Diagnostic Accuracy of Arterial Spin-Labeling, Dynamic Contrast-Enhanced, and DSC Perfusion Imaging in the Diagnosis of Recurrent High-Grade Gliomas: A Prospective Study.

BACKGROUND AND PURPOSE: For patients with high-grade gliomas, the appearance of a new, enhancing lesion after surgery and chemoradiation represents a diagnostic dilemma. We hypothesized that MR perfusion without and with contrast can differentiate tumor recurrence from radiation necrosis. MATERIALS AND METHODS: In this prospective study, we performed 3 MR perfusion methods: arterial spin-labeling, DSC, and dynamic contrast enhancement. For each lesion, we measured CBF from arterial spin-labeling, uncorrected relative CBV, and leakage-corrected relative CBV from DSC imaging. The volume transfer constant and plasma volume were obtained from dynamic contrast-enhanced imaging without and with T1 mapping using modified Look-Locker inversion recovery (MOLLI). The diagnosis of tumor recurrence or radiation necrosis was determined by either histopathology for patients who underwent re-resection or radiologic follow-up for patients who did not have re-resection. RESULTS: There were 26 patients with 32 lesions, 19 lesions with tumor recurrence and 13 lesions with radiation necrosis. Compared with radiation necrosis, lesions with tumor recurrence had higher CBF (P = .033), leakage-corrected relative CBV (P = .048), and plasma volume using MOLLI T1 mapping (P = .012). For differentiating tumor recurrence from radiation necrosis, the areas under the curve were 0.81 for CBF, 0.80 for plasma volume using MOLLI T1 mapping, and 0.71 for leakage-corrected relative CBV. A correlation was found between CBF and leakage-corrected relative CBV (r s = 0.54), volume transfer constant, and plasma volume (0.50 < r s< 0.77) but not with uncorrected relative CBV (r s = 0.20, P = .29). CONCLUSIONS: In the differentiation of tumor recurrence from radiation necrosis in a newly enhancing lesion, the diagnostic value of arterial spin-labeling-derived CBF is similar to that of DSC and dynamic contrast-enhancement-derived blood volume.

The Perplexity Surrounding Chiari Malformations - Are We Any Wiser Now?

Chiari malformations are a diverse group of abnormalities of the brain, craniovertebral junction, and the spine. Chiari 0, I, and 1.5 malformations, likely a spectrum of the same malformation with increasing severity, are due to the inadequacy of the para-axial mesoderm, which leads to insufficient development of occipital somites. Chiari II malformation is possibly due to nonclosure of the caudal end of the neuropore, with similar pathogenesis in the rostral end, which causes a Chiari III malformation. There have been significant developments in the understanding of this complex entity owing to insights into the pathogenesis and advancements in imaging modalities and neurosurgical techniques. This article aims to review the different types and pathophysiology of the Chiari malformations, along with a description of the various associated abnormalities. We also highlight the role of ante- and postnatal imaging, with a focus on the newer techniques in the presurgical evaluation, with a brief mention of the surgical procedures and the associated postsurgical complications.

Posterior spinal cord indentation: imaging findings and clinical outcome.

AIM: To identify the imaging findings associated with worse clinical outcome in posterior spinal cord indentation. MATERIALS AND METHODS: A retrospective search for cases of dorsal cord indentation on magnetic resonance imaging (MRI) from April 2009 to March 2016 was undertaken. Imaging follow-up and clinical data were recorded. Two neuroradiologists blinded to the clinical data assessed the imaging findings. Differences and association of imaging and clinical findings were assessed via t-test and Fisher's exact and chi-squared tests for continuous and categorical data. Inter-rater agreement was calculated. RESULTS: Seventy-three patients were included, 65 were clinically stable, or the finding was incidental and eight had clinical worsening or required surgery. There was a significant difference in the percentage of cord diameter decrease between the two clinical groups (p=0.013, reader 1; p=0.027 reader 2). The clinical course was significantly associated with subjective cord indentation depth assessment (p=0.03 reader 1) and presence of syrinx (p=0.017 reader 2) on original MRI and worsening on imaging follow-up (p=0.03). The interrater agreement was moderate for syrinx identification (k=0.58). There was only fair agreement for the scalpel sign classification and in the final diagnosis (k=0.35 and 0.28). CONCLUSION: The degree of cord indentation, the presence of syrinx, and worsening of imaging findings on follow-up are associated with worse clinical course and can be useful in guiding management and directing subspecialty referrals.

Diagnostic Accuracy of Centrally Restricted Diffusion in the Differentiation of Treatment-Related Necrosis from Tumor Recurrence in High-Grade Gliomas.

BACKGROUND AND PURPOSE: Centrally restricted diffusion has been demonstrated in recurrent high-grade gliomas treated with bevacizumab. Our purpose was to assess the accuracy of centrally restricted diffusion in the diagnosis of radiation necrosis in high-grade gliomas not treated with bevacizumab. MATERIALS AND METHODS: In this prospective study, we enrolled patients with high-grade gliomas who developed a new ring-enhancing necrotic lesion and who underwent re-resection. The presence of a centrally restricted diffusion within the ring-enhancing lesion was assessed visually on diffusion trace images and by ADC measurements on 3T preoperative diffusion tensor examination. The percentage of tumor recurrence and radiation necrosis in each surgical specimen was defined histopathologically. The association between centrally restricted diffusion and radiation necrosis was assessed using the Fisher exact test. Differences in ADC and the ADC ratio between the groups were assessed via the Mann-Whitney U test, and receiver operating characteristic curve analysis was performed. RESULTS: Seventeen patients had re-resected ring-enhancing lesions: 8 cases of radiation necrosis and 9 cases of tumor recurrence. There was significant association between centrally restricted diffusion by visual assessment and radiation necrosis (P = .015) with a sensitivity of 75% and a specificity of 88.9%, a positive predictive value 85.7%, and a negative predictive value of 80% for the diagnosis of radiation necrosis. There was a statistically significant difference in the ADC and ADC ratio between radiation necrosis and tumor recurrence (P = .027). CONCLUSIONS: The presence of centrally restricted diffusion in a new ring-enhancing lesion might indicate radiation necrosis rather than tumor recurrence in high-grade gliomas previously treated with standard chemoradiation without bevacizumab.

Fluorimetric determination of aminoglycoside antibiotics using lanthanide probe ion spectroscopy.

The application of probe ion fluorimetry has succeeded in the microdetermination of six aminoglycoside antibiotics: neomycin, streptomycin, gentamicin, tobramycin, amikacin and kanamycin as sulfate salts in pure form and in some pharmaceutical preparations. The method is based on the reaction of Eu(3+) ions with aminoglycosides through amino and hydroxy groups. Such interactions enhance the intensity of the 616 nm fluorescence emission of the Eu(3+) ion. The fluorescence at 592 nm comes from a non-hypersensitive transition and is not affected by the ligand which is bound to the probe ions. The intensity ratio R, defined as I (592)I (616) was used to determine the amount of free and bound europium ions. A linear relationship between bound europium ions and aminoglycoside was found within the concentration ranges 20-100 ppm for neomycin, 5-60 ppm for streptomycin, and 10-70 ppm for gentamicin, tobramycin, amikacin, and kanamycin as sulfate salts. The percentage recoveries ranged from 99.22 to 101.07, with standard deviations ranging from +/- 1.5 to +/- 4.38. The relative stability constants ranged from 5 x 10(3) to 2 x 10(4). The optimum reaction conditions were studied and the results obtained compared favourably with the fluorimetric method using fluorescmine reagent.

Europium(III) ion probe spectrofluorometric determination of diclofenac sodium.

A new method has been devised for the determination of diclofenac sodium in bulk and in pharmaceutical preparations using Eu3+ ions as the Fluorescent probe. The technique was built around the hypersensitive property of the transitions of the fluorescent probe ion, Eu3+, at 616 nm. This is normally a forbidden transition, but the interaction with diclofenac sodium, which contains a carboxylic group, makes the transition allowed and enhances the intensity of its fluorescence emission. The Eu3+ fluorescence emission at 592 nm comes from a non-hypersensitive transition and is not affected by ligation. The intensity ratio, R, defined as I592/I616, was used as a measure of the percentage of bound probe ions. Diclofenac and Eu(III) forms a (1:1) molar complex. The relative stability constant of the complex was found to be 10(5). A linear relationship between bound Eu3+ and the concentration of diclofenac sodium was found for concentrations from 10 to 200 micrograms ml-1, with a recovery percentage of 100.22 +/- 2.27. The method shows a good agreement with a spectrophotometric method.

Assay of certain oral contraceptive formulations by gas chromatography-mass spectrometry-selected ion monitoring.

The combined technique of gas chromatography--mass spectrometry--selected ion monitoring (GC-MS-SIM) has been employed for the nanogram level determination of ethinyloestradiol, mestranol, norgestrel and norethisterone in various oral contraceptive formulations. Steroids were assayed as their DMES-or methoxime DMES ether derivatives in the presence of ethisterone as the internal standard. The method is accurate, specific and suitable for single tablet assay.

Sensitive colorimetric determination of copper (II) ions in some chemicals and multivitamins.

A sensitive and selective colorimetric method has been devised for the micro-determination of copper (II) ions in pure form, some chemicals and multivitamin preparations. The method depends on the formation of stable blue complexes in ammonia medium peaking at 615 nm between copper (II) ions, oxalyldihydrazide and one of the following aldehydes: 4-nitrobenzaldehyde, 2-nitrocinnamaldehyde and formaldehyde with minimum detection limits 0.1, 0.16 and 1.1 ppm, respectively. Several metal ions do not interfere. The optimum reaction conditions were studied and the results obtained were favorably comparable to the diethyldithiocarbamate method.

Gas chromatography and mass spectrometry of dimethylethylsilyl ether derivatives of norethisterone metabolites in plasma.

Metabolites isolated from human plasma after oral administration of norethisterone were assayed as their novel dimethylethylsilyl ether derivatives by gas chromatography--mass spectrometry--ion selective monitoring. The major metabolite is 3 alpha, 5 alpha-tetrahydronorethisterone. The unchanged drug is present in a measurable amount even after 8 h of drug administration. The method is accurate, precise and highly sensitive.

Gas chromatographic assay of methyltestosterone in tablets.

A simple gas chromatographic procedure has been developed for the determination of methyltestosterone in bulk powders and in tablets. Two new silyl ether derivatives of methyltestosterone have been prepared using dimethylethylsilylimidazole (DMESI) and dimethylisopropylsilylimidazole (DMiPSI). The method is accurate and selective for methyltestosterone within the concentration range 0.1-1.5 micrograms microliters-1.

Non-aqueous titration of quinine and quinidine sulphates by use of barium perchlorate.

A simple non-aqueous titration method has been devised for determining the sulphates of quinine and quinidine. The sulphate is precipitated by addition of excess of barium perchlorate solution in acetic and the liberated alkaloid is then titrated in 1:2 anhydrous acetic-dioxan mixture, with an acetic acid solution of perchloric acid. The end-point is determined either visually with Crystal Violet as indicator or potentiometrically with a glass-Ag/AgCl combination electrode. The method is accurate, precise and suitable for routine analysis of pure materials and tablets.

Determination of phenothiazines by charge-transfer complex formation with chloranilic acid.

A rapid and sensitive spectrophotometrc method has been developed for the microdetermination of some phenothiazine derivatives as the pure substances and in different dosage forms. The method depends on the formation of stable donor-acceptor complexes between phenothiazines and chloranilic acid in an acetonitrile-2-propanol solvent mixture. The resulting intensely purple chloranilic acid radical anion possesses a characteristic absorption maximum at 515 nm. Beer's law is obeyed over the concentration ranges 1-6, 1-10 and 5-30 mug ml for prochlorperazine dimaleate, trifluoperazine dihydrochloride and thiethylperazine dihydrochloride, with apparent molar absorptivities of 7.76 x 10(4), 1.95 x 10(4) and 6.64 x 10(3) 1. mole(-1).cm(-1), respectively. Statistical comparison of the results with those of an official method shows excellent agreement and indicates no significant difference in precision.

Nonaqueous titration of sulfates of quinine and quinidine using barium acetate.

A nonaqueous titrimetric method is proposed for determining the diastereomeric sulfates of quinine and quinidine. The sulfuric acid content of the alkaloid salts is precipitated, in the form of barium sulfate, with acetous barium acetate solution before the liberated alkaloid is titrated; the necessary calculations are provided. A favorable characteristic of the proposed procedure is the accuracy, speed, and ease of performance. The mean percent recoveries (p = 0.05) obtained with the proposed method for the sulfates of quinine and quinidine were 98.84 +/- 1.00 and 99.74 +/- 1.27, respectively, compared with 100.73 +/- 1.44 and 100.82 +/- 1.16, respectively, when the BP 1968 procedure was applied.

Chemistry of nonaqueous titration of chlopromazine.

The chemistry of the red color formed during perchloric acid titration of chlorpromazine hydrochloride in acetic acid in the presence of mercuric acetate is discussed. Addition of ascorbic acid prevents the color formation and allows titration using a crystal violet end-point. Ascorbic acid addition also sharpens the potentiometric end-point. Ascrobic acid and its oxidation product, dehydroascorbic acid, being neutral to perchloric acid, do not interfere with the titration.