RESUMEN
CONTEXT: Gliomas are the most common brain tumors. In addition to conventional magnetic resonance imaging (MRI) techniques, a variety of new techniques offers more than the anatomic information. The new MRI techniques include perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI). AIMS: The aim of this study is to assess the sensitivity, specificity, predictive value, and accuracy of diffusion- and perfusion-weighted MRI in the preoperative grading of gliomas. SETTING/DESIGN: The study was conducted in the Department of Neurosurgery, Pathology, and Radiodiagnosis, Sher-e-Kashmir Institute of Medical Sciences, Kashmir, India, which is the only tertiary care neurosurgical center in the state. It was a prospective study. PATIENTS AND METHODS: Thirty-one consecutive patients with gliomas were included in the study. All the patients were evaluated by a standard conventional contrast-enhanced study on Siemens 1.5 Tesla MRI. In addition to the standard MRI, diffusion- and perfusion-weighted MRI were also performed. The histopathological grading of the tumor was done as per the WHO classification of 2007. The sensitivity, specificity, predictive value, and accuracy of diffusion- and perfusion-weighted MRI in determining tumor grade were calculated. Comparison was done between PWI, DWI findings, and WHO histopathological grading. ANALYSIS METHOD: The statistical analysis was done using the Statistical Package for the Social Sciences, and receiver operating characteristic curves were used to estimate sensitivity, specificity, and accuracy. RESULTS: The overall sensitivity of PWI (with regional cerebral blood volume cutoff of 1.7) in the preoperative assessment of high-grade gliomas was 82.6% and specificity was 75%, the positive predictive value (PPV) was 90.48%, and the negative predictive value (NPV) was 60%. The overall accuracy was 80.65%. In case of DWI, the sensitivity was 69.57% and the specificity was 75%, and the PPV and NPVs were 88.8% and 46.15%, respectively. The overall accuracy was 71%. CONCLUSION: Our results clearly show higher accuracy of diffusion- and perfusion-weighted MRI in assessment of glioma grade as compared to conventional MRI. This information can prove very useful for the operating neurosurgeon in preoperative assessment and surgical planning. Postoperatively, the neuropathologist can also benefit from such information.
RESUMEN
Haemophiliac patient are known to have increased mortality and morbidity in the past due to previous non existence of practice of blood banking. Mainly morbidity increased due to the complications arises such as recurrent bleeding episodes, painful haemarthroses and permanent disability secondary to ankylosed joints. This case enlightens the role and impact of undetected changes in Hemophilia A patient with Buergers disease, highlighting the importance of vigilance on the part of the anesthesiologist, who must ensure the adequacy of hemostatic monitoring in these patients. The clinical presentation of Haemophilia A disease with Buergers disease is a rare entity and can be challangeable for practicing anaesthesiology.
En el pasado, los pacientes hemofílicos han tenido una mortalidad y morbilidad aumentada debido a la inexistencia de los bancos de sangre. La morbilidadaumentada está dada principalmente porlas complicaciones como episodios de sangrados recurrentes, hemartrosis dolorosas y discapacidad permanente secundaria a articulaciones anquilosadas. Este caso ilustra el rol y el impacto de los cambios no detectados en un paciente con hemofilia A que cursa también con enfermedadde Buerger, lo que enfatiza la importancia de la vigilancia por parte del anestesiólogo quien debe garantizar una monitoría adecuada de la hemostasia en estos pacientes. La aparición clínica de un caso de hemofilia A asociado a la enfermedad de Buerger es muy infrecuente y es un reto parael anestesiólogo.