Glioma imaging in Europe: A survey of 220 centres and recommendations for best clinical practice.

OBJECTIVES: At a European Society of Neuroradiology (ESNR) Annual Meeting 2015 workshop, commonalities in practice, current controversies and technical hurdles in glioma MRI were discussed. We aimed to formulate guidance on MRI of glioma and determine its feasibility, by seeking information on glioma imaging practices from the European Neuroradiology community. METHODS: Invitations to a structured survey were emailed to ESNR members (n=1,662) and associates (n=6,400), European national radiologists' societies and distributed via social media. RESULTS: Responses were received from 220 institutions (59% academic). Conventional imaging protocols generally include T2w, T2-FLAIR, DWI, and pre- and post-contrast T1w. Perfusion MRI is used widely (85.5%), while spectroscopy seems reserved for specific indications. Reasons for omitting advanced imaging modalities include lack of facility/software, time constraints and no requests. Early postoperative MRI is routinely carried out by 74% within 24-72 h, but only 17% report a percent measure of resection. For follow-up, most sites (60%) issue qualitative reports, while 27% report an assessment according to the RANO criteria. A minority of sites use a reporting template (23%). CONCLUSION: Clinical best practice recommendations for glioma imaging assessment are proposed and the current role of advanced MRI modalities in routine use is addressed. KEY POINTS: • We recommend the EORTC-NBTS protocol as the clinical standard glioma protocol. • Perfusion MRI is recommended for diagnosis and follow-up of glioma. • Use of advanced imaging could be promoted with increased education activities. • Most response assessment is currently performed qualitatively. • Reporting templates are not widely used, and could facilitate standardisation.

Intracranial primary synovial sarcoma: radiologic-pathologic correlation.

We present a very rare case of spontaneous intracranial synovial sarcoma. A 15-year-old female was admitted to our institution for a cervical spine MRI, reporting a gradual pain of the dorsal neck after an injury three months previously. After obtaining the first sequence we discovered a large skull base mass. We immediately performed a skull base MRI. MR arteriography, MR venography, CT and DSA were also performed. A large space-occupying lesion was demonstrated, extending from the right petrous bone to the occipital bone at the level of the foramen magnum and the right atlantooccipital junction. CT revealed calcifications. The MR venography demonstrated diminished flow in the right transverse and sigmoid sinus, as well in the right internal jugular vein. Otorhinolaryngological evaluation revealed a slight ipsilateral conductive hearing loss. The whole mass was macroscopically removed via a retrosigmoid, transmastoid, infratemporal approach. Postoperative course was uneventful, except for complete palsy of the ipsilateral hypoglossal nerve. The final pathological examination including immunohistochemical picture, showed findings consistent with synovial sarcoma (monophasic spindle-cell type).

Intracranial hemorrhagic arachnoid cyst: the role of diffusion-weighted imaging.

The majority of hemorrhagic arachnoid cysts are correlated with trauma or aneurysmal rupture. We report on a 35-year-old woman with acute headache and an intracranial mass lesion that was hyperdense in CT and hyperintense in conventional MRI images. The history and imaging were negative for trauma or vascular anomaly. Diffusion-weighted imaging (DWI) clearly demonstrated a large right anterior and middle cranial fossa arachnoid cyst with associated subacute intracystic hemorrhage without subdural hematoma. DWI offers invaluable information for the differential diagnosis of hemorrhagic arachnoid cysts from other extra-axial space-occupying lesions.

MRI of spinal cord and brain lesions in subacute combined degeneration.

Subacute combined degeneration is a rare cause of demyelination of the dorsal and lateral columns of the spinal cord and even more rarely of the pyramidal and spinocerebellar tracts and cerebellum. We present the initial and follow-up MRI appearances in a patient with subacute combined degeneration of the spinal cord, brain stem and cerebellum, due to vitamin B12 deficiency. The lesions in these structures were demonstrated clearly as pathologically high-signal areas on T2-weighted images. These lesions, except those of the brain stem and cerebellum, disappeared 4 months after therapy. MRI 14 months after the patient's discharge on vitamin B12 therapy showed the same picture.