using unenhanced and contrast-enhanced MRI. Eight patients underwent unenhanced CT and of these, three underwent contrast-enhanced CT. Two radiologists read the images retrospectively. The images were studied with regard to location, size, margin, signal intensity, enhancement characteristics, cystic changes, and presence of calcifications. Clinical data, such as presenting signs and symptoms, physical findings, and medical histories, were collected. Histopathological and immunohistochemical studies were performed and analysed by two pathologists. Results: In 12 cases the tumours were located in one of the cerebral hemispheres; in the other cases they were located in the brainstem, cerebellum, suprasellar area or the thalamus. The tumour dimension varied from 1-7 cm, with a mean of 3.6 cm {+-} 1.8 cm. The MRI features of ganglioglioma in the present cohort can be divided into three patterns: cystic (n = 2), cystic-solid (n = 6), and solid (n = 8). Solid lesions had a predilection for the temporal lobe; cystic and cystic-solid tumours had a wide anatomical distribution. Cystic lesions were significantly smaller than both cystic-solid and solid lesions (F = 4.28, P < 0.05). Cystic changes in the cystic-solid tumours showed one of the following patterns: those with walls showing contrast enhancement, those containing an enhancing nodule, or cysts without an obvious wall. The solid portion of cystic-solid gangliogliomas and the entire tumour in solid tumours showed homogeneous enhancement of variable degrees on T1-weighted (T1W) spin-echo (SE) images. Five tumours had mild or moderate oedema. In one patient two separate gangliogliomas were found, each lesion exhibiting different MRI features: solid and cystic-solid. One case of cortical ganglioglioma was found, causing bone erosion

Intracranial ganglioglioma: clinicopathological and MRI findings in 16 patients

International Nuclear Information System (INIS)

Zhang, D.; Henning, T.D.; Zou, L.-G.; Hu, L.-B.; Wen, L.; Feng, X.-Y.; Dai, S.-H.; Wang, W.-X.; Sun, Q.-R.; Zhang, Z.-G.

2008-01-01

Aim: To record the clinical findings and magnetic resonance imaging (MRI) characteristics of intracranial gangliogliomas in 16 patients. Materials and methods: Sixteen patients were imaged using unenhanced and contrast-enhanced MRI. Eight patients underwent unenhanced CT and of these, three underwent contrast-enhanced CT. Two radiologists read the images retrospectively. The images were studied with regard to location, size, margin, signal intensity, enhancement characteristics, cystic changes, and presence of calcifications. Clinical data, such as presenting signs and symptoms, physical findings, and medical histories, were collected. Histopathological and immunohistochemical studies were performed and analysed by two pathologists. Results: In 12 cases the tumours were located in one of the cerebral hemispheres; in the other cases they were located in the brainstem, cerebellum, suprasellar area or the thalamus. The tumour dimension varied from 1-7 cm, with a mean of 3.6 cm ± 1.8 cm. The MRI features of ganglioglioma in the present cohort can be divided into three patterns: cystic (n = 2), cystic-solid (n = 6), and solid (n = 8). Solid lesions had a predilection for the temporal lobe; cystic and cystic-solid tumours had a wide anatomical distribution. Cystic lesions were significantly smaller than both cystic-solid and solid lesions (F = 4.28, P < 0.05). Cystic changes in the cystic-solid tumours showed one of the following patterns: those with walls showing contrast enhancement, those containing an enhancing nodule, or cysts without an obvious wall. The solid portion of cystic-solid gangliogliomas and the entire tumour in solid tumours showed homogeneous enhancement of variable degrees on T1-weighted (T1W) spin-echo (SE) images. Five tumours had mild or moderate oedema. In one patient two separate gangliogliomas were found, each lesion exhibiting different MRI features: solid and cystic-solid. One case of cortical ganglioglioma was found, causing bone erosion due

Intracranial Aneurysms of Neuro-Ophthalmologic Relevance.

Science.gov (United States)

Micieli, Jonathan A; Newman, Nancy J; Barrow, Daniel L; Biousse, Valérie

2017-12-01

Intracranial saccular aneurysms are acquired lesions that often present with neuro-ophthalmologic symptoms and signs. Recent advances in neurosurgical techniques, endovascular treatments, and neurocritical care have improved the optimal management of symptomatic unruptured aneurysms, but whether the chosen treatment has an impact on neuro-ophthalmologic outcomes remains debated. A review of the literature focused on neuro-ophthalmic manifestations and treatment of intracranial aneurysms with specific relevance to neuro-ophthalmologic outcomes was conducted using Ovid MEDLINE and EMBASE databases. Cavernous sinus aneurysms were not included in this review. Surgical clipping vs endovascular coiling for aneurysms causing third nerve palsies was compared in 13 retrospective studies representing 447 patients. Complete recovery was achieved in 78% of surgical patients compared with 44% of patients treated with endovascular coiling. However, the complication rate, hospital costs, and days spent in intensive care were reported as higher in surgically treated patients. Retrospective reviews of surgical clipping and endovascular coiling for all ocular motor nerve palsies (third, fourth, or sixth cranial nerves) revealed similar results of complete resolution in 76% and 49%, respectively. Improvement in visual deficits related to aneurysmal compression of the anterior visual pathways was also better among patients treated with clipping than with coiling. The time to treatment from onset of visual symptoms was a predictive factor of visual recovery in several studies. Few reports have specifically assessed the improvement of visual deficits after treatment with flow diverters. Decisions regarding the choice of therapy for intracranial aneurysms causing neuro-ophthalmologic signs ideally should be made at high-volume centers with access to both surgical and endovascular treatments. The status of the patient, location of the aneurysm, and experience of the treating physicians

Somatostatin receptor imaging in intracranial tumours

International Nuclear Information System (INIS)

Schmidt, M.; Scheidhauer, K.; Voth, E.; Schicha, H.; Luyken, C.; Hildebrandt, G.; Klug, N.

1998-01-01

The somatostatin analogue [ 111 In-DTPA-d-Phe 1 ]-octreotide ( 111 In-octreotide) allows scintigraphic visualization of somatostatin receptor-expressing tissue. While it is well known that a large variety of tissues express somatostatin receptors and 111 In-octreotide scintigraphy has a clearly defined role in various neuroendocrine diseases, the clinical value of 111 In-octreotide scintigraphy in brain tumours is still under clinical investigation. In 124 patients with 141 brain lesions (63 meningiomas, 24 pituitary adenomas, 10 gliomas WHO class I and II, 12 gliomas WHO class III and IV, 11 neurinomas and 2 neurofibromas, 7 metastases and 12 other varieties: three non-Hodgkin B-cell lymphomas, two epidermoids, one abscess, one angioleiomyoma, one chordoma, one haemangiopericytoma, one osteosarcoma, one plasmacytoma and one pseudocyst), 111 In-octreotide scintigraphy was performed 4-6 and 24 h after i.v. injection of 110-220 MBq 111 In-octreotide. Planar images of the head in four views with a 128 x 128 matrix and single-photon emission tomographic images (64 x 64 matrix) were acquired, and lesions were graded according to qualitative tracer uptake. Fifty-nine of the 63 meningiomas showed moderate to intense tracer uptake. Nine of 24 pituitary adenomas were visible; the remaining 15 did not show any tracer uptake. None of the class I and II gliomas with an intact blood-brain barrier were detected whereas 11/12 class III and IV gliomas showed 111 In-octreotide uptake. None of the neurinomas or neurofibromas were positive. Five of seven metastases were classified as positive, as were the osteosarcoma, two of three non-Hodgkin B-cell lymphomas, one abscess, one angioleiomyoma, one chordoma and one haemangiopericytoma. The other varieties (one non-Hodgkin B-cell lymphoma, two epidermoids, one plasmacytoma and one pseudocyst) did not show 111 In-octreotide uptake. The results demonstrate that a large variety of intracranial lesions express somatostatin receptors and

Somatostatin receptor imaging in intracranial tumours

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Schmidt, M.; Scheidhauer, K.; Voth, E.; Schicha, H. [Department of Nuclear Medicine, University of Koeln (Germany); Luyken, C.; Hildebrandt, G.; Klug, N. [Department of Neurosurgery, University of Kolen (Germany)

1998-07-01

The somatostatin analogue [{sup 111}In-DTPA-d-Phe{sup 1}]-octreotide ({sup 111}In-octreotide) allows scintigraphic visualization of somatostatin receptor-expressing tissue. While it is well known that a large variety of tissues express somatostatin receptors and {sup 111}In-octreotide scintigraphy has a clearly defined role in various neuroendocrine diseases, the clinical value of {sup 111}In-octreotide scintigraphy in brain tumours is still under clinical investigation. In 124 patients with 141 brain lesions (63 meningiomas, 24 pituitary adenomas, 10 gliomas WHO class I and II, 12 gliomas WHO class III and IV, 11 neurinomas and 2 neurofibromas, 7 metastases and 12 other varieties: three non-Hodgkin B-cell lymphomas, two epidermoids, one abscess, one angioleiomyoma, one chordoma, one haemangiopericytoma, one osteosarcoma, one plasmacytoma and one pseudocyst), {sup 111}In-octreotide scintigraphy was performed 4-6 and 24 h after i.v. injection of 110-220 MBq {sup 111}In-octreotide. Planar images of the head in four views with a 128 x 128 matrix and single-photon emission tomographic images (64 x 64 matrix) were acquired, and lesions were graded according to qualitative tracer uptake. Fifty-nine of the 63 meningiomas showed moderate to intense tracer uptake. Nine of 24 pituitary adenomas were visible; the remaining 15 did not show any tracer uptake. None of the class I and II gliomas with an intact blood-brain barrier were detected whereas 11/12 class III and IV gliomas showed {sup 111}In-octreotide uptake. None of the neurinomas or neurofibromas were positive. Five of seven metastases were classified as positive, as were the osteosarcoma, two of three non-Hodgkin B-cell lymphomas, one abscess, one angioleiomyoma, one chordoma and one haemangiopericytoma. The other varieties (one non-Hodgkin B-cell lymphoma, two epidermoids, one plasmacytoma and one pseudocyst) did not show {sup 111}In-octreotide uptake. The results demonstrate that a large variety of intracranial

Automated analysis of non-mass-enhancing lesions in breast MRI based on morphological, kinetic, and spatio-temporal moments and joint segmentation-motion compensation technique

Science.gov (United States)

Hoffmann, Sebastian; Shutler, Jamie D.; Lobbes, Marc; Burgeth, Bernhard; Meyer-Bäse, Anke

2013-12-01

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) represents an established method for the detection and diagnosis of breast lesions. While mass-like enhancing lesions can be easily categorized according to the Breast Imaging Reporting and Data System (BI-RADS) MRI lexicon, a majority of diagnostically challenging lesions, the so called non-mass-like enhancing lesions, remain both qualitatively as well as quantitatively difficult to analyze. Thus, the evaluation of kinetic and/or morphological characteristics of non-masses represents a challenging task for an automated analysis and is of crucial importance for advancing current computer-aided diagnosis (CAD) systems. Compared to the well-characterized mass-enhancing lesions, non-masses have no well-defined and blurred tumor borders and a kinetic behavior that is not easily generalizable and thus discriminative for malignant and benign non-masses. To overcome these difficulties and pave the way for novel CAD systems for non-masses, we will evaluate several kinetic and morphological descriptors separately and a novel technique, the Zernike velocity moments, to capture the joint spatio-temporal behavior of these lesions, and additionally consider the impact of non-rigid motion compensation on a correct diagnosis.

Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

Science.gov (United States)

... cause is determined and is referred to as “secondary” intracranial hypertension. What are the risk factors for idiopathic intracranial ... clotting disorders, anemia and malnutrition. Can idiopathic intracranial ... to be “secondary” which affects males and females equally. The second ...

Non-mass-like breast lesions at ultrasonography: Feature analysis and BI-RADS assessment

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Ko, Kai-Hsiung [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC (China); Hsu, Hsian-He, E-mail: hsianhe@yahoo.com.tw [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC (China); Yu, Jyh-Cherng [Department of Surgery, Division of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC (China); Peng, Yi-Jen [Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC (China); Tung, Ho-Jui [Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC (China); Chu, Chi-Ming [Section of Health Informatics, Institute of Public Health, National Defense Medical Center and University, Taipei, Taiwan, ROC (China); Chang, Tsun-Hou; Chang, Wei-Chou; Wu, Yu-Cheng; Lin, Yu-Pang; Hsu, Giu-Cheng [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC (China)

2015-01-15

Highlights: • The positive predictive value of an NML lesion on ultrasound ranges from 10 to 79%. • A sizable number of NML malignant lesions are pure DCIS or ILC. • Biopsy is indicated for histopathological diagnosis when an ultrasound NML lesion is recognized. - Abstract: Objective: To analyze the features of non-mass-like (NML) breast lesions on ultrasound (US) and determine their corresponding malignancy rate and to stratify these lesion patterns according to US BI-RADS categories. Materials and methods: One hundred sixty-four consecutive lesions were retrospectively classified into four types according to the US features, the corresponding positive predictive values (PPVs) were obtained. Clinical, imaging, and histopathological findings were reviewed. Results: Among the 164 lesions, 39 (24%) were classified as type Ia, 14 (8%) as type Ib, 39 (24%) as type IIa, 19 (12%) as type IIb, 19 (12%) as type III, and 34 (21%) as type IV. The PPVs for malignancy were 21% for type Ia, 79% for type Ib, 10% for type IIa, 58% for type IIb, 16% for type III, and 21% for type IV. All NML lesions were classified as BI-RADS category 4a (type IIa), 4b (type Ia, III and IV) and 4c (type Ib and IIb) according to their PPVs. There was a significantly higher frequency of malignancy among lesions of type Ib and type IIb compared with the other types (P < 0.01 for each). Lesions with associated calcifications, presence of abnormal axillary nodes, or a mammographic finding of suspected malignancy had a higher probability of malignancy (P < 0.05 for each). Conclusion: US is useful in clarifying the indication for biopsy of NML lesions. The types of US classifications used in our study establish reliable references for the NML patterns when stratified according to the BI-RADS categories.

Non-mass-like breast lesions at ultrasonography: Feature analysis and BI-RADS assessment

International Nuclear Information System (INIS)

Ko, Kai-Hsiung; Hsu, Hsian-He; Yu, Jyh-Cherng; Peng, Yi-Jen; Tung, Ho-Jui; Chu, Chi-Ming; Chang, Tsun-Hou; Chang, Wei-Chou; Wu, Yu-Cheng; Lin, Yu-Pang; Hsu, Giu-Cheng

2015-01-01

Highlights: • The positive predictive value of an NML lesion on ultrasound ranges from 10 to 79%. • A sizable number of NML malignant lesions are pure DCIS or ILC. • Biopsy is indicated for histopathological diagnosis when an ultrasound NML lesion is recognized. - Abstract: Objective: To analyze the features of non-mass-like (NML) breast lesions on ultrasound (US) and determine their corresponding malignancy rate and to stratify these lesion patterns according to US BI-RADS categories. Materials and methods: One hundred sixty-four consecutive lesions were retrospectively classified into four types according to the US features, the corresponding positive predictive values (PPVs) were obtained. Clinical, imaging, and histopathological findings were reviewed. Results: Among the 164 lesions, 39 (24%) were classified as type Ia, 14 (8%) as type Ib, 39 (24%) as type IIa, 19 (12%) as type IIb, 19 (12%) as type III, and 34 (21%) as type IV. The PPVs for malignancy were 21% for type Ia, 79% for type Ib, 10% for type IIa, 58% for type IIb, 16% for type III, and 21% for type IV. All NML lesions were classified as BI-RADS category 4a (type IIa), 4b (type Ia, III and IV) and 4c (type Ib and IIb) according to their PPVs. There was a significantly higher frequency of malignancy among lesions of type Ib and type IIb compared with the other types (P < 0.01 for each). Lesions with associated calcifications, presence of abnormal axillary nodes, or a mammographic finding of suspected malignancy had a higher probability of malignancy (P < 0.05 for each). Conclusion: US is useful in clarifying the indication for biopsy of NML lesions. The types of US classifications used in our study establish reliable references for the NML patterns when stratified according to the BI-RADS categories

CT diagnosis of sellar and juxtasellar lesions, 3. Non-tumorous lesions

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Kobayashi, Tatsuya [Nagoya Univ. (Japan). Faculty of Medicine

1982-08-01

A study is made of the usefulness and limitations of the CT diagnosis of sellar and juxtasellar lesions other than tumors. This study is based on 112 verified cases at Nagoya University Hospital from October, 1976, to December, 1981. The lesions included in this study are classified into four groups: vascular, inflammatory, traumatic lesion, and congenital anomaly. Although cerebral angiography is the cardinal method for the diagnosis of vascular lesions, CT is useful for the evaluation of a giant aneurysm, the localization of bleeding, or infarction by a ruptured aneurysm. Radiation brain necrosis, a special form of vascular lesion, can also be diagnosed if the critical analysis is made after previous irradiation. CT findings are helpful for the local diagnosis of acute inflammatory lesions, such as basal meningitis or abscess, but specific diagnosis is made on the basis of clinical signs and CSF study. Abnormal CT findings are obtained from a chronic inflammatory process, such as arachnoiditis adhesiva, glanuloma, or mucocele. Differential diagnosis is necessary with brain tumors. The CT findings of an arachnoid cyst are often diagnostic. Metrizamide or air cisternography, either combined with CT or without it, is important for the diagnosis of basal meningoencephalocele and hypothalamic hamaroma. Pneumocephalus and an intracranial foreign body resulting from a head injury can be diagnosed by plain skull and CT. The diagnosis of CSF leakage or prolapse cerebri associated with a skull-base fracture has been most difficult, but even it is possible by a combination of polytomography and high-resolution CT with metrizamide cisternography.

Intracranial atherosclerosis: current concepts.

Science.gov (United States)

Arenillas, Juan F

2011-01-01

The most relevant ideas discussed in this article are described here. Intracranial atherosclerotic disease (ICAD) represents the most common cause of ischemic stroke worldwide. Its importance in whites may have been underestimated. New technical developments, such as high-resolution MRI, allow direct assessment of the intracranial atherosclerotic plaque, which may have a profound impact on ICAD diagnosis and therapy in the near future. Early detection of ICAD may allow therapeutic intervention while the disease is still asymptomatic. The Barcelonès Nord and Maresme Asymptomatic Intracranial Atherosclerosis Study is presented here. The main prognostic factors that characterize the patients who are at a higher risk for ICAD recurrence are classified and discussed. The best treatment for ICAD remains to be established. The Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Study is currently ongoing to address this crucial issue. These and other topics will be discussed at the Fifth International Intracranial Atherosclerosis Conference (Valladolid, Spain, autumn 2011).

The value of T/NT in FDG imaging with a coincidence camera for diagnosis of pulmonary nodules and mass lesions

International Nuclear Information System (INIS)

Sun Da; Zhan Hongwei; Xu Wei; Ye Xiaojuan; Liu Qichang

2004-01-01

Objectives: To assess the value of T/NT in FDG imaging with a coincidence camera for diagnosis of pulmonary nodules and mass lesions. Methods: 18F-FDG imaging were performed in 57 patients with a mean age of 62.18 (range from 33 83 years old) for diagnosis of pulmonary nodules and mass lesions using a gamma camera with 1 inch crystal in coincidence mode (Siemens E.comduet). 175 296 MBq (5 8 mci) of 18F-FDG was given by iv on an empty stomach at least for 6 hours, and a whole body imaging without brain and legs was performed after 40 60 minutes. The count rate of target ROI and no-target ROI (T/NT) were calculated as a semiquantative analysis to differentiate malignant from inflammatory lesions. The result was compared with CT, MRI, and/or pathology. Results: The mean value of T/NT in malignant lesions (N=45) in lungs is 4.32 (range 1.61 10.62). But it is 1.52 (range 1.37 1.95) in inflammatory lesions (N=17) in lungs, and 4.09 (range 2.2 7.01) in lung tuberculosis lesions (N=5). In 45 malignant, the value of T/NT is less than 2.0 in only 3 lesions. So the overlapping of T/NT value is very little between malignant and inflammatory lesions. But there is full overlapping of T/NT value between malignant and tuberculosis lesions. Conclusions: Focal pulmonary nodules and mass lesions are commonly encountered in clinical practice, and PET with 18F-FDG has proved to be an accurate noninvasive test for identifying pulmonary malignant lesions. The technique of semiquantity with T/NT is useful to differentiate malignant from inflammatory lesions. But it is invalidate for distinguishing malignant from tuberculosis lesions. (authors)

Intracranial cystic lesions; Intrakranielle zystische Laesionen

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Ahlhelm, F.; Goetschi, S. [Kantonsspital Baden AG, Abteilung fuer Neuroradiologie, Baden (Switzerland); Shariat, K. [Kantonsspital Winterthur, Klinik fuer Neurochirurgie, Winterthur (Switzerland); Ulmer, S. [Universitaetsklinikum Schleswig-Holstein, Klinik fuer Radiologie und Neuroradiologie, Kiel (Germany)

2018-02-15

Intracerebral cysts are common findings in imaging of the neurocranium and are not always clinically significant. The pathological spectrum of intracerebral cysts is, however, very broad and in addition to incidental findings includes developmental disorders, malformation tumors, primary and secondary neoplasms and infectious etiologies, such as cerebral abscess formation, cysticercosis or residuals after congenital cytomegalovirus infections. Intracerebral cystic defects may be caused by inflammatory central nervous system (CNS) diseases, such as multiple sclerosis as well as by mitochondriopathies, leukodystrophy, electrolyte disturbances or osmotic demyelination syndrome or brain infarctions, e.g. after lacunar infarctions or as encephalomalacic changes after severe traumatic brain injury. In addition to the radiological findings of cysts in magnetic resonance imaging (MRI) or in computed tomography (CT), the localization, patient age, patient medical history and laboratory diagnostics are helpful for the differential diagnostics. In addition to the morphological assessment, advanced MRI techniques, such as diffusion-weighted imaging for epidermoids or the use of MR spectroscopy, can provide valuable information for the differential diagnosis. Intracranial cysts can be subdivided into intraventricular and periventricular cysts, intra-axial cysts and cysts in the external fluid-filled spaces. Associated tumor nodules and the contrast medium behavior of the cyst walls and/or associated soft tissue components as well as the reaction of the adjacent parenchyma are helpful for the diagnosis and assessment. (orig.) [German] Bei der Bildgebung des Neurokraniums sind intrazerebrale Zysten haeufig und haben nicht immer einen Krankheitswert. Das Spektrum der intrazerebralen Zysten ist jedoch sehr gross und beinhaltet neben Inzidentalbefunden auch Entwicklungsstoerungen, Missbildungstumoren, primaere und sekundaere Neoplasien sowie infektiologische Ursachen, wie z. B

NOISY INTRACRANIAL TUMORS

NARCIS (Netherlands)

VANDOOREN, BTH; VANBRUGGEN, AC; MOOIJ, JJA; HEW, JM; JOURNEE, HL

1994-01-01

Transorbital sound recordings were obtained from 21 patients with intracranial tumours, 28 patients with intracranial aneurysms and 20 control patients. The group of patients with tumours consisted of 12 patients with gliomas, of whom 6 had low-grade gliomas and 6 had high-grade gliomas, and 9

Contribution of bone and brain scintigraphy to diagnosis of the extension and nature of skull lesions

International Nuclear Information System (INIS)

Akerman, M.; Tovar, G. de; Derome, P.

The combination of bone and brain scintigraphy provides a vast amount of information in the study of lesions of the skull. It is especially valuable as a means to circumscribe the invasion of the bones, distinguish between bone and intracranial invasion, diagnose the nature of the lesion, estimate its degree of vascularization and detect remote localisations [fr

Impact of vessel wall lesions and vascular stenoses on cerebrovascular reactivity in patients with intracranial stenotic disease

NARCIS (Netherlands)

Cogswell, Petrice M; Davis, Taylor L; Strother, Megan K; Faraco, Carlos C; Scott, Allison O; Jordan, Lori C; Fusco, Matthew R; Frederick, Blaise deB; Hendrikse, Jeroen; Donahue, Manus J

2017-01-01

PURPOSE: To compare cerebrovascular reactivity (CVR) and CVR lagtimes in flow territories perfused by vessels with vs. without proximal arterial wall disease and/or stenosis, separately in patients with atherosclerotic and nonatherosclerotic (moyamoya) intracranial stenosis. MATERIALS AND METHODS:

Association of benign intracranial hypertension and spontaneous encephalocele with cerebrospinal fluid leak.

Science.gov (United States)

Brainard, Laura; Chen, Douglas A; Aziz, Khaled M; Hillman, Todd A

2012-12-01

To determine the incidence of intracranial hypertension in patients with spontaneous encephalocele with cerebrospinal fluid (CSF) leak. Retrospective case review. Tertiary care neurotology practice. Patients presenting between 2008 and 2011 with spontaneous encephalocele and CSF leak in the temporal bone. Lumbar puncture with opening pressure measurement after encephalocele repair. Patient age, sex, postoperative course, body mass index, and postoperative intracranial pressure. Of the 26 patients identified with spontaneous encephalocele with CSF leak, 9 patients had postoperative lumbar puncture data. Of those 9, 89% were female subjects, and 11% were male, with a mean age of 57 and a mean BMI of 41 kg/m (morbidly obese). The mean opening pressure was 24.5 cm H(2)O. Approximately 33% had normal intracranial pressure (mean, 15 cm H(2)O; range, 10-17 cm H(2)O); 67% had elevated intracranial pressure (mean, 29 cm H(2)O; range, 23.5-40 cm H(2)O). The incidence of BIH in the general population is 0.001%. Of the 6 with intracranial hypertension, 3 (50%) were placed on acetazolamide for fundoscopic findings, postoperative headache, and/or visual changes. Mean time to LP after repair of encephalocele was 13 months (range, 4 days to 75 months). This study shows that benign intracranial hypertension is prevalent in a significant number of patients presenting with spontaneous encephalocele with CSF otorrhea at a rate much higher than is found in the general population. This finding has direct clinical implications and suggests that all patients with spontaneous encephalocele/CSF leak warrant evaluation for benign intracranial hypertension.

Post-treatment intracranial hemorrhage of brain metastases from hepatocellular carcinoma

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Kim, Kyung Su; Kim, Kyu Bo; Chie, Eui Kyu; Kim, Yoon Jun; Yoon, Jung Hwan; Lee, Hyo Suk; Ha, Sung W. [Seoul National University College of Medicine, Seoul (Korea, Republic of)

2015-03-15

To evaluate the incidence and risk factors of post-treatment intracranial hemorrhage of brain metastases from hepatocellular carcinoma (HCC). Medical records of 81 patients who have been diagnosed of brain metastases from HCC and underwent surgery, radiosurgery and/or whole brain radiotherapy (WBRT) between January 2000 and December 2013 were retrospectively reviewed. Intracranial hemorrhage was present in 64 patients (79%) at the time of diagnosis. Median value of alpha-fetoprotein (AFP) level was 1,700 ng/mL. The Eastern Cooperative Oncology Group (ECOG) performance status for 20 patients was greater than 2. Fifty-seven patients underwent WBRT and the others were treated with surgery and/or radiosurgery without WBRT. During follow-up, 12 events of intracranial hemorrhage after treatment were identified. Three-month post-treatment hemorrhage rate was 16.1%. Multivariate analyses revealed that ECOG performance status, AFP, and WBRT were associated with post-treatment hemorrhage (p = 0.013, 0.013, and 0.003, respectively). Kaplan-Meier analysis showed that 3-month post-treatment hemorrhage rate of new lesion was higher in patients treated without WBRT, although statistical significance was not reached. (18.6% vs. 4.6%; p = 0.104). Ten of 12 patients with post-treatment hemorrhage died with neurologic cause. WBRT should be considered to prevent post-treatment hemorrhage in the treatment of brain metastases from HCC.

Intracranial phosphaturic mesenchymal tumor, mixed connective tissue variant presenting without oncogenic osteomalacia.

Science.gov (United States)

Bower, Regina S; Daugherty, Wilson P; Giannini, Caterina; Parney, Ian F

2012-01-01

Phosphaturic mesenchymal tumor, mixed connective tissue variant (PMTMCT) is a rare tumor typically occurring in soft tissues and bone, causing oncogenic (tumor-induced) osteomalacia (TIO) through secretion of the phosphaturic hormone, fibroblast growth factor-23 (FGF-23). Rare tumors identical to PMTMCT occur without known TIO. Intracranial localization of PMTMCT is extremely rare, with only two cases reported in the literature. We present a very unusual case of a patient with an intracranial PMTMCT that presented with neurologic changes without osteomalacia. A 67-year-old woman presented with progressive incontinence, apathy, and abulia after having undergone a total knee replacement 1 month earlier. Imaging disclosed a large left frontal anterior fossa mass. She underwent uncomplicated surgical resection of this tumor. Surprisingly, histopathology suggested PMTMCT. Reverse transcription polymerase chain reaction (RT-PCR) assay demonstrating FGF-23 expression in the tumor confirmed the diagnosis. Serum FGF-23 levels postoperatively were normal and she had no clinical or laboratory evidence of osteomalacia or phosphaturia. This report should serve to alert clinicians to the possibility that PMTMCT can be included in the differential diagnosis of intracranial masses even in the absence of tumor-induced osteomalacia.

Imaging of intracranial neuronal and mixed neuronal-glial tumours

International Nuclear Information System (INIS)

Cui Shimin; Qin Jinxi; Zhang Leili; Liu Meili; Jin Song; Yan Shixin; Liu Li; Dai Weiying; Li Tao; Gao Man

2001-01-01

Objective: To investigate the characteristic clinical, imaging , and pathologic findings of intracranial neuronal and mixed neuronal-glial tumours. Methods: The imaging findings of surgery and pathobiology proved intracranial neuronal and mixed neuronal-glial tumours in 14 cases (7 male and 7 female, ranging in age from 6-56 years; mean age 33.8 years) were retrospectively analyzed. Results: Eight gangliogliomas were located in the frontal lobe (4 cases), temporal lobe (1 case), front- temporal lobe (2 cases), and pons (1 case). They appeared as iso-or low density on CT, iso-or low signal intensity on T 1 WI, and high signal intensity on T 2 WI on MR imaging. Two central neurocytomas were located in the supratentorial ventricles. Four desmoplastic gangliogliomas were seen as cystic masses, appearing as low signal intensity on T 1 WI and high signal intensity on T 2 WI. Conclusion: Intracranial neuronal and mixed neuronal-glial tumours had imaging characteristics. Combined with clinical history, it was possible to make a tendency preoperative diagnosis using CT or MR

Intracranial involvement in extramedullary hematopoiesis: case report and review of the literature

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Haidar, Salwa; Ortiz-Neira, Clara; Shroff, Manohar; Gilday, David; Blaser, Susan [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)

2005-06-01

Intracranial involvement in extramedullary hematopoiesis (EMH) is rare, but it should be suspected in patients with myelofibrosis presenting with chronic severe headache. We present a 9-year-old girl with known myelofibrosis whose headaches were unresponsive to routine treatment. CT and MRI studies of the brain showed diffuse pachymeningeal thickening. CT examinations of the chest and abdomen had demonstrated bilateral thoracic paraspinal masses caused by EMH, suggesting the possibility that the intracranial involvement might also be related to EMH. The diagnosis was confirmed by sulfur colloid isotope scan. (orig.)

Intracranial involvement in extramedullary hematopoiesis: case report and review of the literature

International Nuclear Information System (INIS)

Haidar, Salwa; Ortiz-Neira, Clara; Shroff, Manohar; Gilday, David; Blaser, Susan

2005-01-01

Intracranial involvement in extramedullary hematopoiesis (EMH) is rare, but it should be suspected in patients with myelofibrosis presenting with chronic severe headache. We present a 9-year-old girl with known myelofibrosis whose headaches were unresponsive to routine treatment. CT and MRI studies of the brain showed diffuse pachymeningeal thickening. CT examinations of the chest and abdomen had demonstrated bilateral thoracic paraspinal masses caused by EMH, suggesting the possibility that the intracranial involvement might also be related to EMH. The diagnosis was confirmed by sulfur colloid isotope scan. (orig.)

Mass-like Dieulafoy's lesion associated with advanced gastric cancer at the antrum of stomach: a case report and literature review.

Science.gov (United States)

Huang, Hsi-Lan; Leung, Chi Yan; Cheng, Chien-Jui

2017-10-10

Dieulafoy's lesion, also known as a caliber-persistent artery, is a shallow, small, and rare lesion that occurs along the lesser curvature of proximal stomach. It is rare for a Dieulafoy's lesion to present as a mass-like lesion that coexists with gastric cancer. To our best knowledge, we report the first case and histopathological pictures of a mass-like Dieulafoy's lesion coexisting with advanced gastric cancer in the antrum of the stomach. A 57-year-old female presented with a 6-month history of intermittent epigastric dull pain and dyspepsia. Subsequent upper gastrointestinal endoscopy revealed a friable mass that was located between the distal antrum and the pyloric ring. Biopsy revealed it to be an intestinal type adenocarcinoma. Subtotal gastrectomy was performed after neoadjuvant chemotherapy. Grossly, a large irregular plaque-like tumor lesion was noted at the anterior wall of the distal antrum and pylorus ring near the lesser curvature, measuring 5.6 × 4.8 × 1.0 cm. Histopathological examination of the resected stomach revealed that the plaque-like lesion largely consisted of numerous abnormally large-caliber and tortuous arteries in the submucosa. The increased fibrosis of the submucosa resulted in the formation of elevated plaque. The intestinal type adenocarcinoma was noted to be largely confined to the mucosa layer, with focal submucosal and muscular propria involvement. The patient was discharged one week after the subtotal gastrectomy, and she was alive and well 17 months after discharge, with no major complications. This is the first case of a mass-like Dieulafoy's lesion coexisting with advanced gastric cancer at the distal antrum area. This case highlights the possibility of life-threatening gastric bleeding after mucosal resection or biopsy that could be encountered by endoscopists.

PET examination in intracranial tumor diagnosis of a cat

International Nuclear Information System (INIS)

Angyal, G.; Csepura, G.; Balkay, L.; Galuska, L.; Molnar, J.; Valastyan, I.

2008-01-01

This paper shows the significance of the Positron Emission Tomography (PET) in the veterinary medication through a case study of a cat brain tumor. A castrated male cat with bilateral mydriasis and blindness arrived at the veterinary clinic. After physical, laboratory and neurological investigations other sickness was ruled out and the inkling of the intracranial lesion had come to light. Brain tumor seemed the most likely to cause the illness because other symptoms appeared (for example: anorexia, depression) and they progrediated fast. PET examination, using 18 F-FDG isotope, was performed to confirm the possible causes of the cat's symptoms

PET examination in intracranial tumor diagnosis of a cat

Science.gov (United States)

Angyal, G.; Csepura, G.; Balkay, L.; Galuska, L.; Molnár, J.; Valastyán, I.

2008-12-01

This paper shows the significance of the Positron Emission Tomography (PET) in the veterinary medication through a case study of a cat brain tumor. A castrated male cat with bilateral mydriasis and blindness arrived at the veterinary clinic. After physical, laboratory and neurological investigations other sickness was ruled out and the inkling of the intracranial lesion had come to light. Brain tumor seemed the most likely to cause the illness because other symptoms appeared (for example: anorexia, depression) and they progrediated fast. PET examination, using 18F-FDG isotope, was performed to confirm the possible causes of the cat's symptoms

Hyperdense lesions in CT of cerebral toxoplasmosis

International Nuclear Information System (INIS)

Quinones Tapia, D.; Ramos Amador, A.; Monereo Alonso, A.

1994-01-01

We report a case of cerebral toxoplasmosis in a patient with stage IV C 1 AIDS who presented hyperdense CT images 13 days after beginning antitoxoplasma treatment. These lesions could be caused by calcifications or blood. The attenuation values lead us to believe that they are calcium. Intracranial calcification in adult cerebral toxoplasmosis is an uncommon finding. Its presence in AIDS patients should not suggest any etiology other than toxoplasmosis. (Author) 16 refs

Spectroscopic magnetic resonance imaging of a tumefactive demyelinating lesion

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Law, M.; Meltzer, D.E.; Cha, S. [MRI Department, Department of Radiology, New York University Medical Center, Schwartz Building, Basement HCC, 530 First Avenue, New York, NY 10016 (United States)

2002-12-01

Tumefactive demyelinating lesions can present with features similar, clinically and radiologically, to those of brain tumours. Proton MR spectroscopy has been increasingly used to characterize intracranial pathology. As the underlying pathophysiology of neoplasms is different from that of demyelinating disease, one may expect the metabolic composition of neoplasms to be significantly different from that of demyelinating lesions. We report a 49-year-old woman in whom the neurologic and radiologic findings were highly suggestive of a high-grade brain tumor, and the spectroscopic features were sufficiently similar to that of a tumor to convince the neurosurgeon to operate. This case emphasizes the need for caution when confronted with a patient who presents with a differential diagnosis of demyelinating lesion versus neoplasm. (orig.)

Diagnosis of intracranial tumors by CT (computerized tomography) from a practical point of view

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Elke, M; Wiggli, U; Huenig, R [Basel Univ. (Switzerland). Inst. fuer Medizinische Radiologie

1977-04-01

In a historical abstract the mathematical basis of image reconstruction techniques and CT is reviewed. The enhancement of iodine contrast media is essential in CT diagnostis of space occupying intracranial lesions. Intracranial tumors usually show relatively characteristical but mostly non-specific absorption patterns. Additional clinical information is necessary for differential diagnostic evalution. The development of tables with various tumor patterns is recommended. Absorption feature of primary and secondary brain-tumors with the surrounding edema is explained. Glioblastomas as well as metastases often show a distinct cerebral edema which has been observed in 64% of our patients with metastases and distinctly localized high dense foci in 69%. 6,000 patients were investigated by CT and 1,708 examinations were performed with contrast enhancement. Side-effects are within the known reaction of other intravenously applicated contrast media.

Naso-ethmoid schwannoma with intracranial extension: case report Schwannoma naso-etmoidal com extensão intracraniana: relato de caso

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Mario G. Siqueira

2001-06-01

Full Text Available Intranasal schwannomas are rare lesions, specially when they present with an intracranial extension. The fifth case in the medical literature of a naso-ethmoid schwannoma with extension into the anterior cranial fossa is presented. The magnetic resonance findings and the details of the combined intracranial / transfacial operative approach used are described. The possible origin and the clinical characteristics of this rare lesion are reviewed.Schwannomas intranasais são lesões raras, principalmente quando apresentam um extensão intracraniana. Estamos apresentando o quinto caso da literatura médica de um schwannoma naso-etmoidal com extensão para o interior da fossa craniana anterior. São descritos os achados da ressonância magnética e os detalhes da via de acesso cirúrgico combinada intracraniana/transfacial. A possível origem e as características clínicas dessa lesaõ rara são revistas.

Clinical application of multifocal visual evoked potentials in children with epilepsy caused by intracranial disease

International Nuclear Information System (INIS)

Yukawa, Eiichi; Kim, Yeong-Jin; Kawasaki, Kensuke; Yoshii, Toshiaki; Hara, Yoshiaki

2006-01-01

We investigated whether visual field defects could be objectively evaluated using multifocal visual evoked potential (m-VEP) in two children with epilepsy caused by intracranial disease in whom it was difficult to measure the visual field. To determine normal waves in m-VEP, recording was performed using a visual evoked response imaging system (VERIS) Junior Science program (Mayo, Aichi, Japan) in 20 healthy children (20 eyes) peak latency and amplitude were used for assessment. In the two children with epilepsy, m-VEPs were recorded, and compared with the results of static perimetry or the lesions observed by Magnetic Resonance Imaging (MRI). In the 20 healthy children, there was no significant difference in the peak latency or amplitude among 4 quadrants by one-way analysis of variance. m-VEP in the children with epilepsy showed abnormal waves, corresponding to the visual field defects in the static perimetry or the lesions observed by MRI. Objective evaluation of visual field defects using m-VEP may be useful in children with epilepsy caused by intracranial disease in whom kinetic/static perimetry as a subjective examination is difficult. (author)

Awake craniotomy for intracranial lesions: An audit of the anaesthetists’ initial experience at the University College Hospital, Ibadan

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O.K. Idowu

2016-10-01

Conclusions: This audit showed AC to be a well-tolerated procedure with low rate of complications in our practice, an encouraging prospect for the feasibility of AC for intracranial surgical procedures in developing countries.

PATHOGENESIS OF OPTIC DISC EDEMA IN RAISED INTRACRANIAL PRESSURE

Science.gov (United States)

Hayreh, Sohan Singh

2015-01-01

Optic disc edema in raised intracranial pressure was first described in 1853. Ever since, there has been a plethora of controversial hypotheses to explain its pathogenesis. I have explored the subject comprehensively by doing basic, experimental and clinical studies. My objective was to investigate the fundamentals of the subject, to test the validity of the previous theories, and finally, based on all these studies, to find a logical explanation for the pathogenesis. My studies included the following issues pertinent to the pathogenesis of optic disc edema in raised intracranial pressure: the anatomy and blood supply of the optic nerve, the roles of the sheath of the optic nerve, of the centripetal flow of fluids along the optic nerve, of compression of the central retinal vein, and of acute intracranial hypertension and its associated effects. I found that, contrary to some previous claims, an acute rise of intracranial pressure was not quickly followed by production of optic disc edema. Then, in rhesus monkeys, I produced experimentally chronic intracranial hypertension by slowly increasing in size space-occupying lesions, in different parts of the brain. Those produced raised cerebrospinal fluid pressure (CSFP) and optic disc edema, identical to those seen in patients with elevated CSFP. Having achieved that, I investigated various aspects of optic disc edema by ophthalmoscopy, stereoscopic color fundus photography and fluorescein fundus angiography, and light microscopic, electron microscopic, horseradish peroxidase and axoplasmic transport studies, and evaluated the effect of opening the sheath of the optic nerve on the optic disc edema. This latter study showed that opening the sheath resulted in resolution of optic disc edema on the side of the sheath fenestration, in spite of high intracranial CSFP, proving that a rise of CSFP in the sheath was the essential pre-requisite for the development of optic disc edema. I also investigated optic disc edema with

Assessment of intracranial metastases from neuroendocrine tumors/carcinoma

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Ahmed M Ragab Shalaby

2016-01-01

Full Text Available Background: The most common sites of origin for neuroendocrine carcinoma are gastrointestinal tract and its accessory glands, and lungs. Materials and Methods: One-hundred fifty cases diagnosed with metastatic brain lesions were retrieved from hospital records within 5 years. For these cases, the primary neoplasm, histopathological classification, metastasis, treatment, and fate all were studied. Results: Intracranial deposits were detected in 10%. The primary lesion was in the lungs in 87% of patients, and 1 patient in the breast and 1 in esophagus. Pathological classification of the primary lesion was Grade 2 (MIB-1: 3–20% in 1 patient and neuroendocrine carcinoma (MIB-1: ≥21% in 14 patients. The median period from onset of the primary lesion up to diagnosis of brain metastasis was 12.8 months. About 33% of patients had a single metastasis whereas 67% patients had multiple metastases. Brain metastasis was extirpated in 33% of patients. Stereotactic radiotherapy alone was administered in 20% of patients, and brain metastasis was favorably controlled in most of the patients with coadministration of cranial irradiation as appropriate. The median survival period from diagnosis of brain metastasis was 8.1 months. Conclusion: Most of patients with brain metastasis from neuroendocrine carcinoma showed the primary lesion in the lungs, and they had multiple metastases to the liver, lymph nodes, bones, and so forth at the time of diagnosis of brain metastasis. The guidelines for accurate diagnosis and treatment of neuroendocrine carcinoma should be immediately established based on further analyses of those patients with brain metastasis.

Understanding idiopathic intracranial hypertension

DEFF Research Database (Denmark)

Markey, Keira A; Mollan, Susan P; Jensen, Rigmor H

2016-01-01

Idiopathic intracranial hypertension is a disorder characterised by raised intracranial pressure that predominantly affects young, obese women. Pathogenesis has not been fully elucidated, but several causal factors have been proposed. Symptoms can include headaches, visual loss, pulsatile tinnitus...

Spontaneous intracranial hypotension.

LENUS (Irish Health Repository)

Fullam, L

2012-01-31

INTRODUCTION: Spontaneous\\/primary intracranial hypotension is characterised by orthostatic headache and is associated with characteristic magnetic resonance imaging findings. CASE REPORT: We present a case report of a patient with typical symptoms and classical radiological images. DISCUSSION: Spontaneous intracranial hypotension is an under-recognised cause of headache and can be diagnosed by history of typical orthostatic headache and findings on MRI brain.

Intracranial chondroma: a rare entity.

Science.gov (United States)

Maheshwari, Veena; Mehdi, Ghazala; Varshney, Manoranjan; Jain, Anshu; Vashishtha, Sonal; Gaur, Kavita; Srivastava, Vinod Kumar

2011-05-12

Intracranial chondroma is a rare benign cartilaginous tumour with an incidence of less than 1% of all primary intracranial tumours. The authors are reporting here a case of intracranial chondroma in a 40-year-old man who presented with 5-month history of headache and gradual diminution of vision. A tentative diagnosis of chondroma was made on imprint cytology which was confirmed on histopathological examination.

Differentiation of intracranial tuberculomas and high grade gliomas using proton MR spectroscopy and diffusion MR imaging

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Peng, Juan, E-mail: pengjuan1209@126.com [Department of Radiology, the First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016 (China); Ouyang, Yu, E-mail: 1957ouyangyu@sina.com [Department of Radiology, the First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016 (China); Fang, Wei-Dong, E-mail: fwd9707@yahoo.com.cn [Department of Radiology, the First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016 (China); Luo, Tian-You, E-mail: ltychy@sina.com [Department of Radiology, the First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016 (China); Li, Yong-Mei, E-mail: lymzhang70@yahoo.com.cn [Department of Radiology, the First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016 (China); Lv, Fa-Jin, E-mail: fajinlv@hotmail.com [Department of Radiology, the First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016 (China); Zhang, Zhi-Wei, E-mail: jintianzzw@163.com [Department of Radiology, the First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016 (China); Li, Xin-You, E-mail: lixinyou666@163.com [Department of Radiology, the First Affiliated Hospital, Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016 (China)

2012-12-15

Objective: The purpose of this study was to determine whether proton MR spectroscopy ({sup 1}H MRS) and diffusion-weighted (DW) imaging can be used to differentiate intracranial tuberculomas from high grade gliomas (HGGs). Materials and methods: A total of 41 patients (19 with intracranial tuberculomas and 22 with HGGs) were examined in our study. {sup 1}H MRS and DW imaging were performed at a 1.5T MR scanner before operation or treatment. Concentrations of N-acetylaspartate (NAA), creatine (Cr), choline (Cho), and lipid and lactate (LL) in the contrast-enhancing rim of each lesion were expressed as metabolite ratios and were normalized to the contralateral hemisphere. The apparent diffusion coefficient (ADC) was also calculated. The metabolite ratios and ADC values in the enhancing rim of intracranial tuberculomas and HGGs were compared using the Wilcoxon rank sum test. Diagnostic accuracy was compared using receiver operating characteristic (ROC) analysis. Results: Significant differences were found in the maximum Cho/Cr (P = 0.015), Cho/NAA (P = 0.001) and Cho/Cho-n ratios (P = 0.002), and minimum ADC value (P < 0.001) between the intracranial tuberculomas and HGGs. Diagnostic accuracy was higher by minimum ADC value than maximum Cho/Cr, Cho/NAA and Cho/Cho-n ratios (93.8% versus 75.7%, 80.8% and 78.1%). Conclusion: These results suggest a promising role for {sup 1}H MRS and DW imaging in the differentiation between the intracranial tuberculomas and HGGs.

Gd-DTPA in MRI. Clinical experience in intracranial pathologies

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Bradac, G B; Riva, A; Berger, T; Stura, G; Duca, S

1988-01-01

Sixty-seven patients with various intracranial pathologies were studied using Gd-DTPA as a contrast medium applied to MRI. This paramagnetic substance was well tolerated by all patients, and proved particularly useful in improving the diagnosis of extra-axial tumors, in which a rich enhancement was always present. Gd-DTPA allowed a better definition of the tumor outlines, as well as its differentiation from edema, and the demonstration of its relationship to brain parenchyma and cerebral vessels. This was particularly true for meningiomas, which often display poor contrast enhancement at MRI. Even though acoustic neuromas had, as a rule, high signal intensity, Gd-DTPA was useful to precisely recognise the intracanalar part of the tumor. The value of Gd-DTPA was less evident in intra-axial lesions. It proved nonetheless useful in demonstrating the portions of the tumor where, due to alterations in BBB, enhancement was present. This allowed both to characterized the lesion and to perform accurate biopsies.

Spontaneous regression of intracranial malignant lymphoma

International Nuclear Information System (INIS)

Kojo, Nobuto; Tokutomi, Takashi; Eguchi, Gihachirou; Takagi, Shigeyuki; Matsumoto, Tomie; Sasaguri, Yasuyuki; Shigemori, Minoru.

1988-01-01

In a 46-year-old female with a 1-month history of gait and speech disturbances, computed tomography (CT) demonstrated mass lesions of slightly high density in the left basal ganglia and left frontal lobe. The lesions were markedly enhanced by contrast medium. The patient received no specific treatment, but her clinical manifestations gradually abated and the lesions decreased in size. Five months after her initial examination, the lesions were absent on CT scans; only a small area of low density remained. Residual clinical symptoms included mild right hemiparesis and aphasia. After 14 months the patient again deteriorated, and a CT scan revealed mass lesions in the right frontal lobe and the pons. However, no enhancement was observed in the previously affected regions. A biopsy revealed malignant lymphoma. Despite treatment with steroids and radiation, the patient's clinical status progressively worsened and she died 27 months after initial presentation. Seven other cases of spontaneous regression of primary malignant lymphoma have been reported. In this case, the mechanism of the spontaneous regression was not clear, but changes in immunologic status may have been involved. (author)

Is 99mTc-MDP mammoscintigraphy useful in patients with breast mass lesions?

International Nuclear Information System (INIS)

Park, S. K.; Lee, Y. H.; Rhyu, J. W.; Yoo, S. M.

1998-01-01

Piccolo et al. advocated the usefulness of 99m Tc-MDP breast scan in differential diagnosis of breast mass with high accuracy. But there are little or no follow-up studies about it as we know. We studied 99m Tc-MDP uptake pattern and lesion/background ratio in patients complaining palpable breast lesions to evaluate the clinical usefulness of 99m Tc-MDP scan. Total 34 patients were studied with physical examination, mammogram and 99m Tc-MDP scan prospectively. Anteroposterior and both lateral view of breast were obtained 5 minutes after iv injection of 740 MBq 99m Tc-MDP. Breast uptake pattern of 99m Tc-MDP was analyzed by a grade system: 0=no uptake, grade 1=bilateral diffuse uptake, grade 2=asymmetric faint uptake, grade 3=focal hot uptake. 20 cases were pathologically confirmed by excision biopsy or aspiration biopsy. 14 cases were normal in physical examination and mammogram. Pathologic results showed 7 carcinomas, 6 benign solid tumors, and 7 fibrocystic changes. Grade 3 pattern of 99m Tc-MDP uptake was noted in 4/7 carcinomas, 3/5 benign solid tumors, and 1/7 fibrocystic changes. Grade 2 pattern was 2/7, 0/7, 3/7 respectively. The average L/B ratio was 1.66 in carcinomas, 1.68 in benign solid masses, 1.20 in fibrocystic diseases, 1.05 in normal patients. L/B ratio was higher in carcinoma and benign mass groups than in fibrocystic change and normal control groups(p=0.005). But there was no statistical difference between L/B ratio of malignant mass group and benign mass group. 99m Tc-MDP scan is not suitable to routine clinical use for breast mass diagnosis. It might be used in limited conditions when whole body bone scan is planned

Intracranial hemorrhage due to intracranial hypertension caused by the superior vena cava syndrome

DEFF Research Database (Denmark)

Bartek, Jiri; Abedi-Valugerdi, Golbarg; Liska, Jan

2013-01-01

We report a patient with intracranial hemorrhage secondary to venous hypertension as a result of a giant aortic pseudoaneurysm that compressed the superior vena cava and caused obstruction of the venous return from the brain. To our knowledge, this is the first patient reported to have...... an intracranial hemorrhage secondary to a superior vena cava syndrome. The condition appears to be caused by a reversible transient rise in intracranial pressure, as a result of compression of the venous return from the brain. Treatment consisted of surgery for the aortic pseudoaneurysm, which led...

Intracranial tuberculosis in children : CT findings before and after treatment

International Nuclear Information System (INIS)

Jung, Hye Weon; Kim, In One; Kim, Woo Sun; Hwang, Yong Seong; Yeon, Kyung Mo

1996-01-01

To analyze the CT findings of intracranial tuberculosis in children at initial stage and during follow-up after treatment. We evaluated 25 patients who were diagnosed by CSF analysis or response to anti-tuberculous medication as suffering from intracranial tuberculosis. There were 13 boys and 12 girls aged between 4 months and 14 years. Twenty-five initial and sixty-three follow-up CT scans were retrospectively analyzed. We evaluated the pattern of cisternal enhancement, the locations of infarction, and the presence of calcification and parenchymal granuloma. The changes of hydrocephalus and related complications, as well as cisternal abnormality during anti-tuberculous medication were also evaluated. The initial findings on CT scan were hydrocephalus(75%), cisternal obliteration in precontrast study(64%), thick-line or ring-shaped cisternal enhancement on postcontrast study(44%), infarctions(32%), calcifications(32%), periventricular edema(28%), and parenchymal granulomas(16%). On follow-up CT scan, hydrocephalus and cisternal enhancement had decreased to 35% and 82%, respectively, and the granulomas had changed to calcified nodules(100%). Ventriculo-peritoneal shunt or external ventricular drainage was needed in nine patient, and ventriculitis or complication of shunt procedure developed in four. Intracranial tuberculosis in children presented predominantly as meningitis involving basal cisterns and was associated with hydrocephalus. Infarction and calcification may be seen as parenchymal lesion. In spite of medical treatment, drainage was needed in about half the patients. During this treatment, the resolution of hydrocephalus, decreased cisternal enhancement, and calcification of the granlomas were seen

Diagnóstico de masas intracraneales primarias por medio imagenológicos Diagnosis of intracranial masses using imaging techniques

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Samael Suero Almonte

2012-02-01

Full Text Available Se realizó un estudio descriptivo, longitudinal y transversal que incluyó a los pacientes operados de neoplasia del sistema nervioso central intracraneal en el Hospital General Docente "Abel Santamaría Cuadrado " de la provincia Pinar del Río, durante el período comprendido desde el 1 de enero de 2010 hasta el 31 de diciembre del mismo año. Se incluyeron todos los pacientes egresados a los que se les había realizado tomografía computarizada o resonancia magnética y poseían diagnóstico histológico postoperatorio de neoplasia primaria del sistema nervioso central (SNC intracraneal. Se concluyó que las neoplasias primarias fueron más frecuentes en el sexo femenino y en grupo de edad de 70 años y más. Las localizaciones más frecuentes de las neoplasias primarias del sistema nervioso central fueron las masas intraaxiales y supratentoriales y el tipo histológico más prevalente fue el glioma. Todas se comportaron imagenológicamente captantes de contraste, con poca hemorragia y calcificación intermediamente con efecto de masa y hipointensas en T1 hiperintensas en T2.A descriptive, longitudinal and cross-sectional study including the patients operated on intracranial central nervous system neoplasm was carried out at "Abel Santamaria Cuadrado" University Hospital, Pinar del Rio during January 1, 2010 to December 31, 2010. All patients discharged from the hospital with Computerized Axial Tomography or Magnetic Resonance Imaging and having post-operative histological diagnosis of primary intracranial neoplasm of the central nervous system (CNS were included. Primary neoplasm was the most frequent in female sex and in the age-bracket of 70 years old or older. The most repeated localizations of primary neoplasm in the CNS were in intra-axial and supratentorial masses, glioma was the most prevailing histological type. Contrast examinations could be performed in all masses, presenting not much hemorrhage, with intermediate-mass

Early Parenteral Nutrition in Patients with Biliopancreatic Mass Lesions, a Prospective, Randomized Intervention Trial.

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Janine Krüger

Full Text Available Patients with biliopancreatic tumors frequently suffer from weight loss and cachexia. The in-hospital work-up to differentiate between benign and malignant biliopancreatic lesions requires repeated pre-interventional fasting periods that can aggravate this problem. We conducted a randomized intervention study to test whether routine in-hospital peripheral intravenous nutrition on fasting days (1000 ml/24 h, 700 kcal has a beneficial effect on body weight and body composition.168 patients were screened and 100 enrolled in the trial, all undergoing in-hospital work-up for biliopancreatic mass lesions and randomized to either intravenous nutrition or control. Primary endpoint was weight loss at time of hospital discharge; secondary endpoints were parameters determined by bioelectric impedance analysis and quality of life recorded by the EORTC questionnaire.Within three months prior to hospital admission patients had a median self-reported loss of 4.0 kg (25*th: -10.0 kg and 75*th* percentile: 0.0kg of body weight. On a multivariate analysis nutritional intervention increased body weight by 1.7 kg (95% CI: 0.204; 3.210, p = 0.027, particularly in patients with malignant lesions (2.7 kg (95% CI: 0.71; 4.76, p < 0.01.In a hospital setting, patients with suspected biliopancreatic mass lesions stabilized their body weight when receiving parenteral nutrition in fasting periods even when no total parenteral nutrition was required. Analysis showed that this effect was greatest in patients with malignant tumors. Further studies will be necessary to see whether patient outcome is affected as well.ClinicalTrials.gov NCT02670265.

Virtual MRI endoscopy of the intracranial cerebrospinal fluid spaces

International Nuclear Information System (INIS)

Shigematsu, Y.; Korogi, Y.; Hirai, T.; Okuda, T.; Ikushima, I.; Sugahara, T.; Liang, L.; Ge, Y.; Takahashi, M.

1998-01-01

We used constructive interference in steady state (CISS) 3D Fourier transform (3DFT) MRI data sets to obtain three-dimensional (3D) virtual MRI endoscopic views of the intracranial cerebrospinal fluid (CSF) spaces, processing them with a commercially available perspective endoscopic algorithm. We investigated the potential of the intracranial virtual MRI endoscopy applied to visualisation of the pathology in 13 patients with surgically confirmed trigeminal neuralgia (3), hemifacial spasm (3), acoustic neuroma (3), suprasellar germinoma (1), Langerhans cell histiocytosis (1), lateral ventricle nodules (1) and pituitary dwarfism (1). All images were acquired using a 1.5-T imager employing a circular polarised head coil. The CISS-3DFT data sets were transferred to a workstation for processing with the perspective endoscopic algorithm. Postprocessing for virtual MRI endoscopy was possible for all data sets. The lesions in 12 patients, and their complex anatomical relationships with the surrounding structures, were well seen on the 3D images. A small acoustic neuroma in the internal auditory meatus was not seen using virtual endoscopy. Although virtual MRI endoscopy has limitations, it provides 3D images which cannot be acquired using any other procedure. (orig.)

Virtual MRI endoscopy of the intracranial cerebrospinal fluid spaces

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Shigematsu, Y.; Korogi, Y.; Hirai, T. [Kumamoto Univ. (Japan). Dept. of Radiology; Okuda, T.; Ikushima, I.; Sugahara, T.; Liang, L.; Ge, Y.; Takahashi, M.

1998-10-01

We used constructive interference in steady state (CISS) 3D Fourier transform (3DFT) MRI data sets to obtain three-dimensional (3D) virtual MRI endoscopic views of the intracranial cerebrospinal fluid (CSF) spaces, processing them with a commercially available perspective endoscopic algorithm. We investigated the potential of the intracranial virtual MRI endoscopy applied to visualisation of the pathology in 13 patients with surgically confirmed trigeminal neuralgia (3), hemifacial spasm (3), acoustic neuroma (3), suprasellar germinoma (1), Langerhans cell histiocytosis (1), lateral ventricle nodules (1) and pituitary dwarfism (1). All images were acquired using a 1.5-T imager employing a circular polarised head coil. The CISS-3DFT data sets were transferred to a workstation for processing with the perspective endoscopic algorithm. Postprocessing for virtual MRI endoscopy was possible for all data sets. The lesions in 12 patients, and their complex anatomical relationships with the surrounding structures, were well seen on the 3D images. A small acoustic neuroma in the internal auditory meatus was not seen using virtual endoscopy. Although virtual MRI endoscopy has limitations, it provides 3D images which cannot be acquired using any other procedure. (orig.) With 6 figs., 16 refs.

Assessment of blood supply to intracranial pathologies in children using MR digital subtraction angiography

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Chooi, Weng Kong; Coley, Stuart C. [Royal Hallamshire Hospital, Department of Radiology, Sheffield (United Kingdom); Connolly, Dan J.A. [Royal Hallamshire Hospital, Department of Radiology, Sheffield (United Kingdom); Sheffield Children' s Hospital, Department of Radiology, Sheffield (United Kingdom); Griffiths, Paul D. [Royal Hallamshire Hospital, Department of Radiology, Sheffield (United Kingdom); Sheffield Children' s Hospital, Department of Radiology, Sheffield (United Kingdom); University of Sheffield, Academic Unit of Radiology, Sheffield (United Kingdom); Floor C, Royal Hallamshire Hospital, Section of Academic Radiology, Sheffield (United Kingdom)

2006-10-15

MR digital subtraction angiography (MR-DSA) is a contrast-enhanced MR angiographic sequence that enables time-resolved evaluation of the cerebral circulation. We describe the feasibility and technical success of our attempts at MR-DSA for the assessment of intracranial pathology in children. We performed MR-DSA in 15 children (age range 5 days to 16 years) referred for MR imaging because of known or suspected intracranial pathology that required a dynamic assessment of the cerebral vasculature. MR-DSA consisted of a thick (6-10 mm) slice-selective RF-spoiled fast gradient-echo sequence (RF-FAST) acquired before and during passage of an intravenously administered bolus of Gd-DTPA. The images were subtracted and viewed as a cine loop. MR-DSA was performed successfully in all patients. High-flow lesions were shown in four patients; these included vein of Galen aneurysmal malformation, dural fistula, and two partially treated arteriovenous malformations (AVMs). Low-flow lesions were seen in three patients, all of which were tumours. Normal flow was confirmed in eight patients including two with successfully treated AVMs, and in three patients with cavernomas. Our early experience suggests that MR-DSA is a realistic, non-invasive alternative to catheter angiography in certain clinical settings. (orig.)

Assessment of blood supply to intracranial pathologies in children using MR digital subtraction angiography

International Nuclear Information System (INIS)

Chooi, Weng Kong; Coley, Stuart C.; Connolly, Dan J.A.; Griffiths, Paul D.

2006-01-01

MR digital subtraction angiography (MR-DSA) is a contrast-enhanced MR angiographic sequence that enables time-resolved evaluation of the cerebral circulation. We describe the feasibility and technical success of our attempts at MR-DSA for the assessment of intracranial pathology in children. We performed MR-DSA in 15 children (age range 5 days to 16 years) referred for MR imaging because of known or suspected intracranial pathology that required a dynamic assessment of the cerebral vasculature. MR-DSA consisted of a thick (6-10 mm) slice-selective RF-spoiled fast gradient-echo sequence (RF-FAST) acquired before and during passage of an intravenously administered bolus of Gd-DTPA. The images were subtracted and viewed as a cine loop. MR-DSA was performed successfully in all patients. High-flow lesions were shown in four patients; these included vein of Galen aneurysmal malformation, dural fistula, and two partially treated arteriovenous malformations (AVMs). Low-flow lesions were seen in three patients, all of which were tumours. Normal flow was confirmed in eight patients including two with successfully treated AVMs, and in three patients with cavernomas. Our early experience suggests that MR-DSA is a realistic, non-invasive alternative to catheter angiography in certain clinical settings. (orig.)

Assessment of blood supply to intracranial pathologies in children using MR digital subtraction angiography.

Science.gov (United States)

Chooi, Weng Kong; Connolly, Dan J A; Coley, Stuart C; Griffiths, Paul D

2006-10-01

MR digital subtraction angiography (MR-DSA) is a contrast-enhanced MR angiographic sequence that enables time-resolved evaluation of the cerebral circulation. We describe the feasibility and technical success of our attempts at MR-DSA for the assessment of intracranial pathology in children. We performed MR-DSA in 15 children (age range 5 days to 16 years) referred for MR imaging because of known or suspected intracranial pathology that required a dynamic assessment of the cerebral vasculature. MR-DSA consisted of a thick (6-10 mm) slice-selective RF-spoiled fast gradient-echo sequence (RF-FAST) acquired before and during passage of an intravenously administered bolus of Gd-DTPA. The images were subtracted and viewed as a cine loop. MR-DSA was performed successfully in all patients. High-flow lesions were shown in four patients; these included vein of Galen aneurysmal malformation, dural fistula, and two partially treated arteriovenous malformations (AVMs). Low-flow lesions were seen in three patients, all of which were tumours. Normal flow was confirmed in eight patients including two with successfully treated AVMs, and in three patients with cavernomas. Our early experience suggests that MR-DSA is a realistic, non-invasive alternative to catheter angiography in certain clinical settings.

Intracranial actinomycosis: case report and review of literature

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Pacheco-Hernandez Alfonso

2017-06-01

Full Text Available Actinomycosis infection is a slow progressing disease, in which involvment of the central nervous system by Actinomyces israelii is uncommon (less than 5%. Clinical picture is non-specific and is often misdiagnosed with neoplasia; some clinical clues my arise suspicion. The case of a 59 year-old female is reported who presented headache and focal neurologic signs and in whom a out-of the hospital diagnosis of a neuroepitelial dysembryoplastic tumor was made; nonetheless after careful interview and physical exploration, a spectroscopy magnetic resonance of the brain and hystopathological description of the lesion was made and yielded the definitive diagnosis of intracranial actinomyces infection. Treatment and progression were uneventful.

Sex differences in intracranial arterial bifurcations

DEFF Research Database (Denmark)

Lindekleiv, Haakon M; Valen-Sendstad, Kristian; Morgan, Michael K

2010-01-01

Subarachnoid hemorrhage (SAH) is a serious condition, occurring more frequently in females than in males. SAH is mainly caused by rupture of an intracranial aneurysm, which is formed by localized dilation of the intracranial arterial vessel wall, usually at the apex of the arterial bifurcation. T....... The female preponderance is usually explained by systemic factors (hormonal influences and intrinsic wall weakness); however, the uneven sex distribution of intracranial aneurysms suggests a possible physiologic factor-a local sex difference in the intracranial arteries....

Intracranial hypotension accompanied by trauma. A prospective study in Japan

International Nuclear Information System (INIS)

Maeda, Takeshi; Dohi, Kenji; Katayama, Yoichi

2010-01-01

To clarify the clinical characteristics of definite and non-definite diagnosis groups in intracranial hypotension accompanied by trauma (IHAT), we undertook investigations of registered patients (n=23) prospectively. The results revealed the following features of IHAT: definite diagnosis group, 4 cases; they had long periods from injury to onset (5.5±5.7 days), but these were markedly shorter than in the non-definite group; 75% of definite cases showed typical postural headache; 75% of definite cases showed dural enhancement on Gd-MRI; all 4 cases had confirmed cerebrospinal fluid (CFS) leakage based on imaging diagnosis with cervical lesions in 2 cases and cervical-thoracic lesions in 2 cases; and 6) good recovery was achieved in them by conservative therapy and blood patch, with a cure rate of 100%. These findings suggest that confirmed CFS leakage is indispensable for reaching definite diagnosis of IHAT. (author)

Contrast enhancement of cranial lesions in computed tomography

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Lewander, R; Bergstroem, M; Bergvall, U [Kungliga Karolinska Mediko-Kirurgiska Inst., Stockholm (Sweden)

1978-01-01

The time course of enhancement in apparently normal brain tissue, edema and focal lesions during 30 to 60 min after intravenous injection of vascular contrast medium was evaluated in a series of 41 pateints with differnt intracranial lesions. The attenuation of apparently normal unenhanced brain tissue varied with the level of the scan, mainly an effect of beam hardening. Different types of enhancement response are discussed in terms of a 3-compartment model. The differential diagnostic potential of contrast enhancement in the early phase needs further evaluation using instruments with short scanning time, while the late phase of enhancement must be recorded with the use of a reliable head fixation to provide reproducibility of repeat measurements.

Assessment of intracranial vessels in association with carotid atherosclerosis and brain vascular lesions in rheumatoid arthritis.

Science.gov (United States)

Oláh, Csaba; Kardos, Zsófia; Sepsi, Mariann; Sas, Attila; Kostyál, László; Bhattoa, Harjit Pal; Hodosi, Katalin; Kerekes, György; Tamási, László; Valikovics, Attila; Bereczki, Dániel; Szekanecz, Zoltán

2017-09-26

Stroke has been associated with rheumatoid arthritis (RA). We assessed patients with RA and healthy control subjects by transcranial Doppler (TCD), carotid ultrasonography and brain magnetic resonance imaging (MRI). Altogether, 41 female patients with RA undergoing methotrexate (MTX) or biologic treatment and 60 age-matched control subjects underwent TCD assessment of the middle cerebral artery (MCA) and basilar artery. Pulsatility index (PI), resistivity (resistance) index (RI) and circulatory reserve capacity (CRC) were determined at rest (r) and after apnoea (a) and hyperventilation (h). The presence of carotid plaques and carotid intima-media thickness (cIMT) were also determined. Intracerebral vascular lesions were investigated by brain MRI. MCA PI and RI values at rest and after apnoea were significantly increased in the total and MTX-treated RA populations vs control subjects. MCA CRC was also impaired, and basilar artery PI was higher in RA. More patients with RA had carotid plaques and increased cIMT. Linear regression analysis revealed that left PI(r) and RI(r) correlated with disease duration and that left PI(r), RI(r), PI(a), PI(h) and basilar PI correlated with disease activity. Right CRC inversely correlated with 28-joint Disease Activity Score. Disease activity was an independent determinant of left PI(a) and right CRC. Compared with long-term MTX treatment alone, the use of biologics in combination with MTX was associated with less impaired cerebral circulation. Impaired cerebral circulation was also associated with measures of carotid atherosclerosis. To our knowledge, this is the first study to show increased distal MCA and basilar artery occlusion in RA as determined by TCD. Patients with RA also had CRC defects. We also confirmed increased carotid plaque formation and increased cIMT. Biologics may beneficially influence some parameters in the intracranial vessels.

Diffusion-Weighted Imaging-Detected Ischemic Lesions following Endovascular Treatment of Cerebral Aneurysms: A Systematic Review and Meta-Analysis.

Science.gov (United States)

Bond, K M; Brinjikji, W; Murad, M H; Kallmes, D F; Cloft, H J; Lanzino, G

2017-02-01

Endovascular treatment of intracranial aneurysms is associated with the risk of thromboembolic ischemic complications. Many of these events are asymptomatic and identified only on diffusion-weighted imaging. We performed a systematic review and meta-analysis to study the incidence of DWI positive for thromboembolic events following endovascular treatment of intracranial aneurysms. A comprehensive literature search identified studies published between 2000 and April 2016 that reported postprocedural DWI findings in patients undergoing endovascular treatment of intracranial aneurysms. The primary outcome was the incidence of DWI positive for thromboembolic events. We examined outcomes by treatment type, sex, and aneurysm characteristics. Meta-analyses were performed by using a random-effects model. Twenty-two studies with 2148 patients and 2268 aneurysms were included. The overall incidence of DWI positive for thromboembolic events following endovascular treatment was 49% (95% CI, 42%-56%). Treatment with flow diversion trended toward a higher rate of DWI positive for lesions than coiling alone (67%; 95% CI, 46%-85%; versus 45%; 95% CI, 33%-56%; P = .07). There was no difference between patients treated with coiling alone and those treated with balloon-assisted (44%; 95% CI, 29%-60%; P = .99) or stent-assisted (43%; 95% CI, 24%-63%; P = .89) coiling. Sex, aneurysm rupture status, location, and size were not associated with the rate of DWI positive for lesions. One in 2 patients may have infarcts on DWI following endovascular treatment of intracranial aneurysms. There is a trend toward a higher incidence of DWI-positive lesions following treatment with flow diversion compared with coiling. Patient demographics and aneurysm characteristics were not associated with DWI-positive thromboembolic events. © 2017 by American Journal of Neuroradiology.

Sonographic-pathologic correlation of complex cystic breast lesions

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Saravech Pongrattanaman

2013-02-01

Full Text Available Objective: To understand the pathologic basis for sonographic features of complex cystic lesions. Methods: From 2 646 female patients underwent breast sonography at King Chulalongkorn Memorial Hospital from January 2005 through December 2010, 103 cystic lesions were included. Pathologic confirmation was performed by fine-needle aspiration (n=42, core needle biopsy (n=6, excision (n=54 and mastectomy (n=1. Complex cystic breast masses were classified into 3 types as followings; thick outer wall and/or thick internal septa (type I; thick septation and thick wall were defined as equal or more than 0.5 cm, masses containing mixed cystic and solid components (at least 50% of cystic component (type II, predominantly solid with eccentric cystic foci (at least 50% of solid component (type III. Results: In 103 complex cystic masses, there are 27 lesions (26% classified as type I cystic breast masses, 37 lesions (36% as type II cystic breast masses and 39 lesions (38% type III cystic breast masses, 26 lesions (25.2% are proved to be malignant. All of type I cystic breast masses in our study are benign, and 14 (38% of type II cystic breast masses and 12 lesions (31% of type III cystic breast lesions are proved to be malignant. Conclusions: Type II and III lesions should suggest possibility of malignancy and biopsy should be performed in all lesions. All type I lesion in this study are benign. None of other parameters we included in this study (size or margin can effectively differentiate between benign or malignant cystic breast lesions. Also, grading of the malignant lesions by using type of cystic breast mass cannot be applied.

Intracranial Extramedullary Hematopoiesis in Beta-Thalassemia

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Karki, Bivek; Xu, Yi Kai; Wu, Yuan Kui [Nan fang Hospital, Southern Medical University, Guangzhou (China); Tamrakar, Karuna [Zhujiang Hospital, Southern Medical University, Guangzhou (China)

2012-03-15

Extramedullary hematopoiesis (EMH) represents tumor-like proliferation of hemopoietic tissue which complicates chronic hemoglobinopathy. Intracranial EMH is an extremely rare occurrence. Magnetic resonance imaging (MRI) offers a precise diagnosis. It is essential to distinguish EMH from other extradural central nervous system tumors, because treatment and prognosis are totally different. Herein, we report the imaging findings of beta-thalassemia in a 13-year-old boy complaining of weakness of left side of the body and gait disturbance; CT and MRI revealed an extradural mass in the right temporoparietal region.

Intracranial extramedullary hematopoiesis in beta-thalassemia.

Science.gov (United States)

Karki, Bivek; Xu, Yi-Kai; Tamrakar, Karuna; Wu, Yuan-Kui

2012-01-01

Extramedullary hematopoiesis (EMH) represents tumor-like proliferation of hemopoietic tissue which complicates chronic hemoglobinopathy. Intracranial EMH is an extremely rare occurrence. Magnetic resonance imaging (MRI) offers a precise diagnosis. It is essential to distinguish EMH from other extradural central nervous system tumors, because treatment and prognosis are totally different. Herein, we report the imaging findings of beta-thalassemia in a 13-year-old boy complaining of weakness of left side of the body and gait disturbance; CT and MRI revealed an extradural mass in the right temporoparietal region.

Intracranial Extramedullary Hematopoiesis in Beta-Thalassemia

International Nuclear Information System (INIS)

Karki, Bivek; Xu, Yi Kai; Wu, Yuan Kui; Tamrakar, Karuna

2012-01-01

Extramedullary hematopoiesis (EMH) represents tumor-like proliferation of hemopoietic tissue which complicates chronic hemoglobinopathy. Intracranial EMH is an extremely rare occurrence. Magnetic resonance imaging (MRI) offers a precise diagnosis. It is essential to distinguish EMH from other extradural central nervous system tumors, because treatment and prognosis are totally different. Herein, we report the imaging findings of beta-thalassemia in a 13-year-old boy complaining of weakness of left side of the body and gait disturbance; CT and MRI revealed an extradural mass in the right temporoparietal region.

Outcome of endovascular treatment in symptomatic intracranial vascular stenosis

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Suh, Dae Chul; Kim, Sang Joon; Lee, Duk Hee; Kim, Won; Choi, Choong Gon; Lee, Jeong Hyun; Kwon, Sun Uck; Kim, Jong Sung [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Hyun Jeong [Daejeon Catholic Hospital, Daejeon (Korea, Republic of)

2005-03-15

The outcome evaluation for the revascularization of intracranial vascular stenoses has not been fully described due to the highly technical nature of the procedure. We report here on the early and late clinical outcome of angioplasty and/or stenting of symptomatic severe intracranial vascular stenoses at a single institute. Since 1995, we have treated 35 patients with symptomatic intracranial vascular stenosis (more than 70% stenosis, mean stenosis: 78.6% {+-} 6.2%). Angioplasty (n = 19) was performed for the horizontal segment of the middle cerebral artery (M1) (n = 16) and the basilar artery (BA) (n = 1), the intradural vertebral artery (VA) (n = 1), and the cavernous internal carotid artery (ICA) (n = 1). Stenting (n = 16) was performed for the cavernous or petrous ICAs (n = 9), the intradural VA (n = 3), BA (n = 2), and M1 (n = 2) artery. We assessed the angiographic success (defined as residual stenosis < 50%) rate, the periprocedural complications during the 30-day periprocedural period, the symptomatic recurrence and restenosis during a mean 22-month follow-up (FU) period. The Kaplan-Meier estimate of the cumulative even-free rate of the major cerebrovascular events, i.e. death, stroke or restenosis, was also done. Angiographic success was achieved in 97% of our patients (34/35). There were four procedure-related complications (11%) including a death and a minor stroke. During the mean 22-month FU, the asymptomatic restenosis rate was 9% and the symptomatic restenosis rate was 6% in the target lesion and 9% in all the vascular territories. The Kaplan-Meier estimate was 70.6% (95% confidence interval = 46.5-94.7) after 33 month of FU. In addition to a high angiographic success rate and an acceptable periprocedural complication rate, intracranial angioplasty and/or stenting revealed a relatively low symptomatic recurrence rate. Hemorrhage is a rare, but the physician must aware that potentially fatal periprocedural complications can occur.

Outcome after whole brain radiotherapy alone in intracranial leptomeningeal carcinomatosis from solid tumors

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Gani, C.; Mueller, A.C.; Eckert, F.; Schroeder, C.; Bamberg, M.; Berger, B. [Univ. of Tuebingen (Germany). Dept. of Radiation Oncology; Bender, B. [Univ. of Tuebingen (Germany). Dept. of Diagnostics and Interventional Neuroradiology; Pantazis, G. [Univ. of Tuebingen (Germany). Dept. of Neuropathology

2012-02-15

The purpose of the present study was to investigate outcome after whole brain radiotherapy (WBRT) alone as a palliative treatment without concomitant chemotherapy for intracranial leptomeningeal carcinomatosis (LMC). Overall survival and treatment response were retrospectively analyzed in 27 consecutive patients with LMC from breast and lung cancer. All patients had evidence of intracranial manifestations of LMC. Seven potential prognostic factors were evaluated. Median overall survival (OS) for the entire group was 8.1 weeks. OS rates after 6 and 12 months were 26% and 15%, respectively. Improvement of neurological deficits was observed in 3 patients. In 3 of 4 patients with follow-up MRI studies, a decreased size of contrast-enhanced lesions was observed. Prognostic factors for improved OS on univariate analysis were absence of cranial nerve dysfunction, Karnofsky Performance Score (KPS) > 60%, and time interval > 35 months between the initial diagnosis of malignant disease and development of LMC. On multivariate analysis, absence of cranial nerve dysfunction remained the only significant prognosticator for OS (median 3.7 vs. 19.4 weeks, p < 0.001). WBRT alone is an effective palliative treatment for patients unfit/unsuitable for chemotherapy and low performance status suffering from intracranial LMC. However, prognostic factors should be considered in order to identify patients who are likely to benefit from WBRT. (orig.)

Management strategies for neoplastic and vascular brain lesions presenting during pregnancy: A series of 29 patients.

Science.gov (United States)

Pereira, Celestino Esteves; Lynch, Jose Carlos

2017-01-01

The occurrence of a brain tumor or intracranial vascular lesion during pregnancy is a rare event, but when it happens, it jeopardizes the lives of both the mother and infant. It also creates challenges of a neurosurgical, obstetric, and ethical nature. A multidisciplinary approach should be used for their care. Between 1986 and 2015, 12 pregnant women diagnosed with brain tumors and 17 women with intracranial vascular lesion underwent treatment at the Neurosurgery Department of the Servidores do Estado Hospital and Rede D'Or/São Luis. The Neurosurgery Department teamed up with Obstetrics Anesthesiology Departments in establishing the procedures. The patients' records, surgical descriptions, imaging studies, and histopathological material were reviewed. Among 12 patients presenting with brain tumors, there were neither operative mortality nor fetal deaths. Among the vascular lesions, aneurysm rupture was responsible for bleeding in 6 instances. Arteriovenous malformation was diagnosed in 7 patients. In this subgroup, the maternal and fetal mortality rates were 11.7% and 23.7%, respectively. We can assert that the association between a brain tumor and vascular lesions with pregnancy is a very unusual event, which jeopardizes both the lives of the mother and infant. It remains incompletely characterized due to the rare nature of these potentially devastating events. Knowing the exact mechanism responsible for the interaction of pregnancy and with these lesions will improve the treatment of these patients.

Multiple intracranial aneurysms following radiation therapy for pituitary adenoma. Case report

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Nishi, Tohru; Matsukado, Yasuhiko; Kodama, Takafumi; Hiraki, Toshiro

1987-03-01

A 57-year-old man was admitted because of visual disturbance due to a recurrent pituitary adenoma. Nine years ago craniotomy was performed for the chromophobe adenoma and postoperative radiation therapy was applied with tumor dose of 50 Gy. Digital subtraction angiography indicated existence of an aneurysm at the carotid bifurcation and the finding was confirmed by conventional angiography, which revealed a saccular aneurysm and irregularity of the carotid walls. In surgery there were not only the saccular aneurysm found in the angiogram, but also three other fusiform aneurysms and severe sclerotic change at the major arteries adjoining the sellar region. Azzarelli et al. reported a fatal case due to the development of arteriosclerotic intracranial fusiform aneurysms following radiation therapy for suprasellar germinoma. This case is the second case which indicates the development of intracranial aneurysm following radiation therapy. Emphasis is placed on careful follow-up examination for radiated pituitary adenoma with computed tomography, digital subtraction angiography, or occasionally conventional angiography, even though the postoperative condition of the primary lesion is stabilized.

Intracranial calcification in central diabetes insipidus

International Nuclear Information System (INIS)

Al-Kandari, Salwa R.; Pandey, Tarun; Badawi, Mona H.

2008-01-01

Intracranial calcification is a known but extremely rare complication of diabetes insipidus. To date, only 16 patients have been reported and all had the peripheral (nephrogenic) type of diabetes insipidus. We report a child with intracranial calcification complicating central diabetes insipidus. We also report a child with nephrogenic diabetes insipidus, and compare the patterns of intracranial calcification. (orig.)

Intracranial calcification in central diabetes insipidus

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Al-Kandari, Salwa R. [Al Razi Hospital, Department of Clinical Radiology, Kuwait (Kuwait); Pandey, Tarun [Al Razi Hospital, Department of Clinical Radiology, Kuwait (Kuwait); University of Arkansas for Medical Sciences, Radiology Department, Little Rock, AR (United States); Badawi, Mona H. [Al-Adan Hospital, Department of Paediatrics, Kuwait (Kuwait)

2008-01-15

Intracranial calcification is a known but extremely rare complication of diabetes insipidus. To date, only 16 patients have been reported and all had the peripheral (nephrogenic) type of diabetes insipidus. We report a child with intracranial calcification complicating central diabetes insipidus. We also report a child with nephrogenic diabetes insipidus, and compare the patterns of intracranial calcification. (orig.)

Magnetic resonance imaging of large and giant intracranial aneurysms

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Matsumura, Kenichi; Saito, Akira; Nakasu, Yoko; Matsuda, Masayuki; Handa, Jyoji [Shiga University of Medical Science, Shiga (Japan); Todo, Giro

1990-06-01

Twelve large or giant intracranial aneurysms were studied with magnetic resonance (MR) imaging, and the findings were compared with those from computed tomographic (CT) scanning. Characteristic MR features of such aneurysms are: round, extra-axial mass with hypointensity rim; signal void, paradoxical enhancement, or even-echo rephasing due to blood flow; and laminated, eccentric thrombus with increased signal intensity when fresh, perianeurysmal hemorrhage occurs in the acute or subacute stage after aneurysmal rupture. MR imaging, however, often fails to identify or characterize the area of calcification. For the diagnosis of large or giant intracranial aneurysms, MR imaging is apparently superior to CT scanning in differentiating aneurysms from tumors, delineating the blood flow and intraluminal thrombus, and detecting the exact size of the aneurysm. It may also provide useful information concerning the growth mechanisms of aneurysms with or without thrombus formation. (author).

Primary intracranial malignant lymphoma. Report of nine cases

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Matsumoto, Mikiro; Ohtsuka, Takatsugu; Kuroki, Takao; Shibata, Iekado; Terao, Hideo; Kudo, Motoshige

1988-12-01

Nine cases of primary intracranial malignant lymphoma, which accounts for 3.3 % of all intracranial tumors seen in the authors' institution, were studied in terms of diagnostic computed tomographic (CT) features, the tumors' histologic appearance, treatment, post-treatment blood immunologic and cerebrospinal fluid (CSF) characteristics, and outcome. The patients were seven males and two females aged 42 to 67 years. Their chief signs and symptoms on admission were intracranial hypertension, focal signs, and disturbance of consciousness. CT, which proved the most useful preoperative diagnostic technique, demonstrated multiple lesions in seven cases and, in all cases, regions of isodensity or slight high density that were enhanced by contrast medium. According to the patterns of enhancement, the tumors were classed as diffuse (three cases) or nodular (six cases). The former is considered typical of malignant lymphoma, whereas the latter type was sometimes indistinguishable from metastatic tumor and meningioma. At surgery, one patient underwent radical tumor excision, two partial removal, and six biopsy only. Histologic examination revealed one tumor to be of the diffuse small cell type, three of the medium cell type, and five of the large cell type (Lymphoma Study Group classification). Of seven tumors in which lymphocytes were examined by peroxidase-antiperoxidase staining, four were of the B cell type. Postoperatively, whole brain irradiation with 29 to 46 Gy was followed by local irradiation with 15 to 50 Gy. If the tumor persisted, one of three chemotherapies was administered. In one case, methotrexate was given intrathecally. Seven patients were divided into two groups: long remission (three) and recurrence (four). These two groups were compared in terms of serum immunoglobulin levels, T and B cell ratios, CSF characteristics, CT features, tumor cell type, and treatment. No clear differences were found.

Quantifying Intracranial Aneurysm Wall Permeability for Risk Assessment Using Dynamic Contrast-Enhanced MRI: A Pilot Study.

Science.gov (United States)

Vakil, P; Ansari, S A; Cantrell, C G; Eddleman, C S; Dehkordi, F H; Vranic, J; Hurley, M C; Batjer, H H; Bendok, B R; Carroll, T J

2015-05-01

Pathological changes in the intracranial aneurysm wall may lead to increases in its permeability; however the clinical significance of such changes has not been explored. The purpose of this pilot study was to quantify intracranial aneurysm wall permeability (K(trans), VL) to contrast agent as a measure of aneurysm rupture risk and compare these parameters against other established measures of rupture risk. We hypothesized K(trans) would be associated with intracranial aneurysm rupture risk as defined by various anatomic, imaging, and clinical risk factors. Twenty-seven unruptured intracranial aneurysms in 23 patients were imaged with dynamic contrast-enhanced MR imaging, and wall permeability parameters (K(trans), VL) were measured in regions adjacent to the aneurysm wall and along the paired control MCA by 2 blinded observers. K(trans) and VL were evaluated as markers of rupture risk by comparing them against established clinical (symptomatic lesions) and anatomic (size, location, morphology, multiplicity) risk metrics. Interobserver agreement was strong as shown in regression analysis (R(2) > 0.84) and intraclass correlation (intraclass correlation coefficient >0.92), indicating that the K(trans) can be reliably assessed clinically. All intracranial aneurysms had a pronounced increase in wall permeability compared with the paired healthy MCA (P risk in anatomic (P = .02) and combined anatomic/clinical (P = .03) groups independent of size. We report the first evidence of dynamic contrast-enhanced MR imaging-modeled contrast permeability in intracranial aneurysms. We found that contrast agent permeability across the aneurysm wall correlated significantly with both aneurysm size and size-independent anatomic risk factors. In addition, K(trans) was a significant and size-independent predictor of morphologically and clinically defined high-risk aneurysms. © 2015 by American Journal of Neuroradiology.

Evaluation of the application of chemical shift for the detection of lipid in brain lesion

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Lim, C.J. [Department of Biomedical Imaging, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur (Malaysia); Ng, K.H., E-mail: ngkh@um.edu.m [Department of Biomedical Imaging, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur (Malaysia); Ramli, N.; Azman, R.R. [Department of Biomedical Imaging, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur (Malaysia)

2011-02-15

Non-invasive detection of the presence of lipids is particularly important in staging of intracranial tumours. Presence of lipid peak in aggressive intracranial tumours has been reported widely using MR spectroscopy. However this method has limitation due to long imaging time and artefacts formed by adjacent bones. Chemical shift MR imaging (with has shorter imaging time) is an alternative method that had been used to detect presence of lipid in vivo by means of signal intensity loss. The purpose of this study was to evaluate gradient echo in- and opposed-phase chemical shift pulse sequences for detection of lipid elements in brain lesion. Ten cylindered phantoms measuring 3 x 3 cm were filled with various mixtures of lipid and water: 0-90% lipid, in 10% step by weight. The gradient echo in- and opposed-phase chemical shift sequences were performed using a 1.5 T MRI (Magnetom Vision, Siemens) with a head coil. In addition, we performed MRI and chemical shift studies on 32 patients with brain lesion. We then analysed the association between out of phase intensity value and classification of the lesions. For phantom containing 50% lipid, maximum signal loss on opposed-phase images was observed. There were significant differences between in- and opposed-phase lipid-water phantom images (P = 0.0054). Most of the benign lesions fall into the positive out of phase intensity value, and malignant lesions fall into negative out of phase intensity value. We conclude that chemical shift artefact can be applied in detecting and characterising lipid elements in brain lesion.

Evaluation of the application of chemical shift for the detection of lipid in brain lesion

International Nuclear Information System (INIS)

Lim, C.J.; Ng, K.H.; Ramli, N.; Azman, R.R.

2011-01-01

Non-invasive detection of the presence of lipids is particularly important in staging of intracranial tumours. Presence of lipid peak in aggressive intracranial tumours has been reported widely using MR spectroscopy. However this method has limitation due to long imaging time and artefacts formed by adjacent bones. Chemical shift MR imaging (with has shorter imaging time) is an alternative method that had been used to detect presence of lipid in vivo by means of signal intensity loss. The purpose of this study was to evaluate gradient echo in- and opposed-phase chemical shift pulse sequences for detection of lipid elements in brain lesion. Ten cylindered phantoms measuring 3 x 3 cm were filled with various mixtures of lipid and water: 0-90% lipid, in 10% step by weight. The gradient echo in- and opposed-phase chemical shift sequences were performed using a 1.5 T MRI (Magnetom Vision, Siemens) with a head coil. In addition, we performed MRI and chemical shift studies on 32 patients with brain lesion. We then analysed the association between out of phase intensity value and classification of the lesions. For phantom containing 50% lipid, maximum signal loss on opposed-phase images was observed. There were significant differences between in- and opposed-phase lipid-water phantom images (P = 0.0054). Most of the benign lesions fall into the positive out of phase intensity value, and malignant lesions fall into negative out of phase intensity value. We conclude that chemical shift artefact can be applied in detecting and characterising lipid elements in brain lesion.

Clinical application of diffusion-weighted magnetic resonance imaging to intracranial disorders

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Yanaka, Kiyoyuki; Shirai, Shizuo; Kimura, Hiroshi [Soujinkai Hospital, Ibaraki (Japan); Kamezaki, Takao; Matsumura, Akira; Nose, Tadao

1995-09-01

Diffusion-weighted magnetic resonance imaging was performed to determine the changes in water diffusion and to investigate the detectability of diffusion anisotropy in patients with intracranial disorders. Diffusion maps of the apparent diffusion coefficient (ADC) were created of 19 patients with cerebral infarction, five with intracerebral hematoma, four with glioma, four with meningioma, four with hydrocephalus, and five with subdural hematoma. ADC was increased in chronic cerebral infarction and glioma, and decreased in acute cerebral infarction, meningioma, and the marginal area of glioma compared with the ADC of the normal gray matter. There was a significant difference in ADC between the marginal and internal areas of glioma. Increased ADC may be due to increased vasogenic edema in infarction and a lack of significant restriction of diffusion within glioma. Decreased ADC can be attributed to restricted diffusion caused by cytotoxic edema in infarction and the underlying histological pattern of densely packed tumor cells in glioma. Diffusion anisotropy of the internal capsule was less detectable in pathological than normal hemispheres. Diffusion anisotropy was less detectable in patients with hydrocephalus and subdural hematoma. Intracranial lesions were thought to have influenced the compression of the brain structures and cells, resulting in decreased diffusion. The measurement of ADC by diffusion-weighted magnetic resonance imaging has the potential for greater understanding of the biophysical changes in various intracranial disorders, including correct diagnosis of cerebral infarction, and histological diagnosis of brain tumor. (author).

The diagnosis of intracranial tumors by CT (computerized tomography) from a practical point of view

International Nuclear Information System (INIS)

Elke, M.; Wiggli, U.; Huenig, R.

1977-01-01

In a historical abstract the mathematical basis of image reconstruction techniques and CT is reviewed. The enhancement of iodine contrast media is essential in CT diagnostis of space occupying intracranial lesions. Intracranial tumors usually show relatively characteristical but mostly non-specific absorption patterns. Additional clinical information is necessary for differential diagnostic evalution. The development of tables with various tumor patterns is recommended. Absorption feature of primary and secondary brain-tumors with the surrounding edema is explained. Glioblastomas as well as metastases often show a distinct cerebral edema which has been observed in 64% of our patients with metastases and distinctly localized high dense foci in 69%. 6,000 patients were investigated by CT and 1,708 examinations were performed with contrast enhancement. Side-effects are within the known reaction of other intravenously applicated contrast media. (orig.) [de

Intracranial involvement in plasmacytomas and multiple myeloma: a pictorial essay

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Cerase, Alfonso; Gennari, Paola; Monti, Lucia; Venturi, Carlo [Azienda Ospedaliera Universitaria Senese, Unit of Diagnostic and Therapeutic Neuroradiology, and InterDepartmental Center of Nuclear Magnetic Resonance, Policlinico ' Santa Maria alle Scotte' , Siena (Italy); Tarantino, Annachiara; Muccio, Carmine Franco [Azienda Ospedaliera ' G. Rummo' , Unit of Neuroradiology, Department of Neurosciences, Benevento (Italy); Gozzetti, Alessandro [University of Siena, Unit of Hematology and Transplants, Policlinico ' Santa Maria alle Scotte' , Siena (Italy); Di Blasi, Arturo [Azienda Ospedaliera ' G. Rummo' , Unit of Pathology, Department of Oncology, Benevento (Italy)

2008-08-15

The purpose of this pictorial essay is to increase awareness of the clinical presentation, neuroradiological findings, treatment options, and neuroradiological follow-up of plasmacytomas and multiple myeloma with intracranial growth. This pictorial essay reviews the clinical features and neuroradiological findings in seven patients (four women, three men; age range at diagnosis 62-82 years) followed in two institutions. Six patients, one with IgG-{kappa} plasmacytoma, and five with IgG-{kappa}(n=3), IgG-{lambda}(n=1), and nonsecretory (n=1) multiple myeloma, had been seen over a period of 9 years in one institution, and the other patient with IgG-{kappa} plasmacytoma had been seen over a period of 3.5 years in the other. Intracranial involvement is rare, most frequently resulting from osseous lesions in the cranial vault, skull base, nose, or paranasal sinuses. Primary dural or leptomeningeal involvement is rarer. Some typical findings of a dural and/or osseous plasmacytoma include iso- to hyperdensity on CT scan, T1 equal to high signal intensity and T2 markedly hypointense signal on MRI, and high vascularity possibly documented on intraarterial digital subtraction angiography. However, the neuroradiological findings generally lack specificity, since they are generally no different from those of meningioma, metastasis, lymphoma, dural sarcoma, plasma cell granuloma, infectious meningitis, and leptomeningeal carcinomatosis. The spectrum of clinical and neuroradiological evaluation shows that intracranial involvement from plasmacytoma and multiple myeloma must be taken into account in the differential diagnosis of cranial osseous and meningeal disease. (orig.)

Dosimetric results from a feasibility study of a novel radiosurgical source for irradiation of intracranial metastases

International Nuclear Information System (INIS)

Douglas, Robert M.; Beatty, John; Gall, Kenneth; Valenzuela, Raul F.; Biggs, Peter; Okunieff, Paul; Pardo, Francisco S.

1996-01-01

Purpose: A feasibility study addressing the role of a new miniature x-ray device, the Photon Radiosurgery System (PRS), for interstitial radiosurgical treatment of intracranial metastatic neoplasms, was conducted at our institution. To gain insight into the role of PRS vis-a-vis other currently available radiosurgical treatment modalities, dosimetric comparisons of Linac Radiosurgery and proton beam therapy were performed in the treatment of a small approximately spherical metastasis. Methods and Materials: The photon radiosurgery system is a miniature, battery operated, high-voltage x-ray generator that produces low-energy x-rays with an effective energy of 10-20 keV emanating from the tip of a probe stereotactically inserted into small tumors (< 3 cm in diameter) in humans. Patients, 18 years or older, with supratentorial mass lesions less than 3 cm in diameter were eligible if they were likely to survive their systemic cancer and be capable of self-care for more than 4 months. Patients were ineligible if presenting with infratentorial lesions, contraindications for biopsy, or receipt of chemotherapy or radiotherapy within 4 weeks were ineligible. Results: Fourteen patients with metastatic supratentorial lesions were treated from December 1992 to December 1993 for metastatic tumors to the brain. Single doses of 10-20 Gy were delivered to spherical targets of 10 to 35 mm in diameter. Treatment, including biopsy, pathologic review and radiation treatment, generally took less than 3 h. One patient, later found to have an ischemic stroke, developed a small hemorrhage from the biopsy that preceded interstitial irradiation. There were no other complications. Median survival was 10 months. Three locally recurrent lesions failed at 3.5, 4, and 10 months after treatment. All patients had stable or improved Karnofsky status for 2 weeks to 21 months after treatment. The PRS dosimetry appears at least as good as that obtained using 6 MV Linac or 160 MeV protons. Analyses of

T2 relaxometry of ring lesions of the brain

International Nuclear Information System (INIS)

Jayakumar, P.N.; Srikanth, S.G.; Chandrashekar, H.S.; Subbakrishna, D.K.

2007-01-01

Aim: To differentiate two common aetiologies of 'ring lesions,' tuberculomas and cysticercal cysts, using T2 relaxometry. Materials and methods: Fifty-five ring-enhancing lesions of the brain (32 cysticercal cysts; 23 tuberculomas) in 27 patients with focal seizures were studied for T2 relaxation times. Results: The mean T2 relaxation times of cysticercal cysts was 617 ms (range 305-1365 ms; SD 272.2) and that of tuberculomas 161 ms (range 83-290 ms; SD 60.3; 95% confidence). Conclusion: T2 relaxometry is a simple, reliable and valuable non-invasive magnetic resonance imaging (MRI) technique to differentiate between intracranial cysticercal cysts and tuberculomas, and may be incorporated in routine diagnostic protocols

Is {sup 99m}Tc-MDP mammoscintigraphy useful in patients with breast mass lesions?

Energy Technology Data Exchange (ETDEWEB)

Park, S. K.; Lee, Y. H.; Rhyu, J. W.; Yoo, S. M. [College of Medicine, Dankook Univ., Cheonan (Korea, Republic of)

1998-06-01

Piccolo et al. advocated the usefulness of {sup 99m}Tc-MDP breast scan in differential diagnosis of breast mass with high accuracy. But there are little or no follow-up studies about it as we know. We studied {sup 99m}Tc-MDP uptake pattern and lesion/background ratio in patients complaining palpable breast lesions to evaluate the clinical usefulness of {sup 99m}Tc-MDP scan. Total 34 patients were studied with physical examination, mammogram and {sup 99m}Tc-MDP scan prospectively. Anteroposterior and both lateral view of breast were obtained 5 minutes after iv injection of 740 MBq {sup 99m}Tc-MDP. Breast uptake pattern of {sup 99m}Tc-MDP was analyzed by a grade system: 0=no uptake, grade 1=bilateral diffuse uptake, grade 2=asymmetric faint uptake, grade 3=focal hot uptake. 20 cases were pathologically confirmed by excision biopsy or aspiration biopsy. 14 cases were normal in physical examination and mammogram. Pathologic results showed 7 carcinomas, 6 benign solid tumors, and 7 fibrocystic changes. Grade 3 pattern of {sup 99m}Tc-MDP uptake was noted in 4/7 carcinomas, 3/5 benign solid tumors, and 1/7 fibrocystic changes. Grade 2 pattern was 2/7, 0/7, 3/7 respectively. The average L/B ratio was 1.66 in carcinomas, 1.68 in benign solid masses, 1.20 in fibrocystic diseases, 1.05 in normal patients. L/B ratio was higher in carcinoma and benign mass groups than in fibrocystic change and normal control groups(p=0.005). But there was no statistical difference between L/B ratio of malignant mass group and benign mass group. {sup 99m}Tc-MDP scan is not suitable to routine clinical use for breast mass diagnosis. It might be used in limited conditions when whole body bone scan is planned.

Idiopathic intracranial hypertension

DEFF Research Database (Denmark)

Yri, Hanne M; Jensen, Rigmor H

2015-01-01

AIMS: The aims of this article are to characterize the headache in idiopathic intracranial hypertension (IIH) and to field-test the ICHD diagnostic criteria for headache attributed to IIH. MATERIALS AND METHODS: We included 44 patients with new-onset IIH. Thirty-four patients with suspected but u...... tinnitus may suggest intracranial hypertension. Based on data from a well-defined IIH cohort, we propose a revision of the ICDH-3 beta diagnostic criteria with improved clinical applicability and increased sensitivity and specificity....

Analysis of petrous apex meningocele associated with meningioma. Is there any relation with chronic intracranial hypertension?

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Yang, Wan-Qun; Huang, Biao; Liang, Chang-Hong [Southern Medical University, The Second School of Clinical Medicine, Guangzhou (China); Guangdong Academy of Medical Sciences, Department of Radiology, Guangdong General Hospital, Guangzhou, Guangdong (China); Feng, Jie-Ying [Nanhai Hospital Affiliated Southern Medical University, Department of Radiology, Foshan, Guangdong (China); Liu, Hong-Jun [Guangdong Academy of Medical Sciences, Department of Radiology, Guangdong General Hospital, Guangzhou, Guangdong (China)

2018-02-15

Petrous apex meningocele (PAM) is an uncommon cystic lesion involving the petrous apex. The underlying cause of PAM may be related to chronic elevated intracranial pressure. The aim of the study was to explore the relationship between PAM and meningioma and between PAM and other intracranial hypertension findings. Two hundred seventy-eight consecutive patients with meningiomas were retrospectively studied. Fifty age- and gender-matched controls were also enrolled in this study. The incidence of PAM, empty sella, tortuosity of the optic nerve, and hydrops of optic nerve sheath was evaluated. The maximum width, area, volume of each PAM, or Meckel's cave and volume of meningioma were measured in controls and patients, separately. One hundred fifty-nine (57.19%) patients were detected with coexistent PAMs. One hundred twenty-five patients had bilateral PAMs, 34 had unilateral lesions, and the remaining 119 did not have PAM. Two subjects (4/50) had unilateral PAMs in normal controls. The maximum width, area, volume of PAM, or Meckel's cave were significantly larger in the patients with bilateral PAM group than those in the unilateral PAM group, in the group without PAM, and those in control group (p = 0.000). The volume of meningioma was positively correlated with the PAM volume (r = 0.48). There was a positive correlation for the incidence between PAM and (1) empty sella (r = 0.901) and (2) tortuosity of the optic nerves and hydrops of the optic sheath (r = 0.825). Coexistence of PAMs with meningiomas is not rare in incidence, and it suggests a potential role for chronically elevated intracranial pressure and disturbance of CSF circulation in their pathophysiology. (orig.)

Analysis of petrous apex meningocele associated with meningioma. Is there any relation with chronic intracranial hypertension?

International Nuclear Information System (INIS)

Yang, Wan-Qun; Huang, Biao; Liang, Chang-Hong; Feng, Jie-Ying; Liu, Hong-Jun

2018-01-01

Petrous apex meningocele (PAM) is an uncommon cystic lesion involving the petrous apex. The underlying cause of PAM may be related to chronic elevated intracranial pressure. The aim of the study was to explore the relationship between PAM and meningioma and between PAM and other intracranial hypertension findings. Two hundred seventy-eight consecutive patients with meningiomas were retrospectively studied. Fifty age- and gender-matched controls were also enrolled in this study. The incidence of PAM, empty sella, tortuosity of the optic nerve, and hydrops of optic nerve sheath was evaluated. The maximum width, area, volume of each PAM, or Meckel's cave and volume of meningioma were measured in controls and patients, separately. One hundred fifty-nine (57.19%) patients were detected with coexistent PAMs. One hundred twenty-five patients had bilateral PAMs, 34 had unilateral lesions, and the remaining 119 did not have PAM. Two subjects (4/50) had unilateral PAMs in normal controls. The maximum width, area, volume of PAM, or Meckel's cave were significantly larger in the patients with bilateral PAM group than those in the unilateral PAM group, in the group without PAM, and those in control group (p = 0.000). The volume of meningioma was positively correlated with the PAM volume (r = 0.48). There was a positive correlation for the incidence between PAM and (1) empty sella (r = 0.901) and (2) tortuosity of the optic nerves and hydrops of the optic sheath (r = 0.825). Coexistence of PAMs with meningiomas is not rare in incidence, and it suggests a potential role for chronically elevated intracranial pressure and disturbance of CSF circulation in their pathophysiology. (orig.)

Intracranial metastatic mucinous adrenocarcinoma with characteristic features on diffusion-weighted imaging and in vivo magnetic resonance spectroscopy

International Nuclear Information System (INIS)

Guruprasad, Ashwathnarayan S.; Chandrashekar, Hoskote S.; Jayakumar, Peruvumba N.; Srikanth, Subbamma G.; Shankar, Susarla K.

2004-01-01

Intracranial abscesses and metastases are common lesions that might not be differentiated on routine MR I alone. In vivo proton spectroscopy and diffusion-weighted imaging have been used as complementary investigations for improved tissue characterization. In the present report we illustrate the role of mucin and its contribution to signal characteristics on diffusion-weighted imaging in a metastatic mucinous adenocarcinoma Copyright (2004) Blackwell Publishing Asia Pty Ltd

111In-pentetreotide therapy in patients with inoperable benign intracranial tumors

International Nuclear Information System (INIS)

Minutoli, F.; Sindoni, A.; Cardile, D.; Amato, E.; Cassalia, L.; Herberg, A.; Baldari, S.

2015-01-01

Full text of publication follows. Aim: in the last years Peptide Receptor Radionuclide Therapy (PRRT) acquired greater importance as an alternative or complementary treatment of neuroendocrine tumors (NETs) and other somatostatin receptor positive (sstr+) tumors. Many studies about PRRT using different radiopharmaceuticals, mainly 90 Y and 177 Lu (beta-emitters) labelled peptides, are reported in the literature. 177 Lu-labeled somatostatin analogues seem to be more effective because of their favourable physical properties and the better objective response. On the other hand, only few reports exist on PRRT using 111 In-Pentetreotide, an Auger-emitter. The aim of this study is to evaluate the usefulness of 111 In-Pentetreotide therapy in patients with sstr+ inoperable benign intracranial tumors in which the use of beta-emitters radiopharmaceuticals (characterized by higher penetration range) could be unsafe and questionable since lesions were close to critical anatomical structures, such as optic chiasm or medulla oblongata. Materials and methods: we retrospectively reviewed clinical records of 9 patients (7 Females and 2 Males) affected by sstr+ benign intracranial tumors (mean age: 58.4 years, range 50-81): 8 patients had meningiomas/meningiomatosis and 1 patient had a pituitary macroadenomas. A previous diagnostic scintigraphy with 111 In-Pentetreotide demonstrated high intralesional radiotracer uptake. All patients underwent PRRT with high therapeutic activities of 111 In-Pentetreotide (1-7 cycles, median 4 cycles, activity per cycle 3.7-7.5 GBq, median activity per cycle 7 GBq, cumulative activity range 13.7-66 GBq). Efficacy of PRRT was evaluated according to RECIST criteria. Toxicity was also assessed considering hematological parameters and GFR value estimated by renal dynamic scintigraphy. Results: no patient had acute damage. Complete response was observed in 1 patient (11.1%). Partial response was observed in 2 patients (22.2%); stable disease was observed

Spontaneous intracranial hemorrhage and multiple intracranial aneurysms in a patient with Roberts/SC phocomelia syndrome.

Science.gov (United States)

Wang, Anthony C; Gemmete, Joseph J; Keegan, Catherine E; Witt, Cordelie E; Muraszko, Karin M; Than, Khoi D; Maher, Cormac O

2011-11-01

Roberts/SC phocomelia syndrome (RBS) is a rare but distinct genetic disorder with an autosomal recessive inheritance pattern. It has been associated with microcephaly, craniofacial malformation, cavernous hemangioma, encephalocele, and hydrocephalus. There are no previously reported cases of RBS with intracranial aneurysms. The authors report on a patient with a history of RBS who presented with a spontaneous posterior fossa hemorrhage. Multiple small intracranial aneurysms were noted on a preoperative CT angiogram. The patient underwent emergency craniotomy for evacuation of the hemorrhage. A postoperative angiogram confirmed the presence of multiple, distal small intracranial aneurysms.

Synchronized multiple regression of diagnostic radiation-induced rather than spontaneous: disseminated primary intracranial germinoma in a woman: a case report

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Natsumeda Manabu

2011-01-01

Full Text Available Abstract Introduction Examples of the spontaneous regression of primary intracranial germinomas can be found in the literature. We present the case of a patient with disseminated lesions of primary intracranial germinoma which synchronously shrunk following diagnostic irradiation. We will discuss whether this regression was spontaneous or radiation-induced. Case presentation A 43-year-old Japanese woman presented to our hospital complaining of memory problems over a period of one year and blurred vision over a period of three months. Following magnetic resonance imaging, she was found to have a massive lesion in the third ventricle and small lesions in the pineal region, fourth ventricle, and in the anterior horn of the left lateral ventricle. Prior to an open biopsy to confirm the pathology of the lesions, she underwent a single cranial computed tomography scan and a single cranial digital subtraction angiography for a transcranial biopsy. Fourteen days after the first magnetic resonance image - 12 and eight days after the computed tomography scan and digital subtraction angiography, respectively - a pre-operative magnetic resonance image was taken, which showed a notable synchronous shrinkage of the third ventricle tumor, as well as shrinkage of the lesions in the pineal region and in the fourth ventricle. She did not undergo steroid administration until after a biopsy that confirmed the pathological diagnosis of pure germinoma. She then underwent whole craniospinal irradiation and went into a complete remission. Conclusions In our case report, we state that diagnostic radiation can induce the regression of germinomas; this is the most reasonable explanation for the synchronous multiple regression observed in this case of germinoma. Clinicians should keep this non-spontaneous regression in mind and monitor germinoma lesions with minimal exposure to diagnostic radiation before diagnostic confirmation, and also before radiation treatment with or

Frame-based and frameless stereotactic radiosurgery for intracranial and extracranial tumors

International Nuclear Information System (INIS)

Petrovich, Z.; Cheng Yu

2003-01-01

During the past 10 years stereotactic frame-based radiosurgery (SRS) emerged as an important treatment modality in the management of selected intracranial lesions. More recently, frameless SRS has extended the potential of ibis treatment to include lesions virtually in any site of the body. Many thousands of patients are being treated annually with frame-based SRS limited to the cranial cavity. A total of 180,222 patients were treated to December 2001 with gamma knife (GK) and, very likely, a similar number was treated with various linear accelerator based SRS systems. Frameless SRS has been performed uncommonly until cyber knife (CK) became available. Over 3,000 patients were treated with CK in the US and Japan. This included patients treated for extracranial lesions. Treatment results in patients treated with GK at University of Southern California (USC) will be presented. From 1994 to 2002, a total of 1,126 patients received GK at USC for various indications. Since metastatic tumor constituted the largest (42.4%) diagnostic category treated, the outcome in this group is specifically discussed. The overall median survival was 9.2 months. The median survival was 8.3, 9.0, 17 and 12 months, for melanoma, lung cancer, breast cancer and renal cell carcinoma, respectively. In multivariate analysis Karnofsky's performance status (70 vs. >70), status of systemic disease (inactive vs. active), tumor histology and total intracranial tumor volume were the only important factors predictive of survival, p=0.0001. Cause of death was found to be due to CNS problems in about 25% of patients with a diagnosis other than melanoma, while it was 42% in those with melanoma. GK SRS was given on an outpatient basis and was very well tolerated by the patients. Symptomatic focal radionecrosis requiring craniotomy for its removal was noted in <5% of patients. An excellent palliative benefit was obtained in nearly all patients. The treatment was compatible with a good quality of life

An evaluation and comparison of intraventricular, intraparenchymal, and fluid-coupled techniques for intracranial pressure monitoring in patients with severe traumatic brain injury.

Science.gov (United States)

Vender, John; Waller, Jennifer; Dhandapani, Krishnan; McDonnell, Dennis

2011-08-01

Intracranial pressure measurements have become one of the mainstays of traumatic brain injury management. Various technologies exist to monitor intracranial pressure from a variety of locations. Transducers are usually placed to assess pressure in the brain parenchyma and the intra-ventricular fluid, which are the two most widely accepted compartmental monitoring sites. The individual reliability and inter-reliability of these devices with and without cerebrospinal fluid diversion is not clear. The predictive capability of monitors in both of these sites to local, regional, and global changes also needs further clarification. The technique of monitoring intraventricular pressure with a fluid-coupled transducer system is also reviewed. There has been little investigation into the relationship among pressure measurements obtained from these two sources using these three techniques. Eleven consecutive patients with severe, closed traumatic brain injury not requiring intracranial mass lesion evacuation were admitted into this prospective study. Each patient underwent placement of a parenchymal and intraventricular pressure monitor. The ventricular catheter tubing was also connected to a sensor for fluid-coupled measurement. Pressure from all three sources was measured hourly with and without ventricular drainage. Statistically significant correlation within each monitoring site was seen. No monitoring location was more predictive of global pressure changes or more responsive to pressure changes related to patient stimulation. However, the intraventricular pressure measurements were not reliable in the presence of cerebrospinal fluid drainage whereas the parenchymal measurements remained unaffected. Intraparenchymal pressure monitoring provides equivalent, statistically similar pressure measurements when compared to intraventricular monitors in all care and clinical settings. This is particularly valuable when uninterrupted cerebrospinal fluid drainage is desirable.

Usefulness of low-field FlAIR sequence in MR imaging of intracranial tumors

International Nuclear Information System (INIS)

Sokolowska, D.; Sasiadek, M.; Zimny, A.

2004-01-01

Plain MR study is often insufficient for visualization of all important details of intracranial tumors, hence there are attempts to use supplementary MR techniques. One of them is FLAIR (fluid attenuated inversion recovery) sequence which previously was available only in high-field MR units, but recently has been introduced also in less expensive low-field units. FLAIR is already widely used in the diagnostics of ischemic and demyelinating lesions, while there are few papers concerning its application in intracranial tumors, none of them regarding low-field MR units.The aim of our study was detailed evaluation of low-field FLAIR in the diagnostics of intracranial tumors. The material consisted of 76 patients with intracranial tumors, who were examined with low-field open MR unit (0.23 Tesla). In all patients, standard T2-weighted and T1-weighted (before and after contrast enhancement) sequences, as well as FLAIR sequence, were performed. The following symptoms were compared in the aforementioned sequences: tumor-edema, edema-brain and tumor-brain borders, visualization of tumour structure, vessels in the tumor area and precise tumor localization. A superiority of FLAIR in assessment of all symptoms has been confirmed, at least in part of the patient group. It concerned particularly the evaluation of brain-edema and edema-brain borders which were better visible with FLAIR than with all other sequences in 29 and 30 patients, respectively. In the assessment of the remaining symptoms (tumor-brain border, tumor structure, visualization of vessels, tumor localization) FLAIR was superior to other sequences in smaller number of patients (13,11,11 and 12, respectively). Totally, in 48 out of 76 patients (63.2%) FLAIR allowed better assessment of at least one of the analyzed symptoms. Low-field MR FLAIR enriches diagnostic information in majority of patients with intracranial tumors, therefore it should be included routinely in the diagnostic algorithm in this group of

Intracranial MR angiography

International Nuclear Information System (INIS)

Davis, W.L.; Blatter, D.D.; Parker, D.L.; Robison, R.O.; Harnsberger, H.R.

1991-01-01

This paper compares the more traditional three-dimensional (3D) time-of-flight MR angiography with a novel new technique, MOTSA, in the evaluation of both normal and abnormal intracranial anatomy. The authors performed sequential, location-matched 3D TOF and MOTSA MR angiography in 10 subjects with normal and 25 with abnormal intracranial anatomy. Images were evaluated for visualization of specific vessels and depiction of pathologic anatomy. All images were subjected to an objective scoring system. Digital angiography was available in 15 of 25 abnormal cases. In the normal cases, large- and small-vessel visualization was improved. Significant improvement in visualization of venous anatomy was also observed. In the abnormal cases, pathologic anatomy was better visualized, providing important diagnostic information. Multiple overlapping thin-slab-acquisition MR angiography demonstrates vessel visualization that is increased over that of 3D TOF MR angiography in both normal and abnormal cases. Because of the decrease in saturation effects and phase dispersion, MOTSA is especially useful in the evaluation of complex intracranial vascular abnormalities

The risk of intravenous thrombolysis-induced intracranial hemorrhage in Taiwanese patients with unruptured intracranial aneurysm.

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Wei Ting Chiu

Full Text Available The presence of an intracranial aneurysm is contraindicated to recombinant tissue plasminogen activator (r-tPA treatment for acute ischemic stroke. However, it is difficult to exclude asymptomatic intracranial aneurysms by using conventional, noncontrast head computed tomography (CT, which is the only neuroimaging suggested before r-tPA. Recent case reports and series have shown that administering r-tPA to patients with a pre-existing aneurysm does not increase the bleeding risk. However, Asians are known to have a relatively higher bleeding risk, and little evidence is available regarding the risk of using r-tPA on Asian patients with intracranial aneurysms.Medical records from the Shuang Ho hospital stroke registration between July 2010 and December 2014 were retrospectively reviewed, and 144 patients received r-tPA. Unruptured intracranial aneurysms were detected using CT, or magnetic resonance or conventional angiography after r-tPA. The primary and secondary outcomes were the difference in overall intracranial hemorrhage (ICH and symptomatic ICH after r-tPA. The differences were analyzed using Fisher's exact or Mann-Whitney U tests, and p < 0.05 was defined as the statistical significance.A total of 144 patients were reviewed, and incidental unruptured intracranial aneurysms were found in 11 of them (7.6%. No significant difference was observed in baseline demographic data between the aneurysm and nonaneurysm groups. Among patients with an unruptured aneurysm, two had giant aneurysms (7.7 and 7.4 mm, respectively. The bleeding risk was not significant different between aneurysm group (2 out of 11, 18% with nonaneurysm group (7 out of 133, 5.3% (p = 0.14. None of the patients with an unruptured aneurysm had symptomatic ICH, whereas one patient without an aneurysm exhibited symptomatic ICH.The presence of an unruptured intracranial aneurysm did not significantly increase the risk of overall and symptomatic ICH in Taiwanese patients after they

Intracranial hypertension prediction using extremely randomized decision trees.

Science.gov (United States)

Scalzo, Fabien; Hamilton, Robert; Asgari, Shadnaz; Kim, Sunghan; Hu, Xiao

2012-10-01

Intracranial pressure (ICP) elevation (intracranial hypertension, IH) in neurocritical care is typically treated in a reactive fashion; it is only delivered after bedside clinicians notice prolonged ICP elevation. A proactive solution is desirable to improve the treatment of intracranial hypertension. Several studies have shown that the waveform morphology of the intracranial pressure pulse holds predictors about future intracranial hypertension and could therefore be used to alert the bedside clinician of a likely occurrence of the elevation in the immediate future. In this paper, a computational framework is proposed to predict prolonged intracranial hypertension based on morphological waveform features computed from the ICP. A key contribution of this work is to exploit an ensemble classifier method based on extremely randomized decision trees (Extra-Trees). Experiments on a representative set of 30 patients admitted for various intracranial pressure related conditions demonstrate the effectiveness of the predicting framework on ICP pulses acquired under clinical conditions and the superior results of the proposed approach in comparison to linear and AdaBoost classifiers. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.

The value of MRI in angiogram-negative intracranial haemorrhage

Energy Technology Data Exchange (ETDEWEB)

Renowden, S.A. (Dept. of Neuroradiology, Radcliffe Infirmary, Oxford (United Kingdom)); Molyneux, A.J. (Dept. of Neuroradiology, Radcliffe Infirmary, Oxford (United Kingdom)); Anslow, P. (Dept. of Neuroradiology, Radcliffe Infirmary, Oxford (United Kingdom)); Byrne, J.V. (Dept. of Neuroradiology, Radcliffe Infirmary, Oxford (United Kingdom))

1994-08-01

In one year, cerebral angiograms were performed for intracranial haemorrhage (ICH) on 334 patients. No cause for haemorrhage could be identified in 41 (12 %), 30 of whom had predominantly subarachnoid (SAH) and 11 predominantly parenchymal haemorrhage (PH). These patients were prospectively examined by cranial MRI 1-6 weeks after the ictus. The MRI studies were positive in 7 patients (17 %). In the 30 patients examined after SAH, 2 studies were positive, showing an aneurysm in one case and a brain stem lesion of uncertain aetiology in the other. In those examined after PH, cavernous angiomas were shown in 2, a tumour in 1 and a vascular malformation in another; useful diagnostic information was thus obtained in 36 % of this group. (orig.)

Experience of slowly infused high-iodine-dose contrast computed tomography (SHD) of intracranial tumors

International Nuclear Information System (INIS)

Muraoka, Kiyoaki; Numata, Hideharu; Hokama, Yasuo

1983-01-01

A study was done on 20 patients with intracranial tumors by means of the slowly infused high-iodine-dose (SHD) contrast-enhancement technique. An intravenous drip infusion of 300 ml of Angiografin was given for three hours. Computerized tomograms were taken 1 hour, (2 hours), and 3 hours after the beginning of the drip infusion. The authors divided the lesions into four groups by analyzing the sequential changes in CT numbers using a histograms or profile of the region of interest. In group I, additional lesions were visible on the SHD scan (one case of metastatic brain tumors from lung cancer). In group 2, lesions were better displayed on the SHD scan due to increased enhancement (17 cases). In group 3, SHD scans showed no change (2 cases of fibrous astrocytoma). In group 4, the enhancement was diminished, but the lesion per se was still clealy identifiable (no case). Finally, in 18 cases out of 20 (90%), an additional or better display of the lesion was detected on SHD enhanced CT. The rational for doing the SHD enhancement is to detect a lesion with a minimally impaired blood-brain barrier by exposing a prolonged high blood-iodine level, and so the scanning is delayed until detectable levels of the contrast medium have accumulated within the vascular-channel pool or extravascular space of the lesion. SHD enhancement is useful: I) for revealing any additional lesion in a metastatic brain tumor; 2) for better displaying an obscure lesion on a usual scan; 3) for differentiating the quality of the lesion (for example, malignancy or cyst formation), and 4) for predicting the prognosis of the lesion. (J.P.N.)

Computerized transverse tomography of vascular lesions of the brain. I. Arteriovenous malformations

International Nuclear Information System (INIS)

Pressman, B.D.; Kirkwood, J.R.; Davis, D.O.

1975-01-01

Computerized transverse tomography (CTT) of the brain is a recently developed method which allows non-invasive roentgenologic evaluation of intracranial disease. Since its inception, major attention has been given to the diagnosis and evaluation of tumors, clots, infarcts, venticular size, and orbital lesions. The purpose of this report is to discuss the application of CTT to the diagnosis and evaluation of intracerebral arteriovenous malformations. (U.S.)

Intracranial Monitoring after Severe Traumatic Brain Injury

OpenAIRE

Donnelly, Joseph

2018-01-01

Intracranial monitoring after severe traumatic brain injury offers the possibility for early detection and amelioration of physiological insults. In this thesis, I explore cerebral insults due raised intracranial pressure, decreased cerebral perfusion pressure and impaired cerebral pressure reactivity after traumatic brain injury. In chapter 2, the importance of intracranial pressure, cerebral perfusion pressure and pressure reactivity in regulating the cerebral circulation is elucidated ...

Radionecrosis of the brain presenting as a mass lesion: a case report

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Littman, P [Pennsylvania Univ., Philadelphia (USA). Dept. of Radiology; James, H; Zimmerman, R; Slater, R

1977-08-01

A case of radionecrosis of the brain in a patient previously treated for squamous cell carcinoma of the scalp is presented. Cerebral angiography revealed a mass effect primarily in the right frontal area. Computed tomography showed extensive hemispheric edema. A frontal lobectomy was performed, and the recovery was excellent. The lower limit for brain tolerance for irradiation is about 5000 rads given in five weeks. This dose should not be exceeded when extracranial lesions are treated. Although computed tomography cannot diagnose brain necrosis, specifically, it should, along with the clinical history, be very helpful.

Sex differences in intracranial arterial bifurcations

DEFF Research Database (Denmark)

Lindekleiv, Haakon M; Valen-Sendstad, Kristian; Morgan, Michael K

2010-01-01

. The female preponderance is usually explained by systemic factors (hormonal influences and intrinsic wall weakness); however, the uneven sex distribution of intracranial aneurysms suggests a possible physiologic factor-a local sex difference in the intracranial arteries....

Long-term psychological effects in children treated for intracranial tumors

International Nuclear Information System (INIS)

Jannoun, L.; Bloom, H.J.

1990-01-01

The results are reported of the psychological assessment of 62 children who presented with primary intracranial tumors and who received radiotherapy at the Royal Marsden Hospital between 1963 and 1973. Evaluations were carried out 3-20 years after treatment. All patients were free from progressive tumor at testing. The average IQ of the total series was within the normal range (Full-Scale IQ 92) but 23% of the patients were functioning at an educationally subnormal level of intelligence (IQ less than 80). Sex, tumor type, tumor location and the radiotherapy volume and site of maximum dose were not found to have a significant effect on intellectual outcome. A significant correlation was found between intelligence and age at the time of treatment. Children who received treatment under the age of 5 years were more adversely affected (average IQ 72) than those who were aged 6-10 (average IQ 93) and those aged 11-15 years (average IQ 107). The incidence of neurological abnormalities and physical disability was significantly greater among patients with supratentorial tumors (72% of cases), compared with patients with infratentorial lesions (44% of cases). The results were discussed in terms of the management of young patients with intracranial tumors

Wingspan stent system in the treatment of symptomatic intracranial atherosclerotic stenosis

International Nuclear Information System (INIS)

Li Tianxiao; Li Zhaoshuo; Wang Ziliang; Xue Jiangyu; Bai Weixing; Li Li; Zhai Shuiting; Feng Yingpu

2010-01-01

Objective: To assess the safety, feasibility, short- and mid-term efficacy of wingspan stent for treating patients with symptomatic intracranial artery stenosis. Methods: A total of 113 patients with severe symptomatic intracranial stenosis were enrolled and Gateway-wingspan stenting were performed on all patients. The technical success, the pre- and post-stenting stenosis, perioperative complications, clinical outcome and restenosis rates were recorded, and chi-square test was used for analysis of complication rate by comparing our results with the results of Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study and NIH multi-center Wingspan stenting trial. Results: The technical success rate was 99.1% (112/ 113). The mean pre and post-stent stenoses were (80.7±9.3)% and (27.7±9.7)% (χ 2 =9.397, P<0.05). The total complication rate was 4.4% (5/113) during the follow-up (mean 14.5 months, range 1-28 months), and the frequency of' restenosis was 12.5% (5/40) at 6 months. The primary endpoint events, ischemic stroke, and lesion-related ischemic stroke were lower in our study (4.5%, 3.5%, 3.5%) compared with the results of WASID trial (21.1%, 20.4%, 15.0%, P<0.05). For those with poor outcome in the three high-risk sub-groups which were with more than 70% stenosis, or last event from the treatment was less than 17 days, or NIHSS was above 1, a better outcome was observed in our group (4.5%, 4.7% and 2.0% in our study, 19.0%, 17.0% and 19.6% in previous study, P<0.05). The medium-term efficacy in this group (4.5%) significantly improved compared with NIH study (14.0%, P< 0.05). Conclusions: Wingspan stenting for symptomatic intracranial arterial stenosis is with good safety, feasibility and low perioperative stroke rate and mortality. The incidence of primary endpoint events and the ischemic events are lower than those of medication group, and the efficacy of stenting is significantly better than medication even in high-risk population. (authors)

Remote multiple intracranial hemorrhage in multiple metastatic lung adenocarcinoma following decompression of posterior fossa lesion: Unknown cause

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Subhas Konar

2015-01-01

Full Text Available Cerebral metastasis can present with hemorrhage. However, multiple hemorrhages in metastatic lesions following surgical decompression of a single lesion are never reported. We report a case of cerebral metastasis from lung cancer that developed multiple hemorrhages in supratentorial metastatic lesions following surgical resection of an infratentorial lesion.

Multiple intracranial hydatid cysts: MR findings

International Nuclear Information System (INIS)

Pumar, J.; Alvarez, M.; Leira, R.; Prieto, J.M.; Arrojo, L.; Pereira, J.; Vidal, J.

1992-01-01

Multiple intracranial hydatid cysts are uncommon and usually localized in the supratentorial compartment. We report a case studied by CT and MR of multiple intracranial hydatid cysts scattered in various anatomic sites: supratentorial, infratentorial and also intraventricular. (orig.)

Lithium-induced Nephrotoxicity: A Case Report of Renal Cystic Disease Presenting as a Mass Lesion

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Yvonne McCartney

2014-11-01

Full Text Available Lithium is an effective therapeutic agent used in the management of bipolar disorder. However, lithium is also associated with several side effects, including renal toxicity. We present a case of a symptomatic cystic mass lesion in the kidney of a patient who had a history of lithium therapy for the management of bipolar disorder.

Imagenological characterization by Computerized Axial Tomography of the primary intracranial tumors

International Nuclear Information System (INIS)

Sosa Rivera, Manuel; Quintas Santana, Maria

2009-01-01

A descriptive observational study to 56 patients with imagenological diagnosis of primary intracranial neoplasia attended in the service of imagenology of the Provincial Docent Hospital 'Dr. Antonio Luaces Iraola' was carried out from March 1st 2006 to February 1st 2008, with the aim of characterizing these injuries by Computerized Axial Tomography and establishing an evaluation with the histological diagnosis. A questionnaire with the following variables was applied: sex, presuntive age, clinic, topographical characteristics (location, size, tumoral density, changes with administration of the resistance, calcifications, effect of mass and evaluation of the imagenological diagnosis with the histological diagnosis. Masculine sex and the group of ages of 60 are more predominated. The more frequent clinical manifestations were migraine, convulsions, difficulty to walk and vertigo. The size of the injury that prevailed was of 5, 9 and 2, 1 cm with supratentorial location. The majority of primary intracranial neoplasms were hypodense, and enhancement of the injuries with the administration of the resistance was observed. The mass effect bears a close relation with the location and size of the injury. The imagenological diagnosis fitted in with the histological one, being the gliomas the more frequent histological type

A case of intracranial malignant fibrous histiocytoma

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Amir Hossein Sarrami

2011-01-01

Full Text Available We describe a case of intracranial malignant fibrous histiocytoma which had infiltrated pons, cerebellum and basal surface of left temporal lobe without any visible mass. The patient presented with a sudden loss of consciousness and vomiting. Clinical findings, laboratory tests, imaging and examination of the cerebrospinal fluid tended to establish the diagnosis of an infectious condition than a malignancy. Without any response to the antibiotics and with a progressive deterioration of neurologic and mental condition, the patient died after 20 days. In the autopsy, histological and immunohistochemical study of the brain revealed the diagnosis of malignant fibrous histiocytoma (MFH.

Traumatic and alternating delayed intracranial hematomas

Energy Technology Data Exchange (ETDEWEB)

Lesoin, F.; Redford, H.; Jomin, M.; Viaud, C.; Pruvo, J.

1984-11-01

Repeat computed tomography has enabled us to confirm the concept of delayed hematomas. With this in mind we report two cases of alternating, post-traumatic intracranial hematomas; confirming also the role of tamponade after surgical removal of an intracranial hematoma.

Traumatic and alternating delayed intracranial hematomas

International Nuclear Information System (INIS)

Lesoin, F.; Redford, H.; Jomin, M.; Viaud, C.; Pruvo, J.

1984-01-01

Repeat computed tomography has enabled us to confirm the concept of delayed hematomas. With this in mind we report two cases of alternating, post-traumatic intracranial hematomas; confirming also the role of tamponade after surgical removal of an intracranial hematoma. (orig.)

Intracranial Atherosclerotic Disease

Directory of Open Access Journals (Sweden)

Maria Khan

2011-01-01

Full Text Available Intracranial atherosclerotic disease (ICAD is the most common proximate mechanism of ischemic stroke worldwide. Approximately half of those affected are Asians. For diagnosis of ICAD, intra-arterial angiography is the gold standard to identify extent of stenosis. However, noninvasive techniques including transcranial ultrasound and MRA are now emerging as reliable modalities to exclude moderate to severe (50%–99% stenosis. Little is known about measures for primary prevention of the disease. In terms of secondary prevention of stroke due to intracranial atherosclerotic stenosis, aspirin continues to be the preferred antiplatelet agent although clopidogrel along with aspirin has shown promise in the acute phase. Among Asians, cilostazol has shown a favorable effect on symptomatic stenosis and is of benefit in terms of fewer bleeds. Moreover, aggressive risk factor management alone and in combination with dual antiplatelets been shown to be most effective in this group of patients. Interventional trials on intracranial atherosclerotic stenosis have so far only been carried out among Caucasians and have not yielded consistent results. Since the Asian population is known to be preferentially effected, focused trials need to be performed to establish treatment modalities that are most effective in this population.

Natural history of chondroid skull base lesions - case report and review

International Nuclear Information System (INIS)

Schmidinger, A.; Rosahl, S.K.; Vorkapic, P.; Samii, M.

2002-01-01

Long-term follow-up reports on chondroid lesions of the skull base are rarely presented in the literature. There are virtually no data on natural growth rates of these tumors based on MRI obtained over a period of 10 years or longer. We followed a patient who has had such a lesion for more than 12 years. A non-progressive, slight abducens palsy has been the only associated symptom so far. Even though the patient was operated on for an additional intracranial arterio-venous malformation, clinical features and chromosomal testing excluded Maffucci's syndrome. The MRI follow-up in this case provides an extraordinary perspective on the natural history of chondroid skull base tumors. (orig.)

CT and MR features of the intracranial Schwannomas

International Nuclear Information System (INIS)

Jung, So Lyung; Ro, Hee Jeong; Lee, Hong Jae; Jung, Seung Eun; Byun, Jae Young; Yang, Il Kwon; Lee, Han Jin; Choi, Kyu Ho; Kim, Jong Woo; Shinn, Kyung Sub

1996-01-01

To evaluate CT and MR findings of the intracranial schwannomas arising from variable cranial nerves. The authors retrospectively analyzed CT (n=21) and MR (n=15) findings of 24 cases in 23 patients (M : 7, F : 16) who had suffered from surgically-proven intracranial schwannomas over the previous five years. Schwannomas arose from the acoustic nerve(n=18), the trigeminal nerve(n=2), the glossopha-ryngeal-vagal-accessory nerve complex (n=2), and the olfactory nerve(n=1). Intracranial schwannomas were well defined, ,lobulated and inhomogeneously or homogeneously enhancing masses on CT and MR, and were located along the course of the specific cranial nerve. Acoustic schwannomas involved both the internal auditory canal(IAC) and the cerebellopontive angle(CPA) in 14 case, the IAC in three, and the SPA in two. Two trigeminal schwannomas involved both middle and posterior cranial fossa and were in the shape of a dumbbell. One of the two schwannomas that invelved lower cranial nerve complex(9-11th) was located in the medullary cistern and jugular foramen ; the other was located in the central posterior cranial fossa. A case of olfactory schwannoma was located in the right cribriform plate. The precontrast CT scan showed low density in 13 cases (62%), isodensity in seven(33%) and high density in one(5%). on postcontrast CT scan, enhancement was seen in 20 cases(95%). Of the 15 cases with MR, 2 had low signal intensity on T1 weighted image and 14 had high signal intensity on T2 weighted image. MR imaging after Gd-DTPA infusion showed enhancement in 14 cases. Enhancement was inhomogeneous in 14 cases on CT and in 13 on MR. Of 24 cases, intratumoral necrosis was seen in 19, ring enhancement in five and severe cystic change in one. Other findings were in tratumoral calcification (21%), hemorrhage(8%), pressure bony erosion(70.8%), midline shift(58%), peritumoral edema(29%) and hydrocephalus(33%). On MR, there was in all 15 cases a peritumoral low signal intensity rim on T1-and

Dual-energy bone removal computed tomography (BRCT): preliminary report of efficacy of acute intracranial hemorrhage detection.

Science.gov (United States)

Naruto, Norihito; Tannai, Hidenori; Nishikawa, Kazuma; Yamagishi, Kentaro; Hashimoto, Masahiko; Kawabe, Hideto; Kamisaki, Yuichi; Sumiya, Hisashi; Kuroda, Satoshi; Noguchi, Kyo

2018-02-01

One of the major applications of dual-energy computed tomography (DECT) is automated bone removal (BR). We hypothesized that the visualization of acute intracranial hemorrhage could be improved on BRCT by removing bone as it has the highest density tissue in the head. This preliminary study evaluated the efficacy of a DE BR algorithm for the head CT of trauma patients. Sixteen patients with acute intracranial hemorrhage within 1 day after head trauma were enrolled in this study. All CT examinations were performed on a dual-source dual-energy CT scanner. BRCT images were generated using the Bone Removal Application. Simulated standard CT and BRCT images were visually reviewed in terms of detectability (presence or absence) of acute hemorrhagic lesions. DECT depicted 28 epidural/subdural hemorrhages, 17 contusional hemorrhages, and 7 subarachnoid hemorrhages. In detecting epidural/subdural hemorrhage, BRCT [28/28 (100%)] was significantly superior to simulated standard CT [17/28 (61%)] (p = .001). In detecting contusional hemorrhage, BRCT [17/17 (100%)] was also significantly superior to simulated standard CT [11/17 (65%)] (p = .0092). BRCT was superior to simulated standard CT in detecting acute intracranial hemorrhage. BRCT could improve the detection of small intracranial hemorrhages, particularly those adjacent to bone, by removing bone that can interfere with the visualization of small acute hemorrhage. In an emergency such as head trauma, BRCT can be used as support imaging in combination with simulated standard CT and bone scale CT, although BRCT cannot replace a simulated standard CT.

CT-diagnosis for mass lesions in the parotid gland and cervical region

International Nuclear Information System (INIS)

Matsuyama, Fumihiko; Taniguchi, Satomi; Horii, Masaru; Suzuki, Shigemi; Shiba, Yuko

1982-01-01

Thirty patients suffering from mass lesion in the parotid gland or cervical region were examined by computed tomography (CT). The photographed images were compared with the findings and pathological diagnoses obtained by surgical procedures. The conclusions were as follows: 1) Plain CT demonstrated the location of the parotid tumor. Contrast enhancement seemed to delineate the margin of the tumor more clearly. 2) By contrast enhancement, the branchiogenic cyst was differentiated from the parotid tumor, as a low density mass with an enhanced cyst wall. 3) Parotid tumors enhanced by contrast material did not always appear as solid tumors. 4) In some cases, CT numbers indicated the contents of the tumor. 5) The extension of the tumor to the parapharyngeal space was clearly depicted on CT. 6) It seemed to be difficult to evaluate the relationship of the parotid tumor to the facial nerve on plain CT. (author)

CT-diagnosis for mass lesions in the parotid gland and cervical region

Energy Technology Data Exchange (ETDEWEB)

Matsuyama, F.; Taniguchi, S.; Horii, M.; Suzuki, S.; Shiba, Y. (Kobe Central Municipal Hospital (Japan))

1982-02-01

Thirty patients suffering from mass lesion in the parotid gland or cervical region were examined by computed tomography (CT). The photographed images were compared with the findings and pathological diagnoses obtained by surgical procedures. The conclusions were as follows: 1) Plain CT demonstrated the location of the parotid tumor. Contrast enhancement seemed to delineate the margin of the tumor more clearly. 2) By contrast enhancement, the branchiogenic cyst was differentiated from the parotid tumor, as a low density mass with an enhanced cyst wall. 3) Parotid tumors enhanced by contrast material did not always appear as solid tumors. 4) In some cases, CT numbers indicated the contents of the tumor. 5) The extension of the tumor to the parapharyngeal space was clearly depicted on CT. 6) It seemed to be difficult to evaluate the relationship of the parotid tumor to the facial nerve on plain CT.

Microoptomechanical sensor for intracranial pressure monitoring

International Nuclear Information System (INIS)

Andreeva, A V; Luchinin, V V; Lutetskiy, N A; Sergushichev, A N

2014-01-01

The main idea of this research is the development of microoptomechanical sensor for intracranial pressure monitoring. Currently, the authors studied the scientific and technical knowledge in this field, as well as develop and test a prototype of microoptomechanical sensor for intracranial pressure (ICP) monitoring

Dosimetric performance of the new high-definition multileaf collimator for intracranial stereotactic radiosurgery.

Science.gov (United States)

Dhabaan, Anees; Elder, Eric; Schreibmann, Eduard; Crocker, Ian; Curran, Walter J; Oyesiku, Nelson M; Shu, Hui-Kuo; Fox, Tim

2010-06-21

The objective was to evaluate the performance of a high-definition multileaf collimator (MLC) of 2.5 mm leaf width (MLC2.5) and compare to standard 5 mm leaf width MLC (MLC5) for the treatment of intracranial lesions using dynamic conformal arcs (DCA) technique with a dedicated radiosurgery linear accelerator. Simulated cases of spherical targets were created to study solely the effect of target volume size on the performance of the two MLC systems independent of target shape complexity. In addition, 43 patients previously treated for intracranial lesions in our institution were retrospectively planned using DCA technique with MLC2.5 and MLC5 systems. The gross tumor volume ranged from 0.07 to 40.57 cm3 with an average volume of 5.9 cm3. All treatment parameters were kept the same for both MLC-based plans. The plan evaluation was performed using figures of merits (FOM) for a rapid and objective assessment on the quality of the two treatment plans for MLC2.5 and MLC5. The prescription isodose surface was selected as the greatest isodose surface covering >or= 95% of the target volume and delivering 95% of the prescription dose to 99% of target volume. A Conformity Index (CI) and conformity distance index (CDI) were used to quantifying the dose conformity to a target volume. To assess normal tissue sparing, a normal tissue difference (NTD) was defined as the difference between the volume of normal tissue receiving a certain dose utilizing MLC5 and the volume receiving the same dose using MLC2.5. The CI and normal tissue sparing for the simulated spherical targets were better with the MLC2.5 as compared to MLC5. For the clinical patients, the CI and CDI results indicated that the MLC2.5 provides better treatment conformity than MLC5 even at large target volumes. The CI's range was 1.15 to 2.44 with a median of 1.59 for MLC2.5 compared to 1.60-2.85 with a median of 1.71 for MLC5. Improved normal tissue sparing was also observed for MLC2.5 over MLC5, with the NTD always

Application of dual-energy scanning technique with dual-source CT in pulmonary mass lesions

International Nuclear Information System (INIS)

Jiang Jie; Xu Yiming; He Bo; Xie Xiaojie; Han Dan

2012-01-01

Objective: To explore the feasibility of DSCT dual-energy technique in pulmonary mass lesions. Methods: A total of 100 patients with pulmonary masses underwent conventional plain CT scan and dual-energy enhanced CT scan. The virtual non-contrast (VNC) images were obtained at post-processing workstation.The mean CT value,enhancement value,signal to noise ratio (SNR), image quality and radiation dose of pulmonary masses were compared between the two scan techniques using F or t test and the detectability of lesions was compared using Wilcoxon test. Results: There was no statistically significant difference among VNC (A) (32.89 ± 12.58) HU,VNC (S) (30.86 ± 9.60) HU and conventional plain images (35.89 ± 9.99) HU in mean CT value of mass (F =2.08, P>0.05). There was statistically significant difference among VNC (A) (3.29 ± 1.45), VNC (S) (3.93 ± 1.49) and conventional plain image (4.61 ± 1.50) in SNR (F =6.01, P<0.05), which of conventional plain scan was higher than that of VNC.The enhancement value of mass in conventional enhanced scan (60.74 ± 13.9) HU and distribution of iodine from VNC (A) (58.26 ± 31.99) HU was no statistically significant difference (t=0.48, P>0.05), but there was a significant difference between conventional enhanced scan (56.51 ± 17.94) HU and distribution of iodine from VNC (S) (52.65 ± 16.78) HU (t=4.45, P<0.05). There was no statistically significant difference among conventional plain scan (4.69 ± 0.06) and VNC (A) (4.60 ± 0.09), VNC (S) (4.61 ±0.11) in image quality at mediastinal window (F=3.014, P>0.05). The appearance, size, internal features of mass (such as necrosis, calcification and cavity) were showed the same in conventional plain scan, VNC (A) and VNC (S). Of 41 patients with hilar mass, 18 patients were found to have lobular and segmental perfusion decrease or defect. Perfusion defect area was found in 59 patients with peripheral lung mass. The radiation dose of dual-energy enhanced scan was lower than that of

Management of stenosis lesions during the period of endovascular treatment for acute ischemic stroke

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Hong-xing HAN

2017-11-01

Full Text Available Objective To investigate the management of stenosis lesions during endovascular treatment for acute ischemic stroke. Methods A total of 36 acute ischemic stroke patients combined with intracranial/extracranial arterial stenosis were treated with endovascular treatment or bridging treatment. Time from aggravation on admission or in hospital stay to femoral artery puncture, from femoral arterypuncture to recanalization were recorded. Modified Thrombolysis in Cerebral Infarction (mTICI was usedto assess the recanalization immediately after operation. Modified Rankin Scale (mRS was used to evaluate prognosis at 90 d after operation. Occurrence rate of symptomatic intracranial hemorrhage and mortality were recorded. Results Among 36 patients, 13 patients (36.11% underwent intravenous thrombolysis and then endovascular thrombectomy. In all patients, there were 21 (58.33% with intracranial stenosis and 15 (41.67% with extracranial stenosis, 16 (44.44% with anterior circulation stenosis and 20 (55.56% with posterior circulation stenosis. Stent thrombectomy was used in 25 patients (69.44% , while balloon dilatation and/or stent implantation was used in 11 patients (30.56% . For 21 patients with intracranial arterial stenosis, 4 were treated with balloon dilatation only, 9 with Wingspan self-expandable stents and 8 with Apollo balloon-expandable stents. Fifteen patients with extracranial arterial stenosis were treated with balloon dilatation and stent implantation. A total of 33 patients (91.67% achieved recanalization (mTICI 2b-3 grade, 21 patients (58.33% had good outcomes (mRS ≤ 2 score, while symptomatic intracranial hemorrhage occurred in 2 patients (5.56% and 5 (13.89% died. There were no statistically significant differences in the rate of good prognosis, symptomatic intracranial hemorrhage and mortality between intracranial and extracranial arterial stenosis, anterior and posterior circulation stenosis (Fisher exact probability: P > 0.05, for

[Intracranial remote epidural haematoma as a complication after resection of an occipital lobe metastatic tumour from a testicular embryonal carcinoma – a case report].

Science.gov (United States)

Andrusewicz, Wojciech; Limanówka, Bartosz; Sagan, Leszek; Kojder, Ireneusz

We present the case of a patient who suffered from intracranial epidural haematoma in the left fronto -temporo -parietal region as a complication after left parieto -occipital craniotomy and a resection of a metastatic lesion from a testicular embryonal carcinoma to the left occipital lobe. We also discuss possible causes of this complication.

Spontaneous regression of intracranial malignant lymphoma. Case report

Energy Technology Data Exchange (ETDEWEB)

Kojo, Nobuto; Tokutomi, Takashi; Eguchi, Gihachirou; Takagi, Shigeyuki; Matsumoto, Tomie; Sasaguri, Yasuyuki; Shigemori, Minoru.

1988-05-01

In a 46-year-old female with a 1-month history of gait and speech disturbances, computed tomography (CT) demonstrated mass lesions of slightly high density in the left basal ganglia and left frontal lobe. The lesions were markedly enhanced by contrast medium. The patient received no specific treatment, but her clinical manifestations gradually abated and the lesions decreased in size. Five months after her initial examination, the lesions were absent on CT scans; only a small area of low density remained. Residual clinical symptoms included mild right hemiparesis and aphasia. After 14 months the patient again deteriorated, and a CT scan revealed mass lesions in the right frontal lobe and the pons. However, no enhancement was observed in the previously affected regions. A biopsy revealed malignant lymphoma. Despite treatment with steroids and radiation, the patient's clinical status progressively worsened and she died 27 months after initial presentation. Seven other cases of spontaneous regression of primary malignant lymphoma have been reported. In this case, the mechanism of the spontaneous regression was not clear, but changes in immunologic status may have been involved.

Evaluation of intracranial neoplasia and noninfectious meningoencephalitis in dogs by use of short echo time, single voxel proton magnetic resonance spectroscopy at 3.0 Tesla.

Science.gov (United States)

Carrera, Inés; Richter, Henning; Beckmann, Katrin; Meier, Dieter; Dennler, Matthias; Kircher, Patrick R

2016-05-01

OBJECTIVE To investigate metabolite concentrations of the brains of dogs with intracranial neoplasia or noninfectious meningoencephalitis by use of short echo time, single voxel proton magnetic resonance spectroscopy ((1)H MRS) at 3.0 T. ANIMALS 29 dogs with intracranial lesions (14 with neoplasia [3 oligodendromas, 3 glioblastomas multiformes, 3 astrocytomas, 2 lymphomas, and 3 meningiomas] and 15 is with noninfectious meningoencephalitis) and 10 healthy control dogs. PROCEDURES Short echo time, single voxel (1)H-MRS at 3.0 T was performed on neoplastic and noninfectious inflammatory intracranial lesions identified with conventional MRI. Metabolites of interest included N-acetyl aspartate (NAA), total choline, creatine, myoinositol, the glutamine-glutamate complex (Glx), glutathione, taurine, lactate, and lipids. Data were analyzed with postprocessing fitting algorithm software. Metabolite concentrations relative to brain water content were calculated and compared with results for the healthy control dogs, which had been previously evaluated with the same (1)H MRS technique. RESULTS NAA, creatine, and Glx concentrations were reduced in the brains of dogs with neoplasia and noninfectious meningoencephalitis, whereas choline concentration was increased. Concentrations of these metabolites differed significantly between dogs with neoplasia and dogs with noninfectious meningoencephalitis. Concentrations of NAA, creatine, and Glx were significantly lower in dogs with neoplasia, whereas the concentration of choline was significantly higher in dogs with neoplasia. Lipids were predominantly found in dogs with high-grade intra-axial neoplasia, meningioma, and necrotizing meningoencephalitis. A high concentration of taurine was found in 10 of 15 dogs with noninfectious meningoencephalitis. CONCLUSIONS AND CLINICAL RELEVANCE (1)H MRS provided additional metabolic information about intracranial neoplasia and noninfectious meningoencephalitis in dogs.

Risk Factors for Postoperative Fibrinogen Deficiency after Surgical Removal of Intracranial Tumors.

Directory of Open Access Journals (Sweden)

Naili Wei

Full Text Available Higher levels of fibrinogen, a critical element in hemostasis, are associated with increased postoperative survival rates, especially for patients with massive operative blood loss. Fibrinogen deficiency after surgical management of intracranial tumors may result in postoperative intracranial bleeding and severely worsen patient outcomes. However, no previous studies have systematically identified factors associated with postoperative fibrinogen deficiency. In this study, we retrospectively analyzed data from patients who underwent surgical removal of intracranial tumors in Beijing Tiantan Hospital date from 1/1/2013to12/31/2013. The present study found that patients with postoperative fibrinogen deficiency experienced more operative blood loss and a higher rate of postoperative intracranial hematoma, and they were given more blood transfusions, more plasma transfusions, and were administered larger doses of hemocoagulase compared with patients without postoperative fibrinogen deficiency. Likewise, patients with postoperative fibrinogen deficiency had poorer extended Glasgow Outcome Scale (GOSe, longer hospital stays, and greater hospital expenses than patients without postoperative fibrinogen deficiency. Further, we assessed a comprehensive set of risk factors associated with postoperative fibrinogen deficiency via multiple linear regression. We found that body mass index (BMI, the occurrence of postoperative intracranial hematoma, and administration of hemocoagulasewere positively associated with preoperative-to-postoperative plasma fibrinogen consumption; presenting with a malignant tumor was negatively associated with fibrinogen consumption. Contrary to what might be expected, intraoperative blood loss, the need for blood transfusion, and the need for plasma transfusion were not associated with plasma fibrinogen consumption. Considering our findings together, we concluded that postoperative fibrinogen deficiency is closely associated with

Redistribution of hematoma to spinal subdural space as a mechanism for the rapid spontaneous resolution of posttraumatic intracranial acute subdural hematoma: case report.

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Wong, Sui To; Yuen, Ming Keung; Fok, Kam Fuk; Yuen, Shing Chau; Yam, Kwong Yui; Fong, Dawson

2009-01-01

Rapid spontaneous resolution of posttraumatic intracranial ASDH has been reported in the literature since 1986. We report a case to demonstrate that redistribution of hematoma to the spinal subdural space is a mechanism for the rapid spontaneous resolution of posttraumatic intracranial ASDH. A 73-year-old woman with a slipped-and-fell injury had a worst GCS score of 8/15. Computerized tomography of the brain demonstrated a large intracranial ASDH with mass effect. Conservative management was decided because of her poor premorbid general condition. Rapid clinical improvement was observed within 5 hours after the CT. Progress CT of the brain at 45 hours postinjury showed that the size of the intracranial ASDH was markedly diminished. The CT findings apparently demonstrated a caudal distribution of the intracranial ASDH over the tentorium and then into the posterior fossa. To investigate this further, an MRI of the spine was performed, which showed that there was spinal SDH in the cervical and thoracic spine. This is the first report demonstrating that redistribution of posttraumatic intracranial ASDH to the spinal subdural space is one of the mechanisms behind the rapid spontaneous resolution of posttraumatic intracranial ASDH in the acute phase.

Multiple intracranial aneurysms and moyamoya disease associated with microcephalic osteodysplastic primordial dwarfism type II: surgical considerations.

Science.gov (United States)

Waldron, James S; Hetts, Steven W; Armstrong-Wells, Jennifer; Dowd, Christopher F; Fullerton, Heather J; Gupta, Nalin; Lawton, Michael T

2009-11-01

Microcephalic osteodysplastic primordial dwarfism type II (MOPD II) is a rare genetic syndrome characterized by extremely small stature and microcephaly, and is associated in 25% of patients with intracranial aneurysms and moyamoya disease. Although aneurysmal subarachnoid hemorrhage and stroke are leading causes of morbidity and death in these patients, MOPD II is rarely examined in the neurosurgical literature. The authors report their experience with 3 patients who presented with MOPD II, which includes a patient with 8 aneurysms (the most aneurysms reported in the literature), and the first report of a patient with both moyamoya disease and multiple aneurysms. The poor natural history of these lesions indicates aggressive microsurgical and/or endovascular therapy. Microsurgery, whether for aneurysm clip placement or extracranial-intracranial bypass, is challenging due to tight surgical corridors and diminutive arteries in these patients, but is technically feasible and strongly indicated when multiple aneurysms must be treated or cerebral revascularization is needed.

Comparison of intracranial computed tomographic (CT) findings in pediatric abusive and accidental head trauma

International Nuclear Information System (INIS)

Hymel, K.P.; Rumack, C.M.; Hay, T.C.; Strain, J.D.; Jenny, C.

1997-01-01

Background. Child abuse specialists rely heavily on diagnostic neuroimaging. Objectives. Study objectives were: (1) to compare the frequencies of six specific intracranial CT abnormalities in accidental and non-accidental pediatric head trauma, and (2) to assess interobserver agreement regarding these CT findings. Materials and methods. Three pediatric radiologists blindly and independently reviewed cranial CT scans of pediatric patients who sustained closed head trauma between 1991 and 1994. All patients were less than 4 years of age. Study cases included thirty-nine (50 %) with non-accidental head trauma and thirty-nine (50 %) with accidental head trauma. Each scan was evaluated for the presence or absence of the following six intracranial findings: (1) interhemispheric falx hemorrhage, (2) subdural hemorrhage, (3) large (non-acute) extra-axial fluid, (4) basal ganglia edema, (5) posterior fossa hemorrhage, and (6) frontal-parietal shearing tear(s). Interobserver agreement was calculated as the percentage of total cases in which all reviewers agreed a specific CT finding was present or absent. Diagnosis required independent agreement by all three pediatric radiologists. The frequencies of these six intracranial CT abnormalities were compared between the two study groups by Chi-square analysis and Fisher's exact test. Results. Interobserver agreement between radiologists was greater than 80 % for all lesions evaluated, with the exception of frontal-parietal shearing tear(s). Interhemispheric falx hemorrhage, subdural hemorrhage, large (non-acute) extra-axial fluid, and basal ganglia edema were discovered significantly more frequently in non-accidental trauma (P ≤.05). Conclusion. Although not specific for child abuse, discovery of these intracranial CT abnormalities in young patients should prompt careful evaluation of family and injury circumstances for indicators of non-accidental trauma. (orig.). With 6 figs., 2 tabs

A quantification strategy for missing bone mass in case of osteolytic bone lesions

International Nuclear Information System (INIS)

Fränzle, Andrea; Giske, Kristina; Bretschi, Maren; Bäuerle, Tobias; Hillengass, Jens; Bendl, Rolf

2013-01-01

Purpose: Most of the patients who died of breast cancer have developed bone metastases. To understand the pathogenesis of bone metastases and to analyze treatment response of different bone remodeling therapies, preclinical animal models are examined. In breast cancer, bone metastases are often bone destructive. To assess treatment response of bone remodeling therapies, the volumes of these lesions have to be determined during the therapy process. The manual delineation of missing structures, especially if large parts are missing, is very time-consuming and not reproducible. Reproducibility is highly important to have comparable results during the therapy process. Therefore, a computerized approach is needed. Also for the preclinical research, a reproducible measurement of the lesions is essential. Here, the authors present an automated segmentation method for the measurement of missing bone mass in a preclinical rat model with bone metastases in the hind leg bones based on 3D CT scans. Methods: The affected bone structure is compared to a healthy model. Since in this preclinical rat trial the metastasis only occurs on the right hind legs, which is assured by using vessel clips, the authors use the left body side as a healthy model. The left femur is segmented with a statistical shape model which is initialised using the automatically segmented medullary cavity. The left tibia and fibula are segmented using volume growing starting at the tibia medullary cavity and stopping at the femur boundary. Masked images of both segmentations are mirrored along the median plane and transferred manually to the position of the affected bone by rigid registration. Affected bone and healthy model are compared based on their gray values. If the gray value of a voxel indicates bone mass in the healthy model and no bone in the affected bone, this voxel is considered to be osteolytic. Results: The lesion segmentations complete the missing bone structures in a reasonable way. The mean

Stent-assisted angioplasty for intracranial atherosclerosis

International Nuclear Information System (INIS)

Nakahara, Toshinori; Sakamoto, Shigeyuki; Hamasaki, Osamu; Sakoda, Katsuaki

2002-01-01

We report on two patients with intracranial atherosclerosis of the carotid artery or vertebral artery treated with stent-assisted angioplasty. Both patients have severe intracranial atherosclerosis (>70%) with refractory symptoms despite optimal medical treatment. In both patients, a coronary balloon-expandable stent was successfully placed using a protective balloon technique without procedural complications. The patients were asymptomatic and neurologically intact at a mean clinical follow-up of 13 months. Follow-up angiograms did not show restenosis 3 or 4 months after procedure, respectively. Stent-assisted angioplasty for intracranial atherosclerosis in the elective patient has proven effective, with an acceptable low rate of morbidity and mortality. (orig.)

Syphilis mimicking idiopathic intracranial hypertension

DEFF Research Database (Denmark)

Yri, Hanne; Wegener, Marianne; Jensen, Rigmor

2011-01-01

Idiopathic intracranial hypertension (IIH) is a condition of yet unknown aetiology affecting predominantly obese females of childbearing age. IIH is a diagnosis of exclusion as raised cerebrospinal fluid pressure may occur secondary to numerous other medical conditions. An atypical phenotype or a...... antibiotic treatment, signs and symptoms of elevated intracranial pressure resolved completely. Syphilis is a rare, but very important, differential diagnosis that in this case was clinically indistinguishable from IIH....

Intracranial meningiomas in the present era of modern neuroimaging

African Journals Online (AJOL)

Background: Intracranial meningioma is the most common primary, intracranial, extra-axial neoplasm. It is mesenchymal in origin and arises from meningothelial cells of arachnoid villi of meninges. Objectives: To re-emphasize the regional anatomic localisation and diagnostic radiological features of intracranial ...

Imaging in the trilateral retinoblastoma syndrome

International Nuclear Information System (INIS)

Bagley, L.J.; Hurst, R.W.; Zimmerman, R.A.; Shields, J.A.; Shields, C.L.; De Potter, P.

1996-01-01

The medical records, CT, and MRI of ten children with trilateral retinoblastoma were reviewed. The intracranial pathology consisted of eight pineal neoplasms and two parasellar lesions, at least seven of the which were calcified. Two lesions demonstrated calcification only (no soft tissue mass) at initial presentation. Hydrocephalus was seen in eight cases, and concurrent or subsequent subarachnoid dissemination was documented in seven. Only one patient is known to be alive at the present time. The imaging features of the midline intracranial tumors mirror those of the ocular neoplasm. As calcification may be the only clue to the presence of the intracranial malignancy, close surveillance of high-risk patients with retinoblastoma with initial CT and follow-up MRI is suggested. (orig.). With 3 figs., 1 tab

Imaging in the trilateral retinoblastoma syndrome

Energy Technology Data Exchange (ETDEWEB)

Bagley, L.J. [Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104 (United States); Hurst, R.W. [Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104 (United States); Zimmerman, R.A. [Department of Radiology, Children`s Hospital of Philadelphia, 34 th St. and Civic Center Blvd., Philadelphia, PA 19104 (United States); Shields, J.A. [Ocular Oncology Service, Wills Eye Hospital, 900 Walnut St., Philadelphia, PA 19107 (United States); Shields, C.L. [Ocular Oncology Service, Wills Eye Hospital, 900 Walnut St., Philadelphia, PA 19107 (United States); De Potter, P. [Ocular Oncology Service, Wills Eye Hospital, 900 Walnut St., Philadelphia, PA 19107 (United States)

1996-02-01

The medical records, CT, and MRI of ten children with trilateral retinoblastoma were reviewed. The intracranial pathology consisted of eight pineal neoplasms and two parasellar lesions, at least seven of the which were calcified. Two lesions demonstrated calcification only (no soft tissue mass) at initial presentation. Hydrocephalus was seen in eight cases, and concurrent or subsequent subarachnoid dissemination was documented in seven. Only one patient is known to be alive at the present time. The imaging features of the midline intracranial tumors mirror those of the ocular neoplasm. As calcification may be the only clue to the presence of the intracranial malignancy, close surveillance of high-risk patients with retinoblastoma with initial CT and follow-up MRI is suggested. (orig.). With 3 figs., 1 tab.

Intracranial hypotension and hypertension in children and adolescents.

Science.gov (United States)

Ozge, Aynur; Bolay, Hayrunnisa

2014-07-01

The specific aim of this review is to report the features of intracranial pressure changes [spontaneous intracranial hypotension (SIH) and idiopathic intracranial hypertension (IIH)] in children and adolescents, with emphasis on the presentation, diagnosis, and treatment modalities. Headache associated with intracranial pressure changes are relatively rare and less known in children and adolescents. SIH is a specific syndrome involving reduced intracranial pressure with orthostatic headache, frequently encountered connective tissue disorders, and a good prognosis with medical management, initial epidural blood patching, and sometimes further interventions may be required. IIH is an uncommon condition in children and different from the disease in adults, not only with respect to clinical features (likely to present with strabismus and stiff neck rather than headache or pulsatile tinnitus) but also different in outcome. Consequently, specific ICP changes of pediatric ages required specific attention both of exact diagnosis and entire management.

Pre- and postcontrast FLAIR MR imaging in the diagnosis of intracranial meningeal pathology

International Nuclear Information System (INIS)

Tsuchiya, Kazuhiro; Katase, Shichiro; Yoshino, Ayako; Hachiya, Junichi

2000-01-01

Few reports address the use of fluid-attenuated inversion-recovery (FLAIR) images of the brain in the diagnosis of extraaxial lesions. Our purpose was to assess the value of FLAIR images, including postcontrast ones, in the diagnosis of intracranial meningeal diseases. We reviewed precontrast (n=24) and postcontrast (n=20) FLAIR images obtained from 25 patients with infectious meningitis (n=13), carcinomatous meningitis or dissemination of primary brain tumor (n=7), dural metastasis (n=3), and others (n=2) in comparison with fast spin-echo T2-weighted and postcontrast T1-weighted images. In lesion detectability, precontrast FLAIR images were significantly superior to fast spin-echo T2-weighted images but inferior to postcontrast T1-weighted images. There was no significant difference between postcontrast T1-weighted and FLAIR images. Precontrast FLAIR images can substitute for conventional fast spin-echo T2-weighted images. Postcontrast FLAIR images have diagnostic potential equivalent to conventional postcontrast T1-weighted images. (author)

Valid and efficient manual estimates of intracranial volume from magnetic resonance images

International Nuclear Information System (INIS)

Klasson, Niklas; Olsson, Erik; Rudemo, Mats; Eckerström, Carl; Malmgren, Helge; Wallin, Anders

2015-01-01

Manual segmentations of the whole intracranial vault in high-resolution magnetic resonance images are often regarded as very time-consuming. Therefore it is common to only segment a few linearly spaced intracranial areas to estimate the whole volume. The purpose of the present study was to evaluate how the validity of intracranial volume estimates is affected by the chosen interpolation method, orientation of the intracranial areas and the linear spacing between them. Intracranial volumes were manually segmented on 62 participants from the Gothenburg MCI study using 1.5 T, T 1 -weighted magnetic resonance images. Estimates of the intracranial volumes were then derived using subsamples of linearly spaced coronal, sagittal or transversal intracranial areas from the same volumes. The subsamples of intracranial areas were interpolated into volume estimates by three different interpolation methods. The linear spacing between the intracranial areas ranged from 2 to 50 mm and the validity of the estimates was determined by comparison with the entire intracranial volumes. A progressive decrease in intra-class correlation and an increase in percentage error could be seen with increased linear spacing between intracranial areas. With small linear spacing (≤15 mm), orientation of the intracranial areas and interpolation method had negligible effects on the validity. With larger linear spacing, the best validity was achieved using cubic spline interpolation with either coronal or sagittal intracranial areas. Even at a linear spacing of 50 mm, cubic spline interpolation on either coronal or sagittal intracranial areas had a mean absolute agreement intra-class correlation with the entire intracranial volumes above 0.97. Cubic spline interpolation in combination with linearly spaced sagittal or coronal intracranial areas overall resulted in the most valid and robust estimates of intracranial volume. Using this method, valid ICV estimates could be obtained in less than five

Management of intracranial dural arteriovenous shunts in adults

International Nuclear Information System (INIS)

Sarma, Dipanka; Brugge, Karel ter

2003-01-01

Dural arteriovenous shunts are abnormal arteriovenous communications within the dura. They are thought to be an acquired condition in adults and can present with a variety of clinical features, ranging from benign bruits to intracranial hemorrhage and neurological deficits. The presentation and natural history of these shunts is largely determined by the pattern of venous drainage. Knowledge of natural history and careful study of the angioarchitexture by angiography is therefore mandatory for correct management of these lesions. In this review, principles of management in adults and the various factors that influence treatment decisions are discussed, with a focus on endovascular therapy. Retrograde leptomeningeal or cortical venous drainage has a strong correlation with adverse clinical events and the requirement for aggressive management in this situation is highlighted. Indications for endovascular treatment, therapeutic goals, approaches and techniques are reviewed. The role of surgical treatment is also briefly discussed

Analysis of diffuse brain injury with primary brainstem lesion on MRI

International Nuclear Information System (INIS)

Shibata, Masayoshi; Matsumae, Mitsunori; Shimoda, Masami; Ishizaka, Hideo; Shiramizu, Hideki; Morita, Seiji; Tsugane, Ryuichi

2003-01-01

It has been reported that diffuse brain injury patients with primary brainstem lesions have a poor prognosis. Predicting the existence of brainstem injury at hospital arrival is problematic in actual clinical practice. We conducted magnetic resonance imaging (MRI), to visualize brainstem lesions clearly, and retrospectively analyzed predictive factors of brainstem lesions by stepwise multiple logistic regression analysis of patient characteristics, neurological findings, laboratory data, and CT findings at arrival in each case. We compared 24 patients with brainstem lesion and 60 without using MRI obtained less than 3 weeks after admission. Items investigated were blood pressure immediately after hospital arrival, arterial blood gas analysis, existence of abnormal respiration, blow direction, Glasgow coma scale (GCS), light reflex, oculocephalic reflex, corneal reflex, intracranial pressure, jugular venous oxygen saturation, and CT findings such as existence of subarachnoid hemorrhage at the suprasellar cistern, perimesencephalic cistern and convexity, lesions on the thalamus and basal ganglia, gliding contusion, intraventricular hemorrhage and Traumatic Coma Data Bank classification. Independent predictive factors of primary brainstem lesion included impaired light reflex (odds ratio: 2.269), subarachnoid hemorrhage at convexity (odds ratio: 3.592) and suprasellar cistern (odds ratio: 2.458), and Traumatic Coma Data Bank group III (odds ratio: 11.062). (author)

Idiopathic Intracranial Hypertension – Pathophysiology Based on Case Series

Directory of Open Access Journals (Sweden)

Ljubisavljević Srdjan

2016-09-01

Full Text Available According to the definition, idiopathic intracranial hypertension (IIH is a pathological state characterized by an increase in intracranial pressure; however, there are no obvious intracranial pathological processes. The pathophysiology of this disorder is not clear, although there are many reports related to it.

Intraventricular pneumocephalus associated with nasocephalic necrosis in a puppy: a case report

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J.O. Sena

Full Text Available ABSTRACT Pneumocephalus is defined as the presence of air in any of the intracranial compartments. Its most frequent causes are trauma and cranial surgery. Clinical signs occur as a result of increased intracranial pressure and vary with the location and extent of the lesion. A case involving a seven-month-old female Saint Bernard, who suffered cranial trauma caused by a bite to the face at ten days of age and had presented with seizures and localized pain four months previously is reported. A computed tomography scan of the skull revealed a nasocephalic mass with low contrast enhancement, bone lysis, and hypodensity (-940 Hounsfield units of the lateral and third ventricles, indicating intraventricular pneumocephalus. During surgery, a fragment of the mass was collected for histopathological examination, which demonstrated the presence of multifocal areas of necrosis. The computed tomography (CT is a reliable method for the characterization of intracranial lesions and diagnosis of pneumocephalus, whose occurrence must be considered in pathological processes in which there is increased intracranial pressure and in patients undergoing certain surgical procedures and anesthetic specific, and CT is indicated as a monitoring tool for these patients.

Intracranial cavernous angioma

International Nuclear Information System (INIS)

Yuhi, Fumiaki; Gondou, Masazumi; Sasahira, Masahiro; Ichitsubo, Hidenori; Asakura, Tetsuhiko.

1986-01-01

The present authors have experienced 2 cases of intracranial cavernous angioma. Of these cases, one was admitted because of generalized convulsions, while the other was admitted because of headache. In both cases, neither plain X-ray films nor carotid angiography showed any abnormality, but computerized tomography (CT) revealed a slightly high-density area which was not enhanced with contrast media. Histologically, the tumors had many vascular cavities with walls lined with a single layer of endothelial cells and had no neural tissue between the vascular cavities; therefore, they were diagnosed as cases of cavernous angioma. The authors discussed the radiological findings of the intracranial cavernous angioma with a review of the literature and stressed the role of computerized tomography in the diagnosis of cavernous angioma. (author)

Spaceflight-Induced Intracranial Hypertension.

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Michael, Alex P; Marshall-Bowman, Karina

2015-06-01

Although once a widely speculated about and largely theoretical topic, spaceflight-induced intracranial hypertension has gained acceptance as a distinct clinical phenomenon, yet the underlying physiological mechanisms are still poorly understood. In the past, many terms were used to describe the symptoms of malaise, nausea, vomiting, and vertigo, though longer duration spaceflights have increased the prevalence of overlapping symptoms of headache and visual disturbance. Spaceflight-induced visual pathology is thought to be a manifestation of increased intracranial pressure (ICP) because of its similar presentation to cases of known intracranial hypertension on Earth as well as the documentation of increased ICP by lumbar puncture in symptomatic astronauts upon return to gravity. The most likely mechanisms of spaceflight-induced increased ICP include a cephalad shift of body fluids, venous outflow obstruction, blood-brain barrier breakdown, and disruption to CSF flow. The relative contribution of increased ICP to the symptoms experienced during spaceflight is currently unknown, though other factors recently posited to contribute include local effects on ocular structures, individual differences in metabolism, and the vasodilator effects of carbon dioxide. This review article attempts to consolidate the literature regarding spaceflight-induced intracranial hypertension and distinguish it from other pathologies with similar symptomatology. It discusses the proposed physiological causes and the pathological manifestations of increased ICP in the spaceflight environment and provides considerations for future long-term space travel. In the future, it will be critical to develop countermeasures so that astronauts can participate at their peak potential and return safely to Earth.

Development of intracranial hypertension after surgical management of intracranial arachnoid cyst: report of three cases and review of the literature.

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Kaliaperumal, Chandrasekaran

2013-11-12

To describe three cases of delayed development of intracranial hypertension (IH) after surgical treatment of intracranial arachnoid cyst, including the pathogenesis of IH and a review of the literature.

Detection and characterization of intracranial aneurysms: magnetic resonance angiography versus digital subtraction angiography

International Nuclear Information System (INIS)

Shahzad, R.; Younas, F.

2011-01-01

Objective: To compare magnetic resonance angiography (MRA) with Intra-arterial digital subtraction angiography (IA-DSA) in detection and characterization of intracranial aneurysms. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Diagnostic Imaging, Lahore General Hospital, Lahore, from January to June 2007. Methodology: Thirty patients presented with aneurysmal subarachnoid haemorrhage (SAH) and focal neurological signs were selected by convenience sampling. Three dimensional time of flight (3D TOF) MRA using maximum intensity projection (MIP) was performed on all patients along with DSA. Results of 3D TOF MRA were compared with those of IA-DSA taking IA-DSA as Gold standard. Results: Out of 30 patients 14 (46.7%) were males and 16 (53.3%) were females with mean age of 41+-14.1 years. MRA detected 29 out of 30 aneurysmal lesions with sensitivity of 96.7%. Regarding characterization of aneurysms results of MRA were comparable to those of IA-DSA. Conclusion: 3D TOF MRA technique showed a high sensitivity in this study. This technique can be used as a non-invasive screening test for intracranial aneurysms and as a suitable alternative primary examination to IA-DSA prior to aneurysmal surgery. (author)

Diagnosis of ruptured intracranial aneurysm in acute stage

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Yoshiyama, Masataka; Nakagawa, Toshifumi

1980-01-01

Subarachnoid hemorrhage at an acute stage within one day from the onset to the first CT scan was classified into subarachnoid hemorrhage secondary to intracranial aneurysm, subarachnoid hemorrhage of unknown origin and subarachnoid hemorrhage of which angiography could not be carried out, and the first CT findings, the severity, and the prognosis of these subarachnoid hemorrhage were compared and discussed. CT findings of subarachnoid hemorrhage secondary to intracranial aneurysm showed various changes according to progress in the severity with time, and intracranial hematoma, intraventricular clots and ventricular dilatation increased according to progress in the severity. Ruptured intracranial aneurysm in middle cerebral artery, anterior cerebral artery and anterior communicating artery could be found easily by CT, but that in internal carotid artery and vertabral basilar artery was difficult to be detected by CT. When cerebral angiography was carried out repeatedly for ruptured intracranial aneurysm of unknown origin, the time of performance must be consifered with attention to angiospasms or hematoma. (Tsunoda, M.)

Clinical results of stereotactic heavy-charged-particle radiosurgery for intracranial angiographically occult vascular malformations

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Levy, R.P.; Fabrikant, J.I.; Phillips, M.H.; Frankel, K.A.; Steinberg, G.K.; Marks, M.P.; DeLaPaz, R.L.; Chuang, F.Y.S.; Lyman, J.T.

1989-12-01

Angiographically occult vascular malformations (AOVMs) of the brain have been recognized for many years to cause neurologic morbidity and mortality. They generally become symptomatic due to intracranial hemorrhage, focal mass effect, seizures or headaches. The true incidence of AOVMs is unknown, but autopsy studies suggest that they are more common than high-flow angiographically demonstrable arteriovenous malformations (AVMs). We have developed stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of inoperable intracranial vascular malformations, using the helium ion beams at the Lawrence Berkeley Laboratory 184-inch Synchrocyclotron and Bevatron. This report describes the protocol for patient selection, radiosurgical treatment planning method, clinical and neuroradiologic results and complications encountered, and discusses the strengths and limitations of the method. 10 refs., 1 fig

Clinical results of stereotactic heavy-charged-particle radiosurgery for intracranial angiographically occult vascular malformations

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Levy, R.P.; Fabrikant, J.I.; Phillips, M.H.; Frankel, K.A.; Steinberg, G.K.; Marks, M.P.; DeLaPaz, R.L.; Chuang, F.Y.S.; Lyman, J.T.

1989-12-01

Angiographically occult vascular malformations (AOVMs) of the brain have been recognized for many years to cause neurologic morbidity and mortality. They generally become symptomatic due to intracranial hemorrhage, focal mass effect, seizures or headaches. The true incidence of AOVMs is unknown, but autopsy studies suggest that they are more common than high-flow angiographically demonstrable arteriovenous malformations (AVMs). We have developed stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of inoperable intracranial vascular malformations, using the helium ion beams at the Lawrence Berkeley Laboratory 184-inch Synchrocyclotron and Bevatron. This report describes the protocol for patient selection, radiosurgical treatment planning method, clinical and neuroradiologic results and complications encountered, and discusses the strengths and limitations of the method. 10 refs., 1 fig.

Alveolar soft part sarcoma: the new primary intracranial malignancy : A case report and review of the literature.

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Kumar, Aditaya; Alrohmain, B; Taylor, W; Bhattathiri, P

2017-07-26

The purpose of this paper is to serve as a reference to aid in the management of this poorly understood intracranial malignancy. The authors report their experience treating the eighth ostensible case of a primary intracranial alveolar soft part sarcoma (ASPS). A 21-year-old man presented to hospital after collapsing. He gave a 1-year history of headache, a 2-month history of reduced visual acuity and on examination had left facial paraesthesia with left-sided incoordination. MRI of the brain revealed a large left posterior fossa mass. The patient underwent resection of the tumour with good recovery in function. Immunohistochemical analysis of the tumour specimen confirmed an ASPS, and multimodal imaging in search of an extra-cranial disease primary was negative. A review of the literature yielded only seven other cases of primary intracranial ASPS. A variety of diagnostic imaging modalities were employed in search of a disease primary, as were various combinations of surgical resection, chemotherapy and radiotherapy as treatment. Half of the cases documented delayed disease recurrence. The authors discuss the following: the unique radiological and immunohistological characteristics of this disease including the potential for its misdiagnosis; the investigations required to diagnose a primary intracranial ASPS; the efficacy of current medical and surgical treatment options and the factors that will aid in prognostication. This is the first review of this new primary intracranial malignancy. From our analysis, we offer a joint radiological and immunohistochemical algorithm for the diagnosis of primary intracranial ASPS and specific operative considerations prior to resection.

Experimental study of virtual colonoscopy of simulated mass lesions in pig colon: comparison of CT and MR techniques

International Nuclear Information System (INIS)

Yang Xiujun; He Zhiyan; Tao Yonghao; Miao Jingtao; Chen Yuanjiong; Hu Yuansheng; Wang Linchuan

2000-01-01

Objective: To probe into the technique and diagnostic value of MR virtual colonoscopy (MRVC) compared with CT virtual colonoscopy (CTVC) and colonoscopy. Methods: Two approximately 25-cm-long-sections of fresh pit colon in vitro had 20 mass lesions created ranging from 3 mm to 12 mm in diameter. MR scanning, as well as CT scanning of the water- or air-insufflated colon was performed, and CT data were obtained with collimation of 3 mm at a pitch of 1.0 and reconstruction intervals of 1.5 mm. MRI data were acquired with the same matrix and reformatting slab, and with heavily T 2 -weighted fast spin-echo pulse sequences. Post processed image sets were performed by the same experienced doctor on a workstation using navigator software based on CT or MRI source imaging data. One section was also underwent electron colonoscopy. Results: MRVC and CTVC displayed colon morphology in a manner similar to colonoscopy. The sensitivity of MRVC and CTVC were all 100%, and the accuracy was 71.4% for MRVC and 100% for CTVC. With the combined analysis of the four-in-one multi-view images, they accurately demonstrated the site and size of lesions and distinguished the lesions from the artifacts such as small air bubbles, and the accuracy of MRVC was improved up to 100%. CTVC was better than MRVC (P<0.05), but both were inferior to colonoscopy in depicting mucosal details of the colon and lesions (P < 0.025). Conclusion: Virtual colonoscopy (CTVC or MRVC, the former appears better) provided noninvasive endoscope-like display of the colon, and permitted identification of colonic mass lesions as small as 3 mm in diameter, the diagnostic accuracy could be improved by combining with source images and other reformations

[Congenital anomalies of cerebral artery and intracranial aneurysm].

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Nakajima, K; Ito, Z; Hen, R; Uemura, K; Matsuoka, S

1976-02-01

It is well known that congenital anomalies such as polycystic kidney, aortic coarctation, Marfan syndrome, Ehler-Danlos syndrome are apt to be complicated by intracranial aneurysms. In this report we attempt to reveal the relation and incidence between cerebrovascular anomalies and intracranial aneurysms. The etiology of aneurysms has been discussed, too. 12 cases of persistent trigeminl artery, 2 cases of persistent hypoglossal artery and 11 cases of fenestration were obtained from 3841 patients who were angiographically examined in our clinic for 5 years. The incidence is 0.31%, 0.05% and 0.29%, respectively. Persistent trigeminal arteries were complicated by 2 cases of intracranial aneurysms and one case of arterivenous malformations (AVM), persistent hypoglossal arteries were complicated by one case of aneurysm, and fenestrations were complicated by 2 cases of aneurysms and one case of AVM. One case of congenital agenesis of right internal carotid artery was obtained which was complicated by aneurysm of anterior communicating artery. Totally, 8 cases of aneurysms and AVM were obtained from 26 cases of cerebrovascular anomalies (incidence 30.8%). On the other hand, thalamic or caudate hemorrhage revealed the highest incidence of complication of intracranial aneurysms among intracerebral hematomas (10.7%). Compared with the incidence of aneurysms between cerebro vascular anomalies (30.8%) and thalamic or caudate hemorrhage (10.7%), the difference is statistically signigicant (P less than 0.05). The cause of intracranial aneurysm has not yet been clarified. But it is well accepted that the defect of tunica media vasorum is most responsible factor as to the occurrence of intracranial aneurysms. We concluded that the genetic error of cerebral vessels including defect of media caused intracranial aneurysms, and this result was supported from the evidence that cerebrovascular anomalies showed statistically high incidence of complication of intracranial aneurysms.

Solving the Issue of Restenosis After Stenting of Intracranial Stenoses: Experience with Two Thin-Strut Drug-Eluting Stents (DES)—Taxus Element™ and Resolute Integrity™

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Kurre, Wiebke, E-mail: wiebke.kurre@gmx.de; Aguilar-Pérez, Marta [Klinikum Stuttgart, Klinik für Diagnostische und Interventionelle Neuroradiologie (Germany); Fischer, Sebastian [Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin (Germany); Arnold, Guy [Klinikverbund Südwest, Klinikum Sindelfingen, Klinik für Neurologie (Germany); Schmid, Elisabeth; Bäzner, Hansjörg [Klinikum Stuttgart, Klinik für Neurologie (Germany); Henkes, Hans [Klinikum Stuttgart, Klinik für Diagnostische und Interventionelle Neuroradiologie (Germany)

2015-06-15

PurposeThin-strut, flexible DES are suitable for intracranial stenting and may improve long-term vessel patency. The purpose of this study was to report our experience with two new-generation DES for the treatment of intracranial atherosclerotic disease.Patients and MethodsWe retrospectively reviewed all patients treated with Taxus Element™ or Resolute Integrity™ stent for an intracranial atherosclerotic stenosis between March 2011 and August 2013. Technical success was defined as the ability to deploy the device at the desired location and reduce the degree of stenosis below 50 %. All procedure-related strokes were recorded. Control angiography was scheduled after 6 weeks, 3, 6, and 12 months and yearly thereafter. A luminal narrowing ≥50 % was regarded as a restenosis. Stroke recurrence in the territory of the treated artery was reported.ResultsIn the defined period we treated 101 patients harboring 117 intracranial stenoses. The procedure was successful in 100 (85.5 %) lesions. Procedure-related strokes occurred in 10 (9.9 %) patients with a permanent morbidity in 3 (3.0 %). Follow-up angiography was available for 83 of 100 (83.0 %) successfully treated lesions with an average of 355 days (IQR 153–482 days). Three (3.6 %) asymptomatic restenoses were detected. All occurred after treatment with Resolute Integrity™, none after Taxus Element™ (p = 0.059). New strokes in the territory of the treated artery were encountered in 2 (2.6 %) occasions.ConclusionThin-strut DES improve long-term patency and reduce the risk of subsequent stroke. Differences between devices may exist. Feasibility is comparable to bare-metal balloon-mounted stents and procedure-related strokes occurred within the expected range.

Pupillary abnormalities in three dogs with post-retinal nervous system lesions

International Nuclear Information System (INIS)

Bagley, R.S.; Moore, M.P.; Baszler, T.V.; Harrington, M.L.; Tucker, R.L.; Gavin, P.R.

1995-01-01

Three dogs had atypical pupillary abnormalities in association with post-retinal nervous system lesions. Two dogs were admitted with unilateral visual deficits and anisocoria. In both dogs, the larger pupil was found in the blind eye. Pupils responded adequately to both light stimulation and dark adaptation; however, anisocoria remained regardless of the light intensity entering the eyes. Intracranial central nervous system lesions were found in both dogs. A third dog was admitted for unilateral visual deficit and epistaxis. Mild resting anisocoria was noted, with the larger pupil found in the avisual eye. With light directed toward the medial retina, no direct or consensual pupillary light reflex was elicited. When light was directed toward the lateral retina, however, a normal pupillary light reflex was elicited. The lesion in this dog extended from the nasal cavity caudally to the optic foramen involving the ipsilateral prechiasmic optic nerve. Possible neuroanatomical explanations for these pupillary and visual abnormalities are discussed

Recurrent myelinoclastic diffuse sclerosis: a case report of a child with Schilder's variant of multiple sclerosis

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Fitzgerald, M.J.; Coleman, L.T.

2000-01-01

Myelinoclastic diffuse sclerosis (MDS, Schilder's disease) is a rare CNS demyelinating disorder affecting mainly children and usually presenting as an intracranial mass lesion. We report the first case of recurrent intracranial MDS where the third episode of demyelination involved the cervical spinal cord. This may represent a subset of the disease, which should be considered as Schilder's variant (childhood form) of multiple sclerosis. (orig.)

Application of Intraoperative Ultrasonography for Guiding Microneurosurgical Resection of Small Subcortical Lesions

International Nuclear Information System (INIS)

Wang, Jia; Duan, Yun You; Liu, Xi; Wang, Yu; Gao, Guo Dong; Qin, Huai Zhou; Wang, Liang

2011-01-01

We wanted to evaluate the clinical value of intraoperative ultrasonography for real-time guidance when performing microneurosurgical resection of small subcortical lesions. Fifty-two patients with small subcortical lesions were involved in this study. The pathological diagnoses were cavernous hemangioma in 25 cases, cerebral glioma in eight cases, abscess in eight cases, small inflammatory lesion in five cases, brain parasite infection in four cases and the presence of an intracranial foreign body in two cases. An ultrasonic probe was sterilized and lightly placed on the surface of the brain during the operation. The location, extent, characteristics and adjacent tissue of the lesion were observed by high frequency ultrasonography during the operation. All the lesions were located in the cortex and their mean size was 1.3 ± 0.2 cm. Intraoperative ultrasonography accurately located all the small subcortical lesions, and so the neurosurgeon could provide appropriate treatment. Different lesion pathologies presented with different ultrasonic appearances. Cavernous hemangioma exhibited irregular shapes with distinct margins and it was mildly hyperechoic or hyperechoic. The majority of the cerebral gliomas displayed irregular shapes with indistinct margins, and they often showed cystic and solid mixed echoes. Postoperative imaging identified that the lesions had completely disappeared, and the original symptoms of all the patients were significantly alleviated. Intraoperative ultrasonography can help accurately locate small subcortical lesions and it is helpful for selecting the proper approach and guiding thorough resection of these lesions.

Application of Intraoperative Ultrasonography for Guiding Microneurosurgical Resection of Small Subcortical Lesions

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Wang, Jia; Duan, Yun You; Liu, Xi; Wang, Yu; Gao, Guo Dong; Qin, Huai Zhou; Wang, Liang [Tangdu Hospital of the Fourth Military Medicine University, Xi an (China)

2011-10-15

We wanted to evaluate the clinical value of intraoperative ultrasonography for real-time guidance when performing microneurosurgical resection of small subcortical lesions. Fifty-two patients with small subcortical lesions were involved in this study. The pathological diagnoses were cavernous hemangioma in 25 cases, cerebral glioma in eight cases, abscess in eight cases, small inflammatory lesion in five cases, brain parasite infection in four cases and the presence of an intracranial foreign body in two cases. An ultrasonic probe was sterilized and lightly placed on the surface of the brain during the operation. The location, extent, characteristics and adjacent tissue of the lesion were observed by high frequency ultrasonography during the operation. All the lesions were located in the cortex and their mean size was 1.3 {+-} 0.2 cm. Intraoperative ultrasonography accurately located all the small subcortical lesions, and so the neurosurgeon could provide appropriate treatment. Different lesion pathologies presented with different ultrasonic appearances. Cavernous hemangioma exhibited irregular shapes with distinct margins and it was mildly hyperechoic or hyperechoic. The majority of the cerebral gliomas displayed irregular shapes with indistinct margins, and they often showed cystic and solid mixed echoes. Postoperative imaging identified that the lesions had completely disappeared, and the original symptoms of all the patients were significantly alleviated. Intraoperative ultrasonography can help accurately locate small subcortical lesions and it is helpful for selecting the proper approach and guiding thorough resection of these lesions.

Spontaneous rupture of intracranial dermoid tumor in a patient with vertigo. Computed tomography and magnetic resonance imaging findings

International Nuclear Information System (INIS)

Asil, Kıyasettin; Gunduz, Yasemin; Ayhan, Laçin Tatli; Aksoy, Yakup Ersel; Yildiz, Can

2013-01-01

Congenital dermoid cysts are very rare, constituting less than 1% of intracranial tumors. Spontaneous rupture of dermoid tumor is a potentially serious complication that can lead to meningitis, seizures, cerebral ischemia and hydrocephalus. Occasionally, dermoid tumors are incidentally discovered on computed tomography (CT) of the brain or magnetic resonance imaging (MRI) following unrelated clinical complaints. They are also discovered during radiologic investigations of unexplained headaches, seizures, and rarely olfactory delusions. In this report we describe a patient complaining of vertigo caused by spontaneous rupture of dermoid cyst, preoperatively diagnosed by CT and MRI. Cranial CT revealed a dense fatty lesion adjacent to the posterolateral parasellar region on the left with multiple small, dense fat droplets scattered in the subarachnoid space corresponding to a dermoid cyst rupture. Cranial MRI sections revealed a lesion with mixed-signal-intensity and multiple hyperintense droplets scattered through the cerebellar surface on the left. No enhancement was found on axial T1-weighted MRI after intravenous Gadolinium administration. Diffusion weighted image (DWI) and apparent diffusion coefficient map studies exhibited explicit restricted diffusion. Many studies and literature case reports concerning the rupture of dermoid cyst have been reported. However, multimodal imaging of this rare pathology in the same patient is uncommon. Although dermoid cysts are pathognomonic in appearance on a CT examination, the MRI is also of value in helping to understand the effect of extension and pressure of the mass. DWI is also important for support of the diagnosis and patient follow-up

Intracranial structural alteration predicts treatment outcome in patients with spontaneous intracranial hypotension.

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Choi, Hanna; Lee, Mi Ji; Choi, Hyun Ah; Cha, Jihoon; Chung, Chin-Sang

2018-02-01

Background Intracranial structural dislocation in spontaneous intracranial hypotension (SIH) can be measured by various intracranial angles and distances. We aimed to identify the clinical significance of structural dislocation in relation to treatment outcome in patients with SIH. Methods In this retrospective analysis, we identified patients with SIH who received an epidural blood patch (EBP) at Samsung Medical Center from January 2005 to March 2015. Structural dislocation in pretreatment MRIs of SIH patients was assessed by measuring tonsillar herniation, mamillopontine distance, the angle between the vein of Galen and straight sinus (vG/SS angle), the pontomesencephalic angle, and the lateral ventricular angle. After the first EBP, poor response was defined as the persistence of symptoms that prompted a repeat EBP. Results Out of the 95 patients included, 31 (32.6%) showed poor response. Among the radiological markers of structural dislocation, the vG/SS angle was associated with poor response (49.82 ± 16.40° vs 66.58 ± 26.08°, p = 0.002). Among clinical variables, premorbid migraine ( p = 0.036) was related to poor response. In multivariate analysis, reduced vG/SS angle was independently associated with poor response (OR 1.04 [95% CI 1.01 - 1.07] per 1° decrease, p = 0.006). In 23 patients who underwent MRI after successful treatment, the vG/SS angle significantly increased after the EBP ( p < 0.001, by paired t-test), while two patients with aggravation or recurrence showed a further reduction of their vG/SS angles. Conclusions Intracranial structural dislocation, measured by the vG/SS angle, is associated with poor response to the first EBP in patients with SIH. Successful treatment can reverse the structural dislocation.

Simultaneous Intracranial and Spinal Subdural Hematoma: Two Case Reports

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Yoon, Chung Dae; Song, Chang Joon; Lee, Jeong Eun; Choi, Seung Won [Chungnam National University, Daejeon (Korea, Republic of)

2009-02-15

Spinal subdural hematoma is a rare disease. Simultaneous intracranial and spinal subdural hematoma is extremely rare and only 14 such cases have been reported. We report here on two cases of simultaneous intracranial and spinal subdural hematoma that occurred following a fall-down head injury and intracranial surgery, and we discuss the pathogenesis of the disease.

Neonatal intracranial hemorrhages (perinatal onset)

International Nuclear Information System (INIS)

Ban, Sadahiko; Ogata, Masahiro; Yamamoto, Toyoshiro; Nakao, Satoshi; Mizue, Hidenari; Kobayashi, Yutaka.

1982-01-01

1. We have reviewed 34 cases of neonatal intracranial hemorrhages (perinatal onset, 23 mature and 11 premature infants) experienced in 10-year period from 1971 to 1980, with special reference to gestational age, birth weight, type of delivery, presence or absence of asphyxia, symptoms and cause of death. 2. Regarding 9 autopsied cases and 7 cases diagnosed by CT-scan, 10 mature infants composed of 3 subarachnoid hemorrhages, 2 intraventricular hemorrhages, 2 subdural hematomas, 2 intracerebral and 1 subependymal hemorrhage; 6 premature infants consisted of 4 subependymal hemorrhages with ventricular rupture and 2 subarachnoid hemorrhages. Most of them presented with respiratory distress, vomiting and convulsive seizures which developed within 5 days after birth. 3. Poor outcome including death amounted 49% of mature and 63% of premature infants. Along with degree of intracranial hematoma, prematurity and pulmonary complication were felt to be important prognostic factors. 4. Introduction of CT-scan led to prompt diagnosis and treatment, thus lowering mortality rate of neonatal intracranial hemorrhages. (author)

[Intracranial plasmocytomas: biology, diagnosis, and treatment].

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Belov, A I; Gol'bin, D A

2006-01-01

Intracranial plasmocytomas are a rare abnormality in a neurosurgeon's practice. The plasmocytomas may originate from the skull bones or soft tissue intracranial structures; they may be solitary or occur as a manifestation of multiple myeloma, this type being typical of most intracranial plasmocytomas. Progression of solitary plasmocytoma to multiple myeloma is observed in a number of cases. Preoperative diagnosis involves computed tomography or magnetic resonance imaging; angiography is desirable. The final diagnosis of plasmocytoma is chiefly based on a morphological study. Special immunohistochemical studies yield very promising results; these are likely to be of high prognostic value. Intracranial plasmocytomas require a differential approach and a meticulous examination since the presence or absence of multiple myeloma radically affects prognosis. There are well-defined predictors; however, it is appropriate that craniobasal plasmocytomas show a worse prognosis than plasmocytomas of the skull vault and more commonly progress to multiple myeloma. Plasmocytomas respond to radiotherapy very well. The gold standard of treatment for plasmocytoma is its total removal and adjuvant radiation therapy; however, there is evidence for good results when it is partially removed and undergoes radiotherapy or after radical surgery without subsequent radiation. The role of chemotherapy has not been defined today.

Increased intracranial pressure

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... the membranes covering the brain and spinal cord) Subdural hematoma (bleeding between the covering of the brain and ... intracranial pressure Patient Instructions Ventriculoperitoneal shunt - discharge Images Subdural hematoma Central nervous system and peripheral nervous system References ...

Diagnostic value of somatostatin receptor scintigraphy in patients with intracranial tumours. Diagnostische Wertigkeit der Somatostatin-Rezeptor-Szintigraphie bei Patienten mit intrakraniellen Raumforderungen

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Luyken, C. (Klinik fuer Neurochirurgie, Koeln Univ. (Germany)); Hildebrandt, G. (Klinik fuer Neurochirurgie, Koeln Univ. (Germany)); Scheidhauer, K. (Klinik fuer Nuklearmedizin, Koeln Univ. (Germany)); Kirsch, B. (Anatomisches Inst., Kiel Univ. (Germany))

1993-12-01

The aim of the study was to detect the SR binding sites in intracranial tumours and to evaluate the benefit of SRS in pre- and postoperative diagnostics. 86 patients with 94 intracranial tumours (39 meningiomas, 18 pituitary adenomas, 11 gliomas grade 3 or 4, 8 gliomas grade 2, 5 neurinomas, 5 intracranial metastases, 4 tumours of the orbit, 2 neurofibromas, 1 brain abscess and 1 cystic lesion) were examined. [sup 111]In-octreotide was injected i.v. as 10 [mu]g or 20 [mu]g bolus, corresponding to 110 or 220 MBq (3 or 6 mCi). Gamma-camera images and SPECT were obtained 3-6 h and 24 h post injection. The scintigraphic evaluation was performed without knowledge of CT and MRI results. The histological classification corresponded to the WHO grading system. Somatostatin binding sites were detected in vito using somatostatin-gold conjugates. All patients with meningiomas showed a high focal tracer uptake corresponding to SR binding sites in vitro, whereas only in 50% of the pituitary adenomas SRS was positive. Neurinomas did not show any tracer uptake. In patients with gliomas with disturbed blood-brain-barrier positive tracer uptake was detected, while none of the gliomas with intact blood-brain-barrier could be visualized by SRS but showed somatostatin binding sites in vitro. In intracranial metastases a local tracer uptake was detected in vivo. In vitro 3 of 4 cases showed somatostatin binding sites. In 2 cases extracranial tracer uptake showed the primary tumour and metastases of the lymphnodes. Somatostatin receptor scintigraphy can help to detect or to exclude meningiomas especially in the cerebellopontine angle or in the orbit. In intracranial metastases SRS may point to the primary tumour or other metastases. In all other intracranial tumours receptor scintigraphy provides no clinical relevant information. (orig./MG)

An autopsy case of methanol induced intracranial hemorrhage.

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Kim, Hye-Jeong; Na, Joo-Young; Lee, Young-Jik; Park, Jong-Tae; Kim, Hyung-Seok

2015-01-01

The major component of car washer fluid is a methanol. Intracranial hemorrhage is a rare but lethal complication in methanol poisoning. We report a case of massive bilateral basal ganglia hematoma in a 32-year-old man with methanol poisoning. He drank car washer solution twice time (about 500 ml), and was admitted to a territorial hospital 10 hours post-ingestion for depressed mental status, lower blood pressure, and high anion gap metabolic acidosis. Computed tomographic (CT) scan showed lesions in both putamen and cerebral deep white matter. Twenty-one days after methanol exposure, he suddenly developed cardiorespiratory arrest. In autopsy, external examination revealed moderate cerebral edema, but no evidence of herniation. Coronal sections of the brain showed softening and about 34 g hematoma in the bilateral putamen and 3rd ventricles. The toxic effect of methanol on the visual system has been noted in the absence of neurologic manifestations; however, there have also been a report of concomitant brain in Korea.

Reversible Holmes' tremor due to spontaneous intracranial hypotension.

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Iyer, Rajesh Shankar; Wattamwar, Pandurang; Thomas, Bejoy

2017-07-27

Holmes' tremor is a low-frequency hand tremor and has varying amplitude at different phases of motion. It is usually unilateral and does not respond satisfactorily to drugs and thus considered irreversible. Structural lesions in the thalamus and brainstem or cerebellum are usually responsible for Holmes' tremor. We present a 23-year-old woman who presented with unilateral Holmes' tremor. She also had hypersomnolence and headache in the sitting posture. Her brain imaging showed brain sagging and deep brain swelling due to spontaneous intracranial hypotension (SIH). She was managed conservatively and had a total clinical and radiological recovery. The brain sagging with the consequent distortion of the midbrain and diencephalon was responsible for this clinical presentation. SIH may be considered as one of the reversible causes of Holmes' tremor. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Spontaneous Intracranial Hypotension without Orthostatic Headache

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Tülay Kansu

2009-03-01

Full Text Available We report 2 cases of spontaneous intracranial hypotension that presented with unilateral abducens nerve palsy, without orthostatic headache. While sixth nerve palsies improved without any intervention, subdural hematoma was detected with magnetic resonance imaging. We conclude that headache may be absent in spontaneous intracranial hypotension and spontaneous improvement of sixth nerve palsy can occur, even after the development of a subdural hematoma

The intracranial facial nerve as seen through different surgical windows: an extensive anatomosurgical study.

Science.gov (United States)

Bernardo, Antonio; Evins, Alexander I; Visca, Anna; Stieg, Phillip E

2013-06-01

The facial nerve has a short intracranial course but crosses critical and frequently accessed surgical structures during cranial base surgery. When performing approaches to complex intracranial regions, it is essential to understand the nerve's conventional and topographic anatomy from different surgical perspectives as well as its relationship with surrounding structures. To describe the entire intracranial course of the facial nerve as observed via different neurosurgical approaches and to provide an analytical evaluation of the degree of nerve exposure achieved with each approach. Anterior petrosectomies (middle fossa, extended middle fossa), posterior petrosectomies (translabyrinthine, retrolabyrinthine, transcochlear), a retrosigmoid, a far lateral, and anterior transfacial (extended maxillectomy, mandibular swing) approaches were performed on 10 adult cadaveric heads (20 sides). The degree of facial nerve exposure achieved per segment for each approach was assessed and graded independently by 3 surgeons. The anterior petrosal approaches offered good visualization of the nerve in the cerebellopontine angle and intracanalicular portion superiorly, whereas the posterior petrosectomies provided more direct visualization without the need for cerebellar retraction. The far lateral approach exposed part of the posterior and the entire inferior quadrants, whereas the retrosigmoid approach exposed parts of the superior and inferior quadrants and the entire posterior quadrant. Anterior and anteroinferior exposure of the facial nerve was achieved via the transfacial approaches. The surgical route used must rely on the size, nature, and general location of the lesion, as well as on the capability of the particular approach to better expose the appropriate segment of the facial nerve.

Syphilis mimicking idiopathic intracranial hypertension

DEFF Research Database (Denmark)

Yri, Hanne; Wegener, Marianne; Jensen, Rigmor

2011-01-01

Idiopathic intracranial hypertension (IIH) is a condition of yet unknown aetiology affecting predominantly obese females of childbearing age. IIH is a diagnosis of exclusion as raised cerebrospinal fluid pressure may occur secondary to numerous other medical conditions. An atypical phenotype...... or an atypical disease course should alert the physician to reevaluate a presumed IIH-diagnosis. The authors report a case of a 32-year-old non-obese male with intracranial hypertension, secondary to a syphilitic central nervous system infection, initially misdiagnosed as being idiopathic. Upon relevant...

Intraosseous osteolytic lesions

Energy Technology Data Exchange (ETDEWEB)

Adler, C.P.; Wenz, W.

1981-10-01

Any pathological damage occurring in a bone will produce either an osteolytic or osteosclerotic lesion which can be seen in the macroscopic specimen as well as in the roentgenogram. Various bone lesions may lead to local destructions of the bone. An osteoma or osteoplastic osteosarcoma produces an osteosclerotic lesion showing a dense mass in the roentgenogram; a chondroblastoma or an osteoclastoma, on the other hand, induces an osteolytic focal lesion. This paper presents examples of different osteolytic lesions of the humerus. An osteolytic lesion seen in the roentgenogram may be either produced by an underlying non-ossifying fibroma of the bone, by fibrous dysplasia, osteomyelitis or Ewing's sarcoma. Differential diagnostic considerations based on the radiological picture include eosinophilic bone granuloma, juvenile or aneurysmal bone cyst, multiple myeloma or bone metastases. Serious differential diagnostic problems may be involved in case of osteolytic lesions occurring in the humerus. Cases of this type involving complications have been reported and include the presence of an teleangiectatic osteosarcoma as well as that of a hemangiosarcoma of the bone.

Enterprise stent for the treatment of symptomatic intracranial atherosclerotic stenosis: an initial experience of 44 patients.

Science.gov (United States)

Feng, Zhengzhe; Duan, Guoli; Zhang, Ping; Chen, Lei; Xu, Yi; Hong, Bo; Zhao, Wenyuan; Liu, Jianmin; Huang, Qinghai

2015-10-08

Wingspan stenting for the treatment of complex intracranial atherosclerotic stenosis (ICAS), i.e., that involving tortuous vascular pathways, long (>15 mm) lesions or arterial bifurcations, has a relatively high risk of complications. This retrospective study assessed the safety and efficacy of undersized balloon angioplasty followed by deployment of the more flexible Enterprise stent for the treatment of complex symptomatic ICAS. Forty-four patients on combined antiplatelet therapy and intensive risk factor management and a symptomatic 70-99% stenosis of a major intracranial artery in complex settings that was treated with balloon angioplasty and Enterprise stent deployment between July 2009 and August 2013 were enrolled. Primary outcome was occurrence of ischemic or hemorrhagic stroke or death within 30 days after intervention. Secondary outcomes included procedural success (defined as achievement of 50% in-stent restenosis after mean 22 months follow-up. In this retrospective, single-center experience, undersized balloon angioplasty followed by Enterprise stent deployment appears technically feasible with a relatively low rate of complications for the treatment of complex symptomatic ICAS. Prospective, multicenter, randomized controlled trials against optimal medical management are warranted.

Long-Term Results of Gamma Knife Radiosurgery for Intracranial Meningioma.

Science.gov (United States)

Jang, Chang Ki; Jung, Hyun Ho; Chang, Jong Hee; Chang, Jin Woo; Park, Yong Gou; Chang, Won Seok

2015-10-01

The predominant treatment modality for meningioma is surgical resection. However, gamma knife radiosurgery is also an important treatment modality for meningioma that is small or cannot be completely removed because of its location. In this study, we evaluated the effectiveness and long-term results of radiosurgical treatment for meningioma in our institution. We studied 628 patients (130 men and 498 women) who underwent gamma knife radiosurgery for intracranial meningioma, which is radiologically diagnosed, from Jan 2008 to Nov 2012. We included patients with single lesion meningioma, and followed up after 6 months with imaging, and then at 24 months with a clinical examination. Patients with high-grade meningioma or multiple meningiomas were excluded. We analyzed each of the factors associated with progression free survival. The median patient's age was 56.8 years. Maximal dosage was 27.8 Gy and marginal dosage was 13.9 Gy. The overall tumor control rate was 95%. Twenty-eight patients (4.4%) showed evidence of tumor recurrence. Ninety-eight patients (15%) developed peritumoral edema (PTE) after gamma-knife surgery; two of them (2%) underwent surgical resections due to PTE. Nine patients had craniotomy and tumor removal after gamma knife surgery. Gamma knife surgery for intracranial meningioma has proven to be a safe and effective treatment tool with successful long-term outcomes. Gamma knife radiosurgery can be especially effective in cases of remnant meningioma after surgical resection or where PTE is not present.

Learning curve for intracranial angioplasty and stenting in single center.

Science.gov (United States)

Cai, Qiankun; Li, Yongkun; Xu, Gelin; Sun, Wen; Xiong, Yunyun; Sun, Wenshan; Bao, Yuanfei; Huang, Xianjun; Zhang, Yao; Zhou, Lulu; Zhu, Wusheng; Liu, Xinfeng

2014-01-01

To identify the specific caseload to overcome learning curve effect based on data from consecutive patients treated with Intracranial Angioplasty and Stenting (IAS) in our center. The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke and Intracranial Stenosis trial was prematurely terminated owing to the high rate of periprocedural complications in the endovascular arm. To date, there are no data available for determining the essential caseload sufficient to overcome the learning effect and perform IAS with an acceptable level of complications. Between March 2004 and May 2012, 188 consecutive patients with 194 lesions who underwent IAS were analyzed retrospectively. The outcome variables used to assess the learning curve were periprocedural complications (included transient ischemic attack, ischemic stroke, vessel rupture, cerebral hyperperfusion syndrome, and vessel perforation). Multivariable logistic regression analysis was employed to illustrate the existence of learning curve effect on IAS. A risk-adjusted cumulative sum chart was performed to identify the specific caseload to overcome learning curve effect. The overall rate of 30-days periprocedural complications was 12.4% (24/194). After adjusting for case-mix, multivariate logistic regression analysis showed that operator experience was an independent predictor for periprocedural complications. The learning curve of IAS to overcome complications in a risk-adjusted manner was 21 cases. Operator's level of experience significantly affected the outcome of IAS. Moreover, we observed that the amount of experience sufficient for performing IAS in our center was 21 cases. Copyright © 2013 Wiley Periodicals, Inc.

MRI of intracranial meningeal malignant fibrous histiocytoma

International Nuclear Information System (INIS)

Ogino, A.; Ochi, M.; Hayashi, K.; Hirata, K.; Hayashi, T.; Yasunaga, A.; Shibata, S.

1996-01-01

We describe the CT and MRI findings in a patient with primary intracranial meningeal malignant fibrous histiocytoma (MFH). CT delineated the anatomical relations and MRI aided in tissue characterisation. To our knowledge, this is the first report describing the MRI findings in primary intracranial meningeal MFH. (orig.). With 1 fig

Intracranial meningiomas: magnetic resonance imaging findings in 78 cases

International Nuclear Information System (INIS)

Gasparetto, Emerson L.; Leite, Claudia da Costa; Lucato, Leandro T.; Barros, Cristiano Ventorin de; Marie, Sueli K.N.; Santana, Pedro; Aguiar, Paulo Henrique Pires de; Rosemberg, Sergio

2007-01-01

Objective: To present the magnetic resonance (MR) imaging findings of 78 patients with meningiomas diagnosed in a single institution. Method: 78 patients with histological proven intracranial meningioma were studied. There were 52 female and 26 male patients (median=56 years). All MR imaging examinations were performed with 1.5-T MR imaging unit with standard protocol. The images were studied by two neuroradiologists, who reached the decisions regarding the findings by consensus. Results: Most of the tumors showed low signal on T1- (60%) and high signal on T2- (68%) and FLAIR (69%) weighted images. Also, the lesions showed heterogeneous signal on T1 (60%), T2 (68%) and FLAIR (64%) sequences. After contrast administration, 83% (n=65) of the tumors presented accentuated and 17% (n=13) showed moderate enhancement. The tumors were located in the frontal lobe in 44% of the cases, in the parietal lobe in 35%, the occipital lobe in 19% and the temporal lobe in 12% of the patients. Areas of vasogenic edema around the tumors were seen in 90% of the cases. Twenty six per cent of the cases showed bone infiltration, and the dural tail sign was seen in 59% of the tumors. Conclusion: Intracranial meningiomas usually show heterogeneous low signal on T1- and high signal on T2-weighted and FLAIR images, with intense enhancement after contrast administration. The frontal and parietal lobes are commonly affected. In addition, brain edema, dural tail sign and bone infiltration are the most frequent associated findings. (author)

Childhood malignant blue nevus of the ear associated with two intracranial melanocytic tumors-metastases or neurocutaneous melanosis?

Science.gov (United States)

Popović, Mara; Dolenc-Strazar, Zvezdana; Anzic, Jozica; Luzar, Bostjan

2004-10-01

Blue nevus is an uncommon pigmented tumor of dermal melanocytes that has traditionally been classified into common and cellular variant. It is usually a skin tumor in adults but can become apparent in early childhood or even be present at birth. Malignant blue nevus is a rare melanocytic tumor of the skin arising from a preexisting cellular blue nevus. We report a multinodular blue nevus of the left ear in an 11-year-old girl who also had 2 intracranial melanocytic lesions. Differential diagnosis between metastases from malignant blue nevus and neurocutaneous melanosis is discussed.

"Negative symptoms"secondary to intracranial tumor

Directory of Open Access Journals (Sweden)

Natasha Kate

2014-01-01

Full Text Available Intracranial tumors are increasingly common in the elderly population. They may present with varied symptoms, some of which may be psychiatric in nature. In patients with known psychiatric disorders, these symptoms may be misattributed resulting in a delay in diagnosis and management. We present a case of an elderly female with paranoid schizophrenia and new onset symptoms secondary to intracranial tumor, which were initially misdiagnosed.

Graves' disease and idiopathic intracranial hypertension

OpenAIRE

Manish Gutch; Annesh Bhattacharjee; Sukriti Kumar; Durgesh Pushkar

2017-01-01

Idiopathic intracranial hypertension (IIH) is a central nervous system disorder characterized by raised intracranial pressure with normal cerebrospinal fluid composition and absence of any structural anomaly on neuroimaging. Among all endocrine disorders associated with the development of IIH, the association of hyperthyroidism and IIH is very rare with few cases reported till date. Thyroid disturbances have a unique association with IIH. Hypo- and hyper-thyroidism have been reported in assoc...

ICP curve morphology and intracranial flow-volume changes

DEFF Research Database (Denmark)

Unnerbäck, Mårten; Ottesen, Johnny T.; Reinstrup, Peter

2018-01-01

proposed to shape the ICP curve. This study tested the hypothesis that the ICP curve correlates to intracranial volume changes. METHODS: Cine phase contrast magnetic resonance imaging (MRI) examinations were performed in neuro-intensive care patients with simultaneous ICP monitoring. The MRI was set......BACKGROUND: The intracranial pressure (ICP) curve with its different peaks has been extensively studied, but the exact physiological mechanisms behind its morphology are still not fully understood. Both intracranial volume change (ΔICV) and transmission of the arterial blood pressure have been...

A Man with Pancreatic Head Mass Lesion on Endoscopic Ultrasound and Granuloma on Cytopathology

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Neda Rad

2016-12-01

Full Text Available Primary pancreatic lymphoma is an unlikely malignancy accounting for less than 0.5% of pancreatic tumors. Clinical presentation is often nonspecific and may be clinically misdiagnosed as pancreatic adenocarcinoma. Here we present an Iranian case of primary pancreatic lymphoma in a 47-year-old male suffering from jaundice and 20% weight loss. Endoscopic ultrasound revealed a mixed echoic mass lesion at the head of pancreas. The patient underwent endoscopic ultrasound-guided fine needle aspiration of solid pancreatic mass and histopathologic diagnosis revealed granuloma. Computed tomography-guided core needle biopsy was performed and eventually histological examination showed granuloma that was coherent with the diagnosis of primary pancreatic lymphoma. Primary pancreatic lymphoma is a rare entity presenting with nonspecific symptoms, laboratory and radiological findings. Computed tomography results in combination with clinical and radiological studies generally provide guidance for appropriate investigation.

A Man with Pancreatic Head Mass Lesion on Endoscopic Ultrasound and Granuloma on Cytopathology.

Science.gov (United States)

Rad, Neda; Heidarnezhad, Arash; Soheili, Setareh; Mohammad-Alizadeh, Amir Houshang; Nikmanesh, Arash

2016-01-01

Primary pancreatic lymphoma is an unlikely malignancy accounting for less than 0.5% of pancreatic tumors. Clinical presentation is often nonspecific and may be clinically misdiagnosed as pancreatic adenocarcinoma. Here we present an Iranian case of primary pancreatic lymphoma in a 47-year-old male suffering from jaundice and 20% weight loss. Endoscopic ultrasound revealed a mixed echoic mass lesion at the head of pancreas. The patient underwent endoscopic ultrasound-guided fine needle aspiration of solid pancreatic mass and histopathologic diagnosis revealed granuloma. Computed tomography-guided core needle biopsy was performed and eventually histological examination showed granuloma that was coherent with the diagnosis of primary pancreatic lymphoma. Primary pancreatic lymphoma is a rare entity presenting with nonspecific symptoms, laboratory and radiological findings. Computed tomography results in combination with clinical and radiological studies generally provide guidance for appropriate investigation.

Predictors of severe complications in intracranial meningioma surgery

DEFF Research Database (Denmark)

Bartek, Jiri; Sjåvik, Kristin; Förander, Petter

2015-01-01

OBJECTIVE: To investigate predictors of complications after intracranial meningioma resection using a standardized reporting system for adverse events. METHODS: A retrospective review was conducted in a Scandinavian population-based cohort of 979 adult operations for intracranial meningioma perfo...

Dynamic contrast-enhanced subtraction MR angiography in intracranial vascular abnormalities

International Nuclear Information System (INIS)

Takano, K.; Ono, H.; Utsunomiya, H.; Okazaki, M.; Tanaka, A.

1999-01-01

We present our clinical experience with dynamic contrast-enhanced MR angiography (MRA) with subtraction for assessing intracranial vascular abnormalities. Ten patients with various cerebrovascular disorders underwent dynamic contrast-enhanced MRA on a 1.0-T system. Thirty sections (2 mm) were acquired in 29-30 s. Maximum intensity projection images and subtracted source images were compared with those obtained by conventional angiography. In all cases, the presence or absence of abnormalities in the targeted vessels, as well as the morphology of the sagittal sinuses, was clearly visualized as in conventional angiography, without any obstructions such as hyperintense hematomas or thrombi, or intraluminal turbulence. Although the temporal and spatial resolutions with current hardware are insufficient, these preliminary results suggest that dynamic contrast-enhanced MRA with subtraction may be useful for assessing vascular lesions with hemorrhage or thrombus, and the dural sinuses. (orig.)

MRI of cerebral alveolar echinococcosis

International Nuclear Information System (INIS)

Tunaci, M.; Tunaci, A.; Engin, G.; Oezkorkmaz, B.; Ahishali, B.; Rozanes, I.

1999-01-01

Cerebral alveolar echinococcosis is rare. We report a case with multiple intracranial masses which show cauliflower-like contrast enhancement pattern on MRI. The lesions originated from hepatic involvement with invasion of the inferior vena cava. (orig.)

Intracranial subdural hematomas with elevated rivaroxaban concentration and subsequently detected spinal subdural hematoma: A case report.

Science.gov (United States)

Yamaguchi, Yoshitaka; Koga, Masatoshi; Matsuki, Takayuki; Hino, Tenyu; Yokota, Chiaki; Toyoda, Kazunori

2016-07-01

A 79-year-old lean man with a height of 157cm and weight of 42kg (body mass index, 17.2kg/m(2)) receiving rivaroxaban developed an intracranial subdural hematoma and was treated conservatively. Because he had a reduced creatinine clearance of 44mL/min, his dosage of rivaroxaban was reduced from 15 to 10mg daily according to official Japanese prescribing information. However, he developed bilateral intracranial subdural hematomas 2weeks later. Plasma rivaroxaban concentration on anti-factor Xa chromogenic assay was elevated at 301ng/mL, suggesting excessive accumulation. He underwent burr hole drainage and resumed anticoagulation with warfarin. Subsequently, he developed a lumbosacral hematoma. He was treated conservatively and discharged without neurological sequelae. The main cause of the increased concentration of rivaroxaban was believed to be his older age and low body weight. The etiology of the spinal hematoma was suspected to be the migration of intracranial hematoma to the spinal subdural space. Copyright © 2016 Elsevier Ltd. All rights reserved.

Le fort I osteotomy approach for advanced nasopharyngeal angiofibroma with intracranial extension: Report of a case

Directory of Open Access Journals (Sweden)

"Naraghi M

2002-08-01

Full Text Available Angiofibromas are the most common benign tumors of the nasopharynx, Intracranial extension has been reported in approximately 20-25% of cases. Intracranial extension may be difficult to treat because of poor exposure that may lead to recurrence. A 16-year-old male patient presented with a 6-month history of nasal obstruction, intermittent epistaxis, right superior orbital fissure syndrome, and proptosis. Imaging studies revealed a large right sinonasal mass with significant intracranial and infratemporal extensions. The tumor was resected by Le fort I technique because of dissatisfaction with other approaches. Postoperative period was uneventful and follow-up visits showed marked improvement in proptosis and ophthalmologic symptoms, without the evidence of tumor recurrence. Commonly used to treat facial deformities. The Le Fort I osteotomy with down fracturing of the entire palate has been adopted as a surgical option in the management of some angiofibromas. Compared with other popular techniques, it provides excellent exposure for angiofibromas. The merits and limitations of this approach as well as its details are discussed.

Acute surgical management in idiopathic intracranial hypertension.

LENUS (Irish Health Repository)

Zakaria, Zaitun

2012-01-01

Idiopathic intracranial hypertension is a headache syndrome with progressive symptoms of raised intracranial pressure. Most commonly, it is a slow process where surveillance and medical management are the main treatment modalities. We describe herein an acute presentation with bilateral sixth nerve palsies, papilloedema and visual deterioration, where acute surgical intervention was a vision-saving operation.

T1-weighted fluid-attenuated inversion recovery and T1-weighted fast spin-echo contrast-enhanced imaging: a comparison in 20 patients with brain lesions

International Nuclear Information System (INIS)

Al-Saeed, O.; Athyal, R. P.; Ismail, M.; Rudwan, M.; Khafajee, S.

2009-01-01

Full text: Tl-weighted fluid-attenuated inversion recovery (FLAIR) sequence is a relatively new pulse sequence for intracranial MR imaging. This study was performed to compare the image quality of Tl-weighted FLAIR with the Tl-weighted FSE sequence. Twenty patients with brain lesions underwent Tl-weighted fast spin-echo (FSE) and Tl-weighted FLAIR during the same imaging session. Four quantitative and three qualitative criteria were used to compare the two sequences after contrast. Two of four quantitative criteria pertained to lesion characteristics: lesion to white matter (WM) contrast-to-noise ratio (CNR) and lesion to cerebrospinal fluid (CSF) CNR, and two related to signals from normal tissue: grey matter to WM CNR and WM to CSF CNR. The three qualitative criteria were conspicuousness of the lesion, the presence of image artefacts and the overall image contrast. Both Tl-weighted FSE and FLAIR images were effective in demonstrating lesions. Image contrast was superior in Tl-weighted FLAIR images with significantly improved grey matter-WM CNRs and CSF-WM CNRs. The overall image contrast was judged to be superior on Tl-weighted FLAIR images compared with Tl-weighted FSE images by all neuroradiologists. Two of three reviewers considered that the FLAIR images had slightly increased imaging artefacts that, however, did not interfere with image interpretation. Tl-weighted FLAIR imaging provides improved lesion-to-background and grey to WM contrast-to-noise ratios. Superior conspicuity of lesions and overall image contrast is obtained in comparable acquisition times. These indicate an important role for Tl-weighted FLAIR in intracranial imaging and highlight its advantage over the more widely practiced Tl-weighted FSE sequence

An Update on Idiopathic Intracranial Hypertension

OpenAIRE

Thurtell, Matthew J.; Bruce, Beau B.; Newman, Nancy J.; Biousse, Valérie

2010-01-01

Idiopathic intracranial hypertension (IIH) is a condition of unknown etiology often encountered in neurologic practice. It produces non-localizing symptoms and signs of raised intracranial pressure and, when left untreated, can result in severe irreversible visual loss. It most commonly occurs in obese women of childbearing age, but it can also occur in children, men, non-obese adults, and older adults. While it is frequently associated with obesity, it can be associated with other conditions...

Sinogenic intracranial complications

DEFF Research Database (Denmark)

Kofoed, Mikkel Seremet; Fisker, Niels; Christensen, Anne Estmann

2018-01-01

We present two 11-year-old girls with chronic recurrent multifocal osteomyelitis, treated with adalimumab. Both developed severe intracranial complications to sinusitis. Patient 1 had been treated with adalimumab for 15 months when she developed acute sinusitis complicated by an orbital abscess, ...

Mannitol-induced rebleeding from intracranial aneurysm. Case report

DEFF Research Database (Denmark)

Rosenørn, J; Westergaard, L; Hansen, P H

1983-01-01

A case is presented in which rebleeding from an intracranial saccular aneurysm occurred a few minutes after intravenous administration of mannitol during surgery. The relationship between the reducing effect of mannitol on elevated intracranial pressure and the increased pressure gradient across...

Mannitol-induced rebleeding from intracranial aneurysm. Case report

DEFF Research Database (Denmark)

Rosenørn, J; Westergaard, L; Hansen, P H

1983-01-01

A case is presented in which rebleeding from an intracranial saccular aneurysm occurred a few minutes after intravenous administration of mannitol during surgery. The relationship between the reducing effect of mannitol on elevated intracranial pressure and the increased pressure gradient across ...

Spontaneous Intracranial Hypotension

International Nuclear Information System (INIS)

Joash, Dr.

2015-01-01

Epidemiology is not only rare but an important cause of new daily persistent headaches among young & middle age individuals. The Etiology & Pathogenesis is generally caused by spinal CSF leak. Precise cause remains largely unknown, underlying structural weakness of spinal meninges is suspected. There are several MR Signs of Intracranial Hypotension that include:- diffuse pachymeningeal (dural) enhancement; bilateral subdural, effusion/hematomas; Downward displacement of brain; enlargement of pituitary gland; Engorgement of dural venous sinuses; prominence of spinal epidural venous plexus and Venous sinus thrombosis & isolated cortical vein thrombosis. The sum of volumes of intracranial blood, CSF & cerebral tissue must remain constant in an intact cranium. Treatment in Many cases can be resolved spontaneously or by use Conservative approach that include bed rest, oral hydration, caffeine intake and use of abdominal binder. Imaging Modalities for Detection of CSF leakage include CT myelography, Radioisotope cisternography, MR myelography, MR imaging and Intrathecal Gd-enhanced MR

Increased Intracranial Pressure in the Setting of Enterovirus and Other Viral Meningitides

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Jules C. Beal

2017-01-01

Full Text Available Increased intracranial pressure due to viral meningitis has not been widely discussed in the literature, although associations with Varicella and rarely Enterovirus have been described. Patients with increased intracranial pressure and cerebrospinal fluid analysis suggestive of a viral process are sometimes classified as having atypical idiopathic intracranial hypertension (IIH. However, a diagnosis of IIH requires normal cerebrospinal fluid, and therefore in these cases an infection with secondary intracranial hypertension may be a more likely diagnosis. Here seven patients are presented with elevated intracranial pressure and cerebrospinal fluid suggestive of viral or aseptic meningitis. Of these, 1 had Enterovirus and the remainder were diagnosed with nonspecific viral meningitis. These data suggest that viral meningitis may be associated with elevated intracranial pressure more often than is commonly recognized. Enterovirus has previously been associated with increased intracranial pressure only in rare case reports.

MRI of superficial soft tissue masses: analysis of features useful in distinguishing between benign and malignant lesions

Energy Technology Data Exchange (ETDEWEB)

Calleja, Michele; Dimigen, Marion; Saifuddin, Asif [Royal National Orthopaedic Hospital, Stanmore (United Kingdom)

2012-12-15

To identify the MRI features of superficial soft tissue masses, that may allow differentiation between malignant and non-malignant lesions. A total of 136 consecutive patients referred to a supra-regional musculoskeletal oncology center over a 10-year period with the diagnosis of a superficial soft tissue mass were included in this retrospective study. Features analyzed included patient demographics, lesion size, MRI signal characteristics, margins, lobulation, hemorrhage, necrosis, fascial edema, relationship to the fascia, as well as involvement of the skin. Comparison was then made with the final histological diagnosis. Of the patients reviewed, 58 were male and 78 were female, and the mean age was 49.9 years. The mean age for malignant lesions was 57.9 years, and that for non-neoplastic and benign conditions 41.9 years (p < 0.001). A significant relationship was identified between malignancy and lobulation (p < 0.01), hemorrhage (p < 0.001), fascial edema (p < 0.001), hemorrhage (p < 0.0001) and necrosis (p < 0.001). The relationship between skin thickening and skin contact and malignancy was also found to be significant. However, size was not found to be an important determining factor for malignancy, with a significant proportion of malignant superficial sarcomas measuring less than 5 cm in maximal diameter. This study has shown that a significant proportion of malignant superficial sarcomas measured less than 5 cm in maximal diameter. Fascial edema, skin thickening, skin contact, hemorrhage, and necrosis were found to be highly significant factors indicative of malignancy. Lobulation and peritumoral edema were also significant MRI features. (orig.)

Cervical myelopathy due to single level disc herniation presenting as intramedullary mass lesion: What to do first?

Directory of Open Access Journals (Sweden)

Murat Sakir Eksi

2015-01-01

Full Text Available Cervical myelopathy (CM is mostly a degenerative process ending in myelopathic and/or radiculopathic syndromes. On T2-weighted magnetic resonance imaging (MRI, CM appears as a hyperintense area near the spondylotic spine. This high intensity signal depends on the impact of outer forces and their duration. It also determines the prognosis of the surgical candidate. A 40-year-old male patient admitted to our clinic with right upper extremity weakness and hypoesthesia that had started 2 months earlier. On neurological examination there was 2/5 motor weakness of right biceps brachii, and hypoesthesia over right C6 dermatome. Right upper extremity deep tendon reflexes were hypoactive, but lower ones were hyperactive. After clinical and radiological work-up, preliminary diagnosis was directed to a spinal intramedullary tumor. Total resection of the herniated cervical disc fragment and the mass lesion was managed. Pathology of the mass lesion was compatible with subacute infarct tissue and inflammatory response. Final diagnosis was CM under effect of cervical disc herniation. Contrast-enhanced spinal cord myelopathic lesions are very rare and resemble much more tumors and inflammatory processes. However, the principal treatment approach totally differs depending on pathology. When there are both a disc herniation and a high clinical suspicion; biopsy should be delayed. The most probable solution will be surgery for the disc disease with thorough preoperative scanning of vascular malformations; clinical and radiological close follow-up after surgery. Biopsy or surgical resection can be performed if patient deteriorates despite the primary surgery.

Gamma knife treatment of intracranial disorders in children

Energy Technology Data Exchange (ETDEWEB)

Kobayashi, Tatsuya; Kida, Yoshihisa; Tanaka, Takayuki (Komaki City Hospital, Aichi (Japan))

1993-06-01

Radiosurgical treatment with a gamma knife was performed on 160 patients with intracranial lesions at Komaki City Hospital from May 1991 through February 1992. Twenty seven of the patients were under 15 years of age: 19 had arteriovenous malformations (AVM), two had craniopharyngiomas and one each had optic glioma, ganglioglioma, pineal teratoma, ependymoma, medulloblastoma and glioblastoma. It is still too early to evaluate the results of treatment, but some early effects have been found in some cases. There was no immediate side effect of this treatment. A decrease of the nidus was found by MRI angiography (MRA) 7 months after treatment in one patient with AVM. In one of the craniopharyngioma patients the low-intensity area (LIA) of the tumor was larger on T[sub 1]-weighted MRI but smaller 6 months after treatment. An intratumoral LIA was also found in the optic glioma patient 6 months after treatment. There are difficulties in the gamma knife treatment of children, since general anesthesia is needed below 12 years of age, and it is difficult to apply the system below 2 years of age. However, there are advantages: higher radiosensitivity in pediatric AVM and the curability of inoperable lesions without neurological deficit. Radiosurgery for pediatric brain tumors has different indications from those for adults. Patients with small circumscribed benign tumors, such as craniopharyngiomas, optic gliomas, gangliogliomas or pineal tumors are good candidates for radiosurgery. (author).

External validation of a publicly available computer assisted diagnostic tool for mammographic mass lesions with two high prevalence research datasets.

Science.gov (United States)

Benndorf, Matthias; Burnside, Elizabeth S; Herda, Christoph; Langer, Mathias; Kotter, Elmar

2015-08-01

Lesions detected at mammography are described with a highly standardized terminology: the breast imaging-reporting and data system (BI-RADS) lexicon. Up to now, no validated semantic computer assisted classification algorithm exists to interactively link combinations of morphological descriptors from the lexicon to a probabilistic risk estimate of malignancy. The authors therefore aim at the external validation of the mammographic mass diagnosis (MMassDx) algorithm. A classification algorithm like MMassDx must perform well in a variety of clinical circumstances and in datasets that were not used to generate the algorithm in order to ultimately become accepted in clinical routine. The MMassDx algorithm uses a naïve Bayes network and calculates post-test probabilities of malignancy based on two distinct sets of variables, (a) BI-RADS descriptors and age ("descriptor model") and (b) BI-RADS descriptors, age, and BI-RADS assessment categories ("inclusive model"). The authors evaluate both the MMassDx (descriptor) and MMassDx (inclusive) models using two large publicly available datasets of mammographic mass lesions: the digital database for screening mammography (DDSM) dataset, which contains two subsets from the same examinations-a medio-lateral oblique (MLO) view and cranio-caudal (CC) view dataset-and the mammographic mass (MM) dataset. The DDSM contains 1220 mass lesions and the MM dataset contains 961 mass lesions. The authors evaluate discriminative performance using area under the receiver-operating-characteristic curve (AUC) and compare this to the BI-RADS assessment categories alone (i.e., the clinical performance) using the DeLong method. The authors also evaluate whether assigned probabilistic risk estimates reflect the lesions' true risk of malignancy using calibration curves. The authors demonstrate that the MMassDx algorithms show good discriminatory performance. AUC for the MMassDx (descriptor) model in the DDSM data is 0.876/0.895 (MLO/CC view) and AUC

Basic mechanisms in intracranial large-artery atherosclerosis: advances and challenges.

Science.gov (United States)

Arenillas, Juan F; Alvarez-Sabín, José

2005-01-01

Intracranial large-artery atherosclerosis is a major cause of ischemic stroke worldwide. Patients affected by this disease are at a high risk of suffering recurrent ischemic events despite antithrombotic therapy. Progression and a greater extent of intracranial atherosclerosis imply a higher risk for recurrence. Studies performed by our group in patients with symptomatic intracranial large-artery atherosclerosis have shown that: (1) C-reactive protein predicts its progression and recurrence, suggesting that inflammation may play a deleterious role in this condition; (2) a high level of the anti-angiogenic endostatin is also associated with a progressive and recurrent intracranial atherosclerosis, which might support a beneficial role for angiogenesis in this group of patients; and (3) elevated lipoprotein(a) concentration and diabetes mellitus characterize those patients with a higher number of intracranial stenoses. 2005 S. Karger AG, Basel

IDIOPATHIC INTRACRANIAL HYPERTENSION IN A WOMAN WITH SCHIZOPHRENIA

Directory of Open Access Journals (Sweden)

Ivan N. Dimitrov

2012-02-01

Full Text Available Idiopathic intracranial hypertension (IIH or benign intracranial hypertension is a neurological syndrome characterized by elevated intracranial pressure. This uncommon disorder occurs primarily in obese women aged 10 to 50 years, sometimes in association with endocrine and metabolic dysfunction, with systemic diseases or when treated with multiple medications. We describe a case of IIH in a 43-year-old woman with schizophrenia treated with risperidone, demonstrating a typical clinical picture of benign intracranial hypertension. For the 5 years of treatment with risperidone she put on 35 kg in total (BMI> 35; for the last 2-3 months she began to complain of visual obscurations, nausea with vomiting. Ophthalmoscopy revealed bilateral asymmetric papilledema (OD>OS. Magnetic resonance imaging was normal, intracranial pressure was elevated IIH was diagnosed. Risperidone was discontinued and replaced with Seroquel 200 mg daily. Treatment with furosemide and mannitol 10 % was initiated. Papilledema resolved completely over the next 2 months. The patient was followed-up for four years after risperidone withdrawal. Weight loss of 28 kg was noted for four years. There were no relapses of headache, nausea, visual obscuration. Ophthalmologic examination revealed no papilledema.We suggest that prolonged use of antipsychotics, such as risperidone, should require proper surveillance for possible development of IIH and routine ophthalmologic examinations should be performed.

Intracranial Pressure Monitoring

DEFF Research Database (Denmark)

Raboel, P H; Bartek, J; Andresen, M

2012-01-01

Monitoring of intracranial pressure (ICP) has been used for decades in the fields of neurosurgery and neurology. There are multiple techniques: invasive as well as noninvasive. This paper aims to provide an overview of the advantages and disadvantages of the most common and well-known methods...

Raised intracranial pressure

African Journals Online (AJOL)

is article presents an approach to raised intracranial pressure (ICP) constructed in a question-answer fashion. ..... Given that raised ICP is a serious and potentially life-threatening emergency, fast and reliable referral and transfer mechanisms should be established to ensure patients with this condition are effectively treated.

Adipsic diabetes insipidus revealing a bifocal intracranial germinoma.

Science.gov (United States)

Kreutz, Julie; Potorac, Iulia; Lutteri, Laurence; Gennigens, Christine; Martin, Didier; Daly, Adrian F; Bonneville, Jean-Francois; Tshibanda, Luaba; Beckers, Albert

2017-07-01

Adipsic diabetes insipidus is a rare complication of intracranial tumors in which impaired antidiuretic hormone secretion is associated with the loss of thirst sensation. Here, we present the case of a patient with bifocal intracranial germinoma, diagnosed due to symptoms mainly caused by adipsic diabetes insipidus. This is, to our knowledge, the first case of adipsic diabetes insipidus revealing an intracranial germinoma reported in the literature. We describe the diagnostic procedures and the three-year follow-up of this patient. Management of intracranial germ-cell tumors is made complex by the wide range of histological features. Although germinomas have a generally better prognosis than most nongerminomatous tumors, they can have severe or even life-threatening presentations. Adipsic diabetes insipidus is one such severe presentation and its rarity can make it difficult to recognize and manage. Awareness of this potential entity is therefore important for clinical practice. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Potential for increasing conspicuity of short-T1 lesions in the brain using magnetisation transfer imaging

International Nuclear Information System (INIS)

De Souza, N.M.; Hajnal, J.V.; Baudouin, C.J.

1995-01-01

We investigated the feasibility of using T1-weighted magnetisation transfer sequences to generate tissue contrast and increase the conspicuity of short-T1 areas within the brain. We imaged two normal volunteers with and without saturating off-resonance radiofrequency irradiation at a range of repetition times (TR 200-760 ms). T1 values and magnetisation transfer ratios for white matter and deep grey matter were calculated. We studied eight patients with intracranial lesions showing short-T1 areas, using mildly T1-weighted sequences with and without magnetisation transfer contrast. Lesion numbers, areas and signal intensities were measured and lesion-to-background contrast was calculated. Comparison was made with conventional T1-weighted spin-echo images. In the normal volunteers, contrast between the thalamus, caudate and lentiform nuclei and white matter showed striking visual differences, with magnetisation transfer weighting, with decreasing TR. In all patients, short-T1 lesions were seen more clearly on magnetisation transfer-weighted images, with significant increase in lesion number, area and contrast, when compared with conventional T1-weighted scans. (orig.)

THE DIAGNOSIS AND TREATMENT OF INTRACRANIAL ARACHNOID CYSTS

NARCIS (Netherlands)

GO, KG

Intracranial arachnoid cysts have been found in 0.3% of computed tomography (CT) scans and in 0.1% of brain autopsy specimens, more often in children than in adults. Intracranial arachnoid cysts occur prevalently in males, on the left side, and in the temporal fossa. Their occasional association

Intracranial Convexity Lipoma with Massive Calcification: Case Report

Energy Technology Data Exchange (ETDEWEB)

Kim, Eung Tae; Park, Dong Woo; Ryu, Jeong Ah; Park, Choong Ki; Lee, Young Jun; Lee, Seung Ro [Dept. of Radiology, Hanyang University College of Medicine, Seoul (Korea, Republic of)

2011-12-15

Intracranial lipoma is a rare entity, accounting for less than 0.5% of intracranial tumors, which usually develops in the callosal cisterns. We report a case of lipoma with an unusual location; in the high parietal convexity combined with massive calcification, and no underlying vascular malformation or congenital anomaly.

The Technique of Endovascular Intracranial Revascularization

Directory of Open Access Journals (Sweden)

John J. Connors

2014-11-01

Full Text Available Intracranial atherosclerosis was traditionally believed to carry a risk of stroke of 8% to 22% per annum. The annualized stroke rate in the recent Stenting and Aggressive Medical Management for Preventing Stroke in Intracranial Stenosis trial medical management arm was 12.2%. This trial was halted due to excessive periprocedural events in the stent arm. This stroke rate Is still Unacceptably high and a treatment strategy is still needed. SAMMPRIS has no bearing on angioplasty alone. Angioplasty alone has always been our primary intervention for intracranial atherosclerosis and remains so to this day due to its relative simplicity, low complication rate, and efficacy. We have, however, made adjustments to our patient management regimen based on the results of SAMMPRIS. This paper outlines our current patient selection, procedural technique, and post-procedure management. The complications we have encountered while developing our technique are described along with how to avoid them and how to manage them. Our most recent results (since previous publications are also discussed.

Fluvoxamine-induced intracranial hypertension in a 10-year-old boy.

Science.gov (United States)

Samant, Hemalini; Samant, Preetam

2018-05-01

Drug-induced intracranial hypertension is a well-established entity. We report a rare case of intracranial hypertension with papilledema in a 10-year-old boy following use of fluvoxamine, a selective serotonin reuptake inhibitor. On discontinuing the drug, the papilledema resolved over 4 months without any residual visual anomalies. To the best of our knowledge, this is the first report of fluvoxamine-induced intracranial hypertension with papilledema.

F2-isoprostanes and F4-neuroprostanes as markers of intracranial aneurysm development.

Science.gov (United States)

Syta-Krzyżanowska, Anna; Jarocka-Karpowicz, Iwona; Kochanowicz, Jan; Turek, Grzegorz; Rutkowski, Robert; Gorbacz, Krzysztof; Mariak, Zenon; Skrzydlewska, Elżbieta

2018-04-24

Intracranial aneurysms are common, occurring in about 1-2% of the population. Saccular aneurysm is a pouch-like pathological dilatation of an intracranial artery that develops when the cerebral artery wall becomes too weak to resist hemodynamic pressure and distends. The aim of this study was to determine whether the development of intracranial aneurysms and subarachnoid hemorrhage (SAH) affects neuronal phospholipid metabolism, and what influence different invasive treatments have on brain free radical phospholipid metabolism. The level of polyunsaturated fatty acid (PUFA) cyclization products - F2-isoprostanes and F4-neuroprostanes - was examined using liquid chromatography - mass spectrometry (LC-MS) in the plasma of patients with brain aneurysm and resulting subarachnoid hemorrhage. It was revealed that an aneurysm leads to the enhancement of lipid peroxidation with a significant increase in plasma F2-isoprostanes and F4-neuroprostanes (more than 3-fold and 11-fold, respectively) in comparison to healthy subjects. The rupture of an aneurysm results in hemorrhage and an additional increase in examined prostaglandin derivatives. The embolization and clipping of aneurysms contribute to a gradual restoration of metabolic homeostasis in brain cells, which is visible in the decrease in PUFA cyclization products. The results indicate that aneurysm development is associated with enhanced inflammation and oxidative stress, factors which favor lipid peroxidation, particularly in neurons, whose membranes are rich in docosahexaenoic acid, a precursor of F4-neuroprostanes.

Genus Zero Graph Segmentation: Estimation of Intracranial Volume

DEFF Research Database (Denmark)

Jensen, Rasmus Ramsbøl; Thorup, Signe Strann; Paulsen, Rasmus Reinhold

2013-01-01

The intracranial volume (ICV) in children with premature fusion of one or more sutures in the calvaria is of interest due to the risk of increased intracranial pressure. Challenges for automatic estimation of ICV include holes in the skull e.g. the foramen magnum and fontanelles. In this paper, we...

Genus zero graph segmentation: Estimation of intracranial volume

DEFF Research Database (Denmark)

Jensen, Rasmus Ramsbøl; Thorup, Signe Strann; Paulsen, Rasmus Reinhold

2014-01-01

The intracranial volume (ICV) in children with premature fusion of one or more sutures in the calvaria is of interest due to the risk of increased intracranial pressure. Challenges for automatic estimation of ICV include holes in the skull e.g. the foramen magnum and fontanelles. In this paper, w...

Idiopathic intracranial hypertension, hormones, and 11β-hydroxysteroid dehydrogenases

DEFF Research Database (Denmark)

Markey, Keira A; Uldall, Maria; Botfield, Hannah

2016-01-01

Idiopathic intracranial hypertension (IIH) results in raised intracranial pressure (ICP) leading to papilledema, visual dysfunction, and headaches. Obese females of reproductive age are predominantly affected, but the underlying pathological mechanisms behind IIH remain unknown. This review provi...

Spontaneous acute subdural hematoma: A rare presentation of a dural intracranial fistula.

Science.gov (United States)

de Aguiar, Guilherme Brasileiro; Veiga, José Carlos Esteves; Silva, João Miguel de Almeida; Conti, Mario Luiz Marques

2016-03-01

Dural arteriovenous fistulas are acquired lesions between the meningeal arteries and their associated draining veins. They may have highly variable clinical presentations and evolution, from severe neurological deficit to no or trivial symptoms. Intracranial hemorrhage occurs in less than 24% of all dural fistulas, and the bleeding is usually subarachnoid, more infrequently intracerebral, and rarely in the subdural space. Here, we present a rare case of a patient who presented with a subdural spontaneous hemorrhage. After investigation by cerebral angiography, the diagnosis of a dural arteriovenous fistula was made. The patient underwent uneventful endovascular treatment. As there are with only a few reports in the literature of such a presentation, we present this patient and perform a brief review of the literature. Copyright © 2015 Elsevier Ltd. All rights reserved.

Clinical findings of intracranial vertebral artery disease using magnetic resonance angiography.

Science.gov (United States)

Liu, Lu-Han; Chen, Clayton Chi-Chang; Chang, Ming-Hong

2004-09-01

The vertebral artery lesion has a variety of clinical characteristics. We sought to clarify the clinical patterns and the location of the intracranial vertebral artery (ICVA) diseases according to analyses of images obtained using magnetic resonance angiography (MRA). We studied vascular lesions, risk factors, symptoms, signs, and outcomes in 35 patients with ICVA disease (3 had bilateral occlusion; 9, unilateral occlusion; 6, bilateral stenosis; and 17, unilateral stenosis). The most common site of unilateral and bilateral lesions was the distal ICVA after the origin of posterior inferior cerebellar artery (PICA). We found accompanying basilar artery disease in 28.6% of patients with unilateral and bilateral ICVA disease. The majority of the ICVA lesions were associated with internal carotid arteries disease (48.8%). The common vascular risk factors were hypertension (71%), diabetes mellitus (34%), hyperlipidemia (31%), smoking (29%), and coronary artery disease (23%). Eighteen patients (51.4%) had transient ischemic attacks (TIAs) only, 10 patients (28.6%) had TIAs before stroke, and 5 patients (14.3%) had strokes without TIAs. Most patients (80%) with TIAs, with or without stroke, had multiple episodes. Vertigo or dizziness, ataxia, limbs weakness and abnormal gait were the common symptoms and signs. At 6 months follow-up, 66.7% patients had no symptoms or only slight symptoms that caused no disability. Our data showed (1) the usual location of ICVA disease (occlusion or severe stenosis) was distal to PICA, especially near the vertebrobasilar junction; (2) the risk factors were hypertension, diabetes mellitus, hyperlipidemia, smoking, and coronary artery disease; (3) patients with ICVA disease had a high frequency of accompanying internal carotid, middle cerebral, or basilar artery disease; (4) vertigo or dizziness, and ataxia were the common symptoms and signs; (5) TIA was the most common clinical pattern; (6) the outcome was favorable, except in cases with

Clinical characteristics associated with the intracranial dissemination of gliomas.

Science.gov (United States)

Cai, Xu; Qin, Jun-Jie; Hao, Shu-Yu; Li, Huan; Zeng, Chun; Sun, Sheng-Jun; Yu, Lan-Bing; Gao, Zhi-Xian; Xie, Jian

2018-03-01

Glioma is the most common malignant tumor of the brain and the intracranial dissemination of gliomas is the late stage of the development of the tumor. However, there is little research in literature on the occurrence of intracranial dissemination of gliomas. In order to provide a reference for clinical work, we carried out this study on intracranial dissemination of glioma. A total of 629 patients with gliomas received tumor resection by the same surgeon from August 2010 to September 2015 were included in this study. The authors performed a retrospective review of the patients and the information regarding clinical features, histopathological results, molecular pathologic results and clinical outcomes was collected and analyzed. In this retrospective study, we found that the intracranial dissemination phenomenon occurred in 53 patients (8.43%). We analyzed the clinical characteristics of patients and found that the age at diagnosis (P = 0.011), WHO grade of the tumor (P dissemination. The higher grade of the tumor, the more prone to disseminate. Deletion of 1p/19q had no significant correlation with the intracranial dissemination. MMP9, Ki-67, and EGFR were highly expressed in tumor cells that caused dissemination, and the level of Ki-67 expression had significance in statistics (P 40 years), high pathological grade, invasion of the corpus callosum and high levels of Ki-67 expression were risk factors associated with the intracranial dissemination of gliomas. Copyright © 2018 Elsevier B.V. All rights reserved.

Fluvoxamine-induced intracranial hypertension in a 10-year-old boy

Directory of Open Access Journals (Sweden)

Hemalini Samant

2018-01-01

Full Text Available Drug-induced intracranial hypertension is a well-established entity. We report a rare case of intracranial hypertension with papilledema in a 10-year-old boy following use of fluvoxamine, a selective serotonin reuptake inhibitor. On discontinuing the drug, the papilledema resolved over 4 months without any residual visual anomalies. To the best of our knowledge, this is the first report of fluvoxamine-induced intracranial hypertension with papilledema.

Pediatric Idiopathic Intracranial Hypertension Presenting With Sensorineural Hearing Loss.

Science.gov (United States)

Reitsma, Sietze; Stokroos, Robert; Weber, Jacobiene W; van Tongeren, Joost

2015-12-01

To present the rare case of a young boy with idiopathic intracranial hypertension presenting with bilateral sensorineural hearing loss developing over several months. This was accompanied by headaches, otalgia, tinnitus, and vertigo. Furthermore, we aim to provide a concise review on this matter, as this report represents the second case in literature of pediatric idiopathic intracranial hypertension presenting with hearing loss. Workup of a 9-year-old boy with bilateral sensorineural hearing loss, including (among others) physical examination, audiometry, diagnostic imaging, and lumbar puncture. Physical examination including fundoscopy as well as imaging showed no abnormalities. At presentation, pure tone audiometry revealed bone conduction thresholds of about 30 dB HL in both ears. Two months later, this declined to about 35 dB HL in both ears. Lumbar puncture revealed an increased intracranial pressure. The boy was thus diagnosed with idiopathic intracranial hypertension. After the lumbar puncture, the otological complaints gradually resolved, and the hearing normalized (bone conduction thresholds of 0-5 dB HL). Although rare, sensorineural hearing loss in the pediatric population together with otalgia, tinnitus, and vertigo can be due to idiopathic intracranial hypertension and as such can be reversible. © The Author(s) 2015.

Effects of excision of a mass lesion of the precentral region of the left hemisphere on disturbances of graphomotor output

NARCIS (Netherlands)

Tucha, Oliver; Tucha, L.I.; Smely, C.; Lange, K.W.

2012-01-01

In the present study, the effect of neurosurgery on graphomotor output of a right-handed female patient with a mass lesion of the precentral region of the left frontal lobe was reported. For examination of handwriting movements a digitizing tablet was used. Preoperatively, the patient showed longer

Cine-MR imaging in determining the flow characteristics of CSF and blood in spinal and intracranial lesions

International Nuclear Information System (INIS)

Post, M.J.D.; Quencer, R.M.; Green, B.A.; Hinks, R.S.; Sklar, E.M.L.; Patchen, S.J.

1988-01-01

The purpose of this prospective study was to determine the value of cine magnetic resonance (MR) imaging in assessing the flow patterns of patients with vascular cord neoplasms, spinal cord and subarachnoid cysts, obstructive hydrocephalus, and intracranial aneurysms. The authors' results in 26 patients showed that cine MR imaging can be used to (1) identify spinal neoplasms with prominent vascular supply; (2) help distinguish spinal cord cysts occurring above a spinal cord tumor from tumoral cysts; (3) determine which spinal cord or subarachnois cysts need shunting and, postoperatively, which cysts are adequately decompressed; (4) establish which tonsillar herniations in Chiari malformations may require resection; (5) determine the site of the block in obstructive hydrocephalus; and (6) determine the flow characteristics of an aneurysm

Increased intracranial volume in Parkinson's disease

DEFF Research Database (Denmark)

Krabbe, Katja; Karlsborg, Merete; Hansen, Andreas

2005-01-01

segmentation and outlining of regions in order to identify regional volume changes that might be useful in the diagnosis of the two diseases. RESULTS: Patients with PD had significantly larger intracranial volumes (ICVs) and significantly smaller putaminal and sustantia nigra volumes than controls. MSA...... patients had significantly smaller substantia nigra and caudate volumes than controls but normal intracranial volume. In both patient groups there was a further trend towards smaller amygdala volumes. DISCUSSION: Increased ICV in PD patients is a new finding that may be explained by genetic factors...

Intracranial osteosarcoma after radiosurgery. Case report

International Nuclear Information System (INIS)

Sanno, Naoko; Hayashi, Shinkichi; Shimura, Toshiro; Maeda, Shotaro; Teramoto, Akira

2004-01-01

A 56-year-old woman presented with an intracranial osteosarcoma at the site of previous radiosurgery, manifesting as sudden onset of headache and left hemiparesis with aphasia. She had a previous history of stereotactic radiosurgery for an intracranial tumor under a diagnosis of falx meningioma. Computed tomography showed intratumoral and peritumoral hemorrhage at the right parietofrontal region. Gross total resection of the tumor with hematoma was performed. The histological diagnosis was osteosarcoma. Sarcomatous change is a rare complication of radiotherapy. This case illustrates that osteosarcoma may develop years after radiosurgery for benign brain neoplasm. (author)

Pregnant woman with an intracranial meningioma – case report and review of the literature

Directory of Open Access Journals (Sweden)

Dumitrescu Bogdan Constantin

2014-12-01

Full Text Available It is about a 33-year-old female, with a 36 weeks uncomplicated pregnancy and with signs of increased intracranial pressure. Hours after admission and an obstetric evaluation, uterine contraction started and the patient was taken to the delivery room, where she presented a partial motor seizure on the left side with secondary generalization and urine emission. A caesarean section was performed without fetal or maternal complications. The urgent MRI gadolinium-enhanced brain scan revealed a 39/50/54 mm tumoral mass having an aspect of an anterior third falx cerebri meningioma. The patient was transferred to our neurosurgical department and afterwards surgery was performed with gross total removal of the tumoral mass. Histological examination revealed atypical meningioma with direct invasion into the adjacent brain parenchyma. A week later she was discharged from the hospital in good condition. One month after surgery, a contrastenhanced magnetic resonance imaging of the brain did not reveal any signs of tumor recurrence or residual tumor. Our recommendation is for postpartum surgery when is possible. Urgent neurosurgical interventions should be made in case of patients with malignant tumors, active hydrocephalus or benign intracranial tumor such as meningioma associated with signs of impending herniation, progress

Endovascular treatment of intracranial venous sinus thrombosis

International Nuclear Information System (INIS)

Xu Shubin; Liang Zhihui; Cui Jinguo; Tian Huiqin; Li Liang; Chen Feng

2009-01-01

Objective: To evaluate the clinical efficacy and safety of endovascular treatment for intracranial venous sinus thrombosis. Methods: Ten patients with intracranial venous sinus thrombosis, confirmed by CT, MRI, MRV and / or DSA and encountered during the period of Aug. 2005-Aug. 2007, were treated with endovascular management after they failed to respond to anticoagulant therapy. Of ten patients, intravenous thrombolysis and mechanical thrombus maceration were carried out in 6, while intravenous thrombolysis, mechanical thrombus maceration together with intra-arterial thrombolysis were employed in 4. After the treatment, the anticoagulant therapy continued for 6 months. The patients were followed up for 12-29 months (mean 21 months). Results: After the treatment, the clinical symptoms and signs were completely or partially relieved in eight patients, including disappearance of headache (n=6) and relive of headache (n=2). No obvious improvement was found in one patient and linguistic function disturbance was seen in the remaining one. Lumbar puncture showed that the cerebrospinal fluid pressure returned to normal in all patients. Neither recurrence of thrombosis nor new symptom of neuralgic dysfunction was observed. No procedure-related intracranial or systemic hemorrhagic complications occurred both during and after the operation. Conclusion: Endovascular treatment is an effective and safe procedure for the potentially catastrophic intracranial venous thrombosis. (authors)

MR imaging characteristics of intracranial hemorrhage using gradient-echo signal acquisition at 1.5 T: Comparison with spin-echo imaging and clinical applications

International Nuclear Information System (INIS)

Atlas, S.W.; Grossman, R.I.; Gomori, J.M.; Hackney, D.B.; Goldberg, H.I.; Bilaniuk, L.T.; Zimmerman, R.A.

1987-01-01

Evolving paramagnetic blood-breakdown products create static local magnetic susceptibility gradients, which induce rapid phase dispersion on the basis of T2/sup */ shortening. The authors evaluated 30 patients with 50 separate hemorrhagic intracranial lesions with both spin-echo (SE) and gradient echo signal acquisition (GESA) MR imaging at 1.5 T. GESA sequences used repetition time (TR) of 200-750 msec, echo time (TE) of 50-80 msec, and flip angles of 10 0 to 15 0 to emphasize T2/sup */-based contributions to contrast. SE sequences in all cases utilized both short and long TR (600 and 2,500-3,000 msec), with TE of 20-120 msec. Advantages of GESA imaging with Long TE and short flip angles in the evaluation of intracranial hemorrhage include (1) increased sensitivity to susceptibility-induced phase loss from T2/sup */ shortening, resulting in detection of hemorrhagic lesions not seen on conventional long TR/long TE SE images, and (2) very rapid acquisition of images with T2/sup */-based contrast. Limitations of this sequence include (1) severe diamagnetic susceptibility-induced artifacts, especially near air-brain interfaces, which often obscure large portions of the brain and occasionally simulate serious pathology, (2) characteristic internal signal intensity patterns demonstrated by SE imaging, such as in evolving hematomas, occult vascular malformations, and hemorrhagic malignancies, are often obscured by marked hypointensity on GESA images, and (3) reduced signal-noise ratio. The authors conclude that, although images with marked sensitivity to T2/sup */ effects can be rapidly generated by GESA, there is only a limited role for this sequence when evaluating intracranial hemorrhage at 1.5 T, and, in fact, significant information is lost when compared to SE images

Cerebrospinal fluid corticosteroid levels and cortisol metabolism in patients with idiopathic intracranial hypertension: a link between 11beta-HSD1 and intracranial pressure regulation?

Science.gov (United States)

Sinclair, Alexandra J; Walker, Elizabeth A; Burdon, Michael A; van Beek, Andre P; Kema, Ido P; Hughes, Beverly A; Murray, Philip I; Nightingale, Peter G; Stewart, Paul M; Rauz, Saaeha; Tomlinson, Jeremy W

2010-12-01

The etiology of idiopathic intracranial hypertension (IIH) is unknown. We hypothesized that obesity and elevated intracranial pressure may be linked through increased 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) activity. The aim was to characterize 11β-HSD1 in human cerebrospinal fluid (CSF) secretory [choroid plexus (CP)] and drainage [arachnoid granulation tissue (AGT)] structures, and to evaluate 11β-HSD1 activity after therapeutic weight loss in IIH. We conducted in vitro analysis of CP and AGT and a prospective in vivo cohort study set in two tertiary care centers. Twenty-five obese adult female patients with active IIH were studied, and 22 completed the study. Fasted serum, CSF, and 24-h urine samples were collected at baseline, after 3-month observation, and after a 3-month diet. Changes in urine, serum, and CSF glucocorticoids (measured by gas chromatography/mass spectrometry and liquid chromatography/tandem mass spectrometry) after weight loss were measured. 11β-HSD1 and key elements of the glucocorticoid signaling pathway were expressed in CP and AGT. After weight loss (14.2±7.8 kg; Plevels correlated with weight loss (r=-0.512; P=0.018). Therapeutic weight loss in IIH is associated with a reduction in global 11β-HSD1 activity. Elevated 11β-HSD1 may represent a pathogenic mechanism in IIH, potentially via manipulation of CSF dynamics at the CP and AGT. Although further clarification of the functional role of 11β-HSD1 in IIH is needed, our results suggest that 11β-HSD1 inhibition may have therapeutic potential in IIH.

Pilomatrix carcinoma presenting as an extra axial mass: clinicopathological features

Directory of Open Access Journals (Sweden)

Gibbons David

2008-11-01

Full Text Available Abstract Pilomatrix carcinoma is the rare malignant counterpart of pilomatrixoma, a skin adnexal tumour originating from hair matrix cells. Pilomatrix carcinoma can arise as a solitary lesion de novo, or through transformation of a pilomatrixoma. Pilomatrixoma was first described erroneously as being of sebaceous gland origin but was later discovered to be derived from hair matrix cells. They are rare, slow growing tumours of the skin found in the lower dermis and subcutaneous fat and are predominantly found in the neck and the scalp. While known to be locally aggressive, no malignant form was thought to exist until it was described relatively recently. Since then, approximately ninety cases of pilomatrix carcinoma have been reported. We report the case of a 41 year old mentally retarded male who had a longstanding lesion in the left neck for approximately fifteen years previously diagnosed as a pilomatrixoma. He presented with severe headache, falls and visual disturbance and a biopsy showed pilomatrix carcinoma of the occipital region which, on computed tomography ( CT invaded the occipital bone, the cerebellum and the left temporal lobe. At his initial presentation he had a craniotomy and subtotal excision of the lesion but received no adjuvant therapy. After an early intracranial recurrence he had further debulking and adjuvant external beam radiotherapy. He has had no further intracranial recurrence after three and a half years of follow-up. Here we present the pathological features of this uncommon tumour.

Pilomatrix carcinoma presenting as an extra axial mass: clinicopathological features.

LENUS (Irish Health Repository)

Aherne, Noel J

2008-01-01

Pilomatrix carcinoma is the rare malignant counterpart of pilomatrixoma, a skin adnexal tumour originating from hair matrix cells. Pilomatrix carcinoma can arise as a solitary lesion de novo, or through transformation of a pilomatrixoma. Pilomatrixoma was first described erroneously as being of sebaceous gland origin but was later discovered to be derived from hair matrix cells. They are rare, slow growing tumours of the skin found in the lower dermis and subcutaneous fat and are predominantly found in the neck and the scalp. While known to be locally aggressive, no malignant form was thought to exist until it was described relatively recently. Since then, approximately ninety cases of pilomatrix carcinoma have been reported.We report the case of a 41 year old mentally retarded male who had a longstanding lesion in the left neck for approximately fifteen years previously diagnosed as a pilomatrixoma. He presented with severe headache, falls and visual disturbance and a biopsy showed pilomatrix carcinoma of the occipital region which, on computed tomography ( CT ) invaded the occipital bone, the cerebellum and the left temporal lobe. At his initial presentation he had a craniotomy and subtotal excision of the lesion but received no adjuvant therapy. After an early intracranial recurrence he had further debulking and adjuvant external beam radiotherapy. He has had no further intracranial recurrence after three and a half years of follow-up. Here we present the pathological features of this uncommon tumour.

Intracranial vessel wall imaging at 7.0 tesla MRI

NARCIS (Netherlands)

van der Kolk, A.G.

2014-01-01

Intracranial atherosclerosis is one of the main causes of ischemic stroke. Current conventional imaging techniques assessing intracranial arterial disease in vivo only visualize the vessel wall lumen instead of the pathological vessel wall itself. Therefore, not much is known about the imaging

Use of shear wave elastography to differentiate benign and malignant breast lesions.

Science.gov (United States)

Çebi Olgun, Deniz; Korkmazer, Bora; Kılıç, Fahrettin; Dikici, Atilla Süleyman; Velidedeoğlu, Mehmet; Aydoğan, Fatih; Kantarcı, Fatih; Yılmaz, Mehmet Halit

2014-01-01

We aimed to determine the correlations between the elasticity values of solid breast masses and histopathological findings to define cutoff elasticity values differentiating malignant from benign lesions. A total of 115 solid breast lesions of 109 consecutive patients were evaluated prospectively using shear wave elastography (SWE). Two orthogonal elastographic images of each lesion were obtained. Minimum, mean, and maximum elasticity values were calculated in regions of interest placed over the stiffest areas on the two images; we also calculated mass/fat elasticity ratios. Correlation of elastographic measurements with histopathological results were studied. Eighty-three benign and thirty-two malignant lesions were histopathologically diagnosed. The minimum, mean, and maximum elasticity values, and the mass/fat elasticity ratios of malignant lesions, were significantly higher than those of benign lesions. The cutoff value was 45.7 kPa for mean elasticity (sensitivity, 96%; specificity, 95%), 54.3 kPa for maximum elasticity (sensitivity, 95%; specificity, 94%), 37.1 kPa for minimum elasticity (sensitivity, 96%; specificity, 95%), and 4.6 for the mass/fat elasticity ratio (sensitivity, 97%; specificity, 95%). SWE yields additional valuable quantitative data to ultrasonographic examination on solid breast lesions. SWE may serve as a complementary tool for diagnosis of breast lesions. Long-term clinical studies are required to accurately select lesions requiring biopsy.

Masticator space lesions: MRI and CT findings

International Nuclear Information System (INIS)

Kim, Seung Hoon; Han, Moon Hee; Chang, Kee Kyun; Kim, Kwang Hyun; Song, Jae Uoo; Jo, In Cheol; Yeon, Kyung Mo

1995-01-01

We evaluated the MR and CT findings of the masticator space lesions in order to identify the differences among the malignant and benign tumors and infectious conditions. MR and CT findings in 46 cases with proven masticator space lesions were reviewed retrospectively. We analysed the involvement of masticator muscles, adjacent spaces, orbit and intracranium, homogeneity, necrosis, cystic changes, growth patterns, calcifications, enhancement patterns, MR signal intensity, and CT attenuation. Among the 29 cases of malignant tumors, seven cases were mandibular tumors including four chondrosarcomas, and 22 cases were extramandibular tumors. Malignant tumors of mandibular origin showed large masses with severe bone destruction and epicenter of mandible. Extramandibular malignant tumors showed the epicenter out of the mandible and less severe bone destruction than mandibular tumors. Among the nine benign tumors, four cases were ameloblastomas which showed the well-defined masses and the expansion of the mandible, and four cases were extramandibular tumors which showed well-marginated extramandibular masses with no bone destruction. Among the eight infectious conditions, five cases were mandibular osteomyelitis with or without abscess formations, and the other three cases were infections from adjacent soft tissue or limited to the soft tissue. By careful observations of growth patterns, involvement of the masticator and adjacent spaces, bone changes, and epicenter of the lesions, one can discriminate a mandibular lesion from an extramandibular lesion. With this approach, it is thought to be easier to suggest a diagnosis among a wide spectrum of masticator lesions

The role of hypertension in bromocriptine-related puerperal intracranial hemorrhage

International Nuclear Information System (INIS)

Kirsch, C.; Iffy, L.; Zito, G.E.; McArdle, J.J.

2001-01-01

The spate of medicolegal inquiries following the disqualification of Parlodel (bromocriptine mesylate) by the Food and Drug Administration for postpartum ablactation, uncovered previously unreported side effects associated with its postpartum administration. In 1994, bromocriptine mesylate was withdrawn from the market as a milk suppressant. Since this time, over a dozen cases of postpartum intracranial hemorrhages associated with its use have been reported. We describe three additional cases of postpartum intracranial hemorrhage related to bromocriptine usage. One patient, previously normotensive, developed hypertension and a headache; initial CT was normal, but CT 24 h later demonstrated intracranial hemorrhage. This suggests that the blood-pressure elevation was drug-induced and was the cause, rather than the consequence, of bromocriptine-related intracranial hemorrhage. (orig.)

The role of hypertension in bromocriptine-related puerperal intracranial hemorrhage

Energy Technology Data Exchange (ETDEWEB)

Kirsch, C. [Dept. of Radiology, University Hospital, Newark, NJ (United States); Iffy, L. [Dept. of Obstetrics, Gynecology and Womens Health, University Hospital, Newark, NJ (United States); Zito, G.E. [Dept. of Neurology, University Hospital, Newark, NJ (United States); McArdle, J.J. [Dept. of Pharmacology, University Hospital, Newark, NJ (United States)

2001-04-01

The spate of medicolegal inquiries following the disqualification of Parlodel (bromocriptine mesylate) by the Food and Drug Administration for postpartum ablactation, uncovered previously unreported side effects associated with its postpartum administration. In 1994, bromocriptine mesylate was withdrawn from the market as a milk suppressant. Since this time, over a dozen cases of postpartum intracranial hemorrhages associated with its use have been reported. We describe three additional cases of postpartum intracranial hemorrhage related to bromocriptine usage. One patient, previously normotensive, developed hypertension and a headache; initial CT was normal, but CT 24 h later demonstrated intracranial hemorrhage. This suggests that the blood-pressure elevation was drug-induced and was the cause, rather than the consequence, of bromocriptine-related intracranial hemorrhage. (orig.)

Space Occupying Lesions in the Liver

OpenAIRE

Nasser Ebrahimi Daryani

2009-01-01

"nRadiology (imaging) plays a pivotal role for the diagnosis, staging, treatment planning, and follow-up of focal liver lesions. The differential diagnosis in patients presenting with a focal liver lesion is broad. "nThe size of the liver mass is an important consideration in guiding the evaluation. Lesions smaller than approximately 1.0 cm are commonly benign incidental findings on imaging studies, and in most cases represent small cysts, hemangiomas, or biliary hamartomas. Further...

NASO FRONTAL LESIONS IN THE MIDLINE OF CHILDREN

Directory of Open Access Journals (Sweden)

Juan Antonio Lugo Machado

2015-04-01

Full Text Available Congenital nasofrontal lesions of the midline are rare congenital abnormalities such as dermoid cysts, nasal gliomas and encephaloceles, with an occurrence of 1: 20,000 to 40,000 births. Its importance lies in the connection to the central nervous system. The biopsy of the lesions with intracranial communication, produce cerebrospinal fluid leaks or meningitis. Objective: To determine the prevalence of midline nasofrontal lesions in a tertiary hospital of regional referral and it´s relationship with other malformations. Material and Methods: Study Design: Transversal retrospective. Male and female patients aged 1 month to 13 years of age with congenital lesions of the nasofrontal midline, treated at Children's Hospital from 1990 to 2005. Sample: was obtained by a non-probabilistic sample of consecutive cases. Through the Statistical Package for the Social Sciences (SPSS version 13.0 which included descriptive statistics: median as a measure of central tendency and frequency distribution and proportion as a measure of dispersion. Results: a review of clinical records was conducted from 1990 to 2005, finding 38 of 67 records reviewed, 29 files were excluded because they correspond to the diagnosis of occipital encephalocele. Prevalence was 38 cases in 15 years. The gender distribution of nasofrontal midline lesions was slightly higher in females with 22 cases and 16 cases in males. The midline nasofrontal lesions found were midline encephalocele, gliomas and dermoid cysts. In our review most encephaloceles were not associated with the central nervous system and 11 cases did have an associated disorder; 5 cases with hydrocephalus and / or temporal or occipital cysts and 6 cases with nondevelopment of the corpus callosum plus hydrocephalus. Conclusion: Our prevalence was 38 cases in 15 years. Nasofrontal midline lesion disgnosis are usually made in the first months of life. Among the types of midline nasofrontal lesions, the most common type found

Contrast-enhanced spectral mammography: Impact of the qualitative morphology descriptors on the diagnosis of breast lesions.

Science.gov (United States)

Mohamed Kamal, Rasha; Hussien Helal, Maha; Wessam, Rasha; Mahmoud Mansour, Sahar; Godda, Iman; Alieldin, Nelly

2015-06-01

To analyze the morphology and enhancement characteristics of breast lesions on contrast-enhanced spectral mammography (CESM) and to assess their impact on the differentiation between benign and malignant lesions. This ethics committee approved study included 168 consecutive patients with 211 breast lesions over 18 months. Lesions classified as non-enhancing and enhancing and then the latter group was subdivided into mass and non-mass. Mass lesions descriptors included: shape, margins, pattern and degree of internal enhancement. Non-mass lesions descriptors included: distribution, pattern and degree of internal enhancement. The impact of each descriptor on diagnosis individually assessed using Chi test and the validity compared in both benign and malignant lesions. The overall performance of CESM were also calculated. The study included 102 benign (48.3%) and 109 malignant (51.7%) lesions. Enhancement was encountered in 145/211 (68.7%) lesions. They further classified into enhancing mass (99/145, 68.3%) and non-mass lesions (46/145, 31.7%). Contrast uptake was significantly more frequent in malignant breast lesions (p value ≤ 0.001). Irregular mass lesions with intense and heterogeneous enhancement patterns correlated with a malignant pathology (p value ≤ 0.001). CESM showed an overall sensitivity of 88.99% and specificity of 83.33%. The positive and negative likelihood ratios were 5.34 and 0.13 respectively. The assessment of the morphology and enhancement characteristics of breast lesions on CESM enhances the performance of digital mammography in the differentiation between benign and malignant breast lesions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Spiral CT angiography and surgical correlations in the evaluation of intracranial aneurysms

International Nuclear Information System (INIS)

Preda, L.; Di Maggio, E.M.; La Fianza, A.; Dore, R.; Fulle, I.; Solcia, M.; Campani, R.; Gaetani, P.; Rodriguez y Baena, R.; Cecchini, A.; Infuso, L.

1998-01-01

We investigated the accuracy of spiral computed tomography angiography (CTA) in the detection and study of intracranial aneurysms by comparing CTA with selective angiograms and surgical findings. Twenty-six patients (9 men and 17 women; mean age 53.1 ± 1.8 years) with suspected intracranial aneurysms were submitted to CTA (1- to 2-mm slices, pitch 1:1, 24 s, RI = 1) after a conventional CT examination showing subarachnoid hemorrhage (SAH) in 19 cases and during neuroradiological investigations performed for other reasons in 7 cases. One hundred twenty to 150 ml iodate contrast agent (0.3-0.4 gI/ml) were injected intravenously at 5 ml/s rate and with 12- to 25-s delay calculated with a preliminary test bolus. Three-dimensional shaded surface display (3D SSD) and maximum intensity projection (MIP) reconstructions were obtained from axial images. Then, within 48 h, all patients were submitted to digital subtraction angiography (DSA), with separate assessment of CTA and DSA findings. Twenty-two aneurysms shown by CTA were confirmed at DSA and surgery (true positives), whereas the vascular lesion was not confirmed at DSA in 2 cases (false positives). The presence of intracranial aneurysms was excluded at both CTA and subsequent DSA in 7 cases (true negatives) and there were no false negatives; sensitivity was 100 %, specificity 77.8 %, and diagnostic accuracy 93.5 %. Computed tomography angiography aneurysm location was confirmed at surgery in all cases, with very high accuracy in assessing the presence of an aneurysm neck (100 %). Computed tomography angiography accurately depicted the aneurysm shape in 20 of 22 cases, but failed to depict its multilobed nature in 2 cases. The mean aneurysm diameter calculated at CTA was 0.99 ± 0.12 cm vs 1.09 ± 0.11 cm at surgery (p < 0.01). The present results suggest that the high sensitivity of CTA, if confirmed by further studies, might help in avoiding having to resort to arteriography after negative CTA in SAH patients. (orig.)

Role of FDG/CT in imaging of renal lesions

International Nuclear Information System (INIS)

Kochhar, R.; Manoharan, P.; Brown, R.K.; Dunnick, N.R.; Frey, K.A.; Wong, C.O.

2010-01-01

Full text: Focal incidental renal lesions are commonly encountered on positron emission tomography (PET)/computed tomography (CT) imaging. The wast majority of these lesions are benign. However, the interpretation of renal lesions can be problematic if the imaging criteria of simple cysts are not met. Limited literature exists on the characterisation of renal masses with metabolic imaging. The purpose of this article is to focus on the imaging features of benign and malignant renal masses with PET/CT. The lesions discussed include renal cyst, angiomyolipoma, oncocytoma, renal cell carcinoma, renal metastases and other infiltrating neoplastic processes affecting the kidney. Both the anatomical and metabolic features which characterise these benign and malignant entities are described. We emphasise the importance of viewing the CT component to identify the typical morphological features and discuss how to best use hybrid imaging for management of renal lesions. Metabolic imaging has a promising role in the imaging of renal lesions and can help prevent unnecessary biopsies and ensure optimal management of suspicious lesions.

The imaging manifestation of intracranial schwannomas not arising from cranial nerves

International Nuclear Information System (INIS)

Luo Boning; Sun Gengxi; Liang Kangfu

2003-01-01

Objective: To report 4 cases of operation-confirmed intracranial schwannomas not arising from cranial nerves, and to discuss the histogenesis and CT and MRI manifestation combining with the literature. Methods: CT and MRI findings of these 4 intracranial schwannomas were analyzed retrospectively and their pathologic characteristics were reviewed. Results: The tumors demonstrated low-iso mixed density with necrotic and cystic areas. Large degeneration even became the prominent characteristics on CT scan. Low-signal to iso-signal intensity on T 1 -weighted images and heterogeneous high-signal intensity on T 2 -weighted images were revealed. The solid portion and the wall of the tumors were moderately enhanced on enhanced CT and MRI scans. Hematoxylin and eosin-stained sections showed two corresponding histological patterns: Antoni Type A and Antoni Type B pattern. The tumor cells exhibited a strong positive staining pattern for s-100 protein. Conclusion: The imaging manifestations of these tumors were similar to that of cranial nerve schwannomas except that the former had higher cystic degeneration rate. We should take that diagnosis into consideration when the mass is not located on cranial nerve but its image feature resembles schwannomas

CBF before and after extracranial-intracranial bypass surgery in patients with ischemic cerebrovascular disease studied with 133Xe-inhalation tomography

DEFF Research Database (Denmark)

Vorstrup, S; Lassen, N A; Henriksen, L

1985-01-01

Cerebral blood flow (CBF) was studied by 133Xenon inhalation tomography in 22 patients with symptoms of ischemic cerebrovascular disease before and after establishment of an extracranial-intracranial bypass shunt. Selection of patients for shunting was based on angiographically demonstrated...... arterial occlusions and on the finding of focal low flow areas corresponding to the clinical symptoms, that consisted mainly of minor stroke with good remission and with or without subsequent TIAs. It was required that the area of low flow should clearly exceed the CT lesion present in practically all...

Biological signatures of asymptomatic extra- and intracranial atherosclerosis: the Barcelona-AsIA (Asymptomatic Intracranial Atherosclerosis) study.

Science.gov (United States)

López-Cancio, Elena; Galán, Amparo; Dorado, Laura; Jiménez, Marta; Hernández, María; Millán, Mónica; Reverté, Silvia; Suñol, Anna; Barallat, Jaume; Massuet, Anna; Alzamora, Maria Teresa; Dávalos, Antonio; Arenillas, Juan Francisco

2012-10-01

Intracranial atherosclerotic disease (ICAD) remains a challenge for stroke primary and secondary prevention. Molecular pathways involved in the development of ICAD from its asymptomatic stages are largely unknown. In our population-based study, we aimed to compare the risk factor and biomarker profiles associated with intracranial and extracranial asymptomatic cerebral atherosclerosis. The Asymptomatic Intracranial Atherosclerosis (AsIA) study cohort includes a random sample population of 933 white subjects >50 years with a moderate to high vascular risk (based on REGICOR score) and without a history of stroke (64% males; mean age, 66 years). Carotid and intracranial atherosclerosis were screened by cervical and transcranial color-coded Duplex ultrasound, being moderate to severe stenoses confirmed by MR angiography. We registered clinical and anthropometric data and created a biobank with blood samples at baseline. A panel of biomarkers involved in atherothrombogenesis was determined: C-reactive protein, asymmetric-dimethylarginine, resistin, and plasminogen activator inhibitor-1. Insulin resistance was quantified by Homeostasis Model Assessment index. After multinomial regression analyses, male sex, hypertension, smoking, and alcoholic habits were independent risk factors of isolated extracranial atherosclerotic disease. Diabetes and metabolic syndrome conferred a higher risk for ICAD than for extracranial atherosclerotic disease. Moreover, metabolic syndrome and insulin resistance were independent risk factors of moderate to severe ICAD but were not risk factors of moderate to severe extracranial atherosclerotic disease. Regarding biomarkers, asymmetric-dimethylarginine was independently associated with isolated ICAD and resistin with combined ICAD-extracranial atherosclerotic disease. Our findings show distinct clinical and biological profiles in subclinical ICAD and extracranial atherosclerotic disease. Insulin resistance emerged as an important molecular

3D printing of intracranial aneurysm based on intracranial digital subtraction angiography and its clinical application.

Science.gov (United States)

Wang, Jian-Li; Yuan, Zi-Gang; Qian, Guo-Liang; Bao, Wu-Qiao; Jin, Guo-Liang

2018-06-01

The study aimed to develop simulation models including intracranial aneurysmal and parent vessel geometries, as well as vascular branches, through 3D printing technology. The simulation models focused on the benefits of aneurysmal treatments and clinical education. This prospective study included 13 consecutive patients who suffered from intracranial aneurysms confirmed by digital subtraction angiography (DSA) in the Neurosurgery Department of Shaoxing People's Hospital. The original 3D-DSA image data were extracted through the picture archiving and communication system and imported into Mimics. After reconstructing and transforming to Binary STL format, the simulation models of the hollow vascular tree were printed using 3D devices. The intracranial aneurysm 3D printing simulation model was developed based on DSA to assist neurosurgeons in aneurysmal treatments and residency training. Seven neurosurgical residents and 15 standardization training residents received their simulation model training and gave high assessments for the educational course with the follow-up qualitative questionnaire. 3D printed simulation models based on DSA can perfectly reveal target aneurysms and help neurosurgeons select therapeutic strategies precisely. As an educational tool, the 3D aneurysm vascular simulation model is useful for training residents.

Graves' disease and idiopathic intracranial hypertension

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