Heavy metals in plants in constructed and natural wetlands: concentration, accumulation and seasonality.

The accumulation of heavy metals in plants is a function of uptake capacity and intracellular binding sites. The concentrations of heavy metals in plants growing in constructed wetlands vary considerably between species and systems but in general, the concentrations are within the range commonly found in natural stands. The highest concentrations are mostly found in roots, followed by rhizomes, leaves and stems. Unfortunately, concentration values are commonly used to evaluate the 'accumulation' of heavy metals, but this approach is not correct. In order to evaluate heavy metal accumulation, the biomass of particular plant parts must be taken into consideration. In addition, there are two other factors, which need to be taken into consideration when accumulation is evaluated, namely seasonality and distribution within the plant shoot. It has been found that the seasonal distribution of heavy metals in the biomass varies between heavy metals and mostly does not follow the pattern known for nutrients. In addition, the concentration and accumulation of heavy metals vary considerably within the shoot and this fact should be taken into consideration when analyses are carried out.

Are there differences between macrocyclic gadolinium contrast agents for brain tumor imaging? Results of a multicenter intraindividual crossover comparison of gadobutrol with gadoteridol (the TRUTH study).

BACKGROUND AND PURPOSE: Gadobutrol (Gadavist) and gadoteridol (ProHance) have similar macrocyclic molecular structures, but gadobutrol is formulated at a 2-fold higher (1 mol/L versus 0.5 mol/L) concentration. We sought to determine whether this difference impacts morphologic contrast-enhanced MR imaging. MATERIALS AND METHODS: Two hundred twenty-nine adult patients with suspected or known brain tumors underwent two 1.5T MR imaging examinations with gadoteridol or gadobutrol administered in randomized order at a dose of 0.1 mmol/kg of body weight. Imaging sequences and T1 postinjection timing were identical for both examinations. Three blinded readers evaluated images qualitatively and quantitatively for lesion detection and for accuracy in characterization of histologically confirmed brain tumors. Data were analyzed by using the Wilcoxon signed rank test, the McNemar test, and a mixed model. RESULTS: Two hundred nine patients successfully completed both examinations. No reader noted a significant qualitative or quantitative difference in lesion enhancement, extent, delineation, or internal morphology (P values = .69-1.00). One hundred thirty-nine patients had at least 1 histologically confirmed brain lesion. Two readers found no difference in the detection of patients with lesions (133/139 versus 135/139, P = .317; 137/139 versus 136/139, P = .564), while 1 reader found minimal differences in favor of gadoteridol (136/139 versus 132/139, P = .046). Similar findings were noted for the number of lesions detected and characterization of tumors (malignant/benign). Three-reader agreement for characterization was similar for gadobutrol (66.4% [κ = 0.43]) versus gadoteridol (70.3% [κ = 0.45]). There were no significant differences in the incidence of adverse events (P = .199). CONCLUSIONS: Gadoteridol and gadobutrol at 0.1 mmol/kg of body weight provide similar information for visualization and diagnosis of brain lesions. The 2-fold higher gadolinium concentration of gadobutrol provides no benefit for routine morphologic imaging.

Does higher gadolinium concentration play a role in the morphologic assessment of brain tumors? Results of a multicenter intraindividual crossover comparison of gadobutrol versus gadobenate dimeglumine (the MERIT Study).

BACKGROUND AND PURPOSE: Gadobenate dimeglumine has proved advantageous compared with other gadolinium-based contrast agents for contrast-enhanced brain MR imaging. Gadobutrol is a more highly concentrated agent (1.0 mol/L). This study intraindividually compared 0.1-mmol/kg doses of these agents for qualitative and quantitative evaluation of brain tumors. MATERIALS AND METHODS: Adult patients with suspected or known brain tumors underwent 2 identical MR imaging examinations at 1.5T, 1 with gadobenate dimeglumine and the other with gadobutrol, both at a dose of 0.1-mmol/kg body weight. The agents were injected in randomized order separated by 3-14 days. Imaging sequences and acquisition timing were identical for the 2 examinations. Three blinded readers evaluated images qualitatively for diagnostic information (lesion extent, delineation, morphology, enhancement, global preference) and quantitatively for CNR and LBR. RESULTS: One hundred fourteen of 123 enrolled patients successfully underwent both examinations. Final diagnoses were intra-axial tumors, metastases, extra-axial tumors, "other" tumors, and "nontumor" (49, 46, 8, 7, and 4 subjects, respectively). Readers 1, 2, and 3 demonstrated preference for gadobenate dimeglumine in 46 (40.7%), 54 (47.4%), and 49 (43.0%) patients, respectively, compared with 6, 7, and 7 patients for gadobutrol (P < .0001, all readers). Highly significant (P < .0001, all readers) preference for gadobenate dimeglumine was demonstrated for all other qualitative end points. Inter-reader agreement was good for all evaluations (κ = 0.414-0.629). Significantly superior CNR and LBR were determined for gadobenate dimeglumine (P < .019, all readers). CONCLUSIONS: Significantly greater morphologic information and lesion enhancement are achieved on brain MR imaging with 0.1-mmol/kg gadobenate dimeglumine compared with gadobutrol at an equivalent dose.

Gamma knife radiosurgery for endocrine-inactive pituitary adenomas.

BACKGROUND: The goal of nonsecreting pituitary adenoma radiosurgery is to halt tumour growth and to maintain normal performance of the hypophysis and the functionally important structures around the sella. The effectiveness of gamma knife radiosurgery was evaluated. METHOD: Over a period of 10 years (1993-2003), 140 patients with nonsecreting pituitary adenoma were treated by Leksell gamma knife at our Centre. Seventy-nine of them were followed up for longer than 3 years. Their age range was 24-73 years, with a median of 54 years. Eighty-five percent of them had previous open surgery. Fifteen patients had adenoma contact with the optic tract. Fourteen patients had a normally functioning hypophysis, 48 patients had complete panhypopituitarism, while the rest retained partial functions of the normal hypophysis. Adenoma volumes ranged between 0.1 and 31.3, the median being 3.45 ccm. The marginal dose ranged between 12 and -35 Gy, with a median of 20 Gy. FINDINGS: The follow-up ranged from 36 to 122 months, with a median of 60 months. No adenoma growth was detected; 89% of treated adenomas decreased in size, with a median volume reduction of 61%. There was no perimeter vision impairment after radiosurgery, while 4 out of 52 patients with abnormal perimeter vision reported improvement. There was no impairment of oculomotor nerve function. Impairment of hypophysis function was observed in 2 patients. CONCLUSIONS: Radiosurgery has a reliable antiproliferative effect on nonsecreting pituitary adenomas. It is a safe treatment with a low risk of morbidity. Short contact between a nonsecreting pituitary adenoma and the optic pathway is not an absolute contraindication for Gamma knife radiosurgery.

Lesion evolution after gamma knife irradiation observed by magnetic resonance imaging.

PURPOSE: Our study is focused on the magnetic resonance imaging (MRI) observation of lesion development and hippocampus related functional impairments in rats after irradiation with a Leksell Gamma knife (LGK). MATERIALS AND METHODS: We exposed 32 three-month-old Long-Evans rats to various radiation doses (25 Gy, 50 Gy or 75 Gy). The rats were scanned by a 4.7 T magnetic resonance (MR) spectrometer at several timepoints (1 - 18 months) after irradiation. The lesion size was evaluated by manual segmentation; the animals were behaviorally tested in a Morris water maze and examined histologically. RESULTS: We found that a dose of 25 Gy induced no edema, necrosis or behavioral change. The response of the rats to higher doses was not uniform; the first occurrence of lesions in the rat brains irradiated with 50 and 75 Gy was detected six months post-irradiation. Functional impairment correlated well with the lesion size and histology. CONCLUSIONS: Rat brains showed the development of expanding delayed lesions after 50 or 75 Gy doses from the LGK during the first year after irradiation.

[Time perception in functional brain imaging]. / Vnímání casu ve funkcním zobrazení mozku.

BACKGROUND: Knowledge of physiological mechanisms underlying time perception is still rather limited. The aim of our study was to search for a 'time accumulator', i.e. the part of the brain where information on the duration of time is stored. METHODS AND RESULTS: Nine healthy volunteers were given a time reproduction task during event-related fMRI. Subjects were instructed to retain the duration of the stimulus presented (presentation phase) and then to reproduce it by pressing a button (reproduction phase). Two different analyses were made: event-related (P < 0.05, FWR corrected) and parametric (BOLD signal increase/decrease during the presentation/reproduction phases correlated with the time intervals; P < 0.01, FDR corrected). When the event-related approach was employed, activation was noted bilaterally in the inferior prefrontal cortex (IPFC), supplementary motor area (SMA), precuneus and secondary visual cortex. On the right, there was activation in the dorsolateral prefrontal cortex (DLPFC), gyrus cinguli and inferior parietal lobule. On the left, the primary sensory-motor cortex was activated. While during the presentation phase the left DLPFC activity inversely correlated with the presented duration, a nearly identical area showed positive correlation in the reproduction phase. CONCLUSIONS: The event-related analysis did not allow distinguishing the process of time perception from many cognitive processes running simultaneously. In turn, the parametric analysis was based on visualizing regions, in which the signal correlated with the varying duration of the time interval provided the level of attention, decision-making and the processes of behavioral response planning and execution were constant. Moreover, the right and left DLPFC seem to play different roles in time perception. While the left one is functioning as a "time accumulator", the right one is rather involved in the recognition of previously perceived intervals.

[Initial experience with magnetic resonance cholangiopancreatography]. / Nase první zkusenosti s magneticko-rezonancní cholangiopankreatikografií.

BACKGROUND: Magnetic resonance cholangiopancreaticography (MRCP) is based on heavily weighted T2 sequences (ETSE--echo-train spin echo) with suppression of fat, giving visualisation of slowly flowing or stagnating fluid. MRCP are short sequences in coronary plane with thickness of 8 cm or 4 mm. Retrospective analysis of all MRCP examinations performed during last 12 months is presented. METHODS AND RESULTS: Eighty-eight examinations were done, of which 67 ones with both adequate technical quality and clinical indication were included into the study (20 males aged 25-83 years, 47 women aged 19-82 years). Patients were divided into 4 groups regarding to the indications (group I.--temporary cholestasis, normal abdominal ultrasound, II.--definite cholestasis, III.--pathologic findings on pancreas, IV.--other). Vast majority of patients were included into group I (35 subjects). In 7 (20%) of them choledocholithiasis and/or stenoses (including multiple stenoses in primary sclerotizing cholangoitis) were found. MRCP brought diagnostic information in subjects with cholestasis (group II.) and answered questions given by clinicians. However, in 1 of 4 subjects with primary sclerotizing cholangoitis, MRCP did not reveal intra-hepatic stenoses, which were later visualised by classical ERCP. Only the extrahepatic stenoses were diagnosed by MRCP in the latter subject. CONCLUSIONS: MRCP should become a standard examination in the diagnostic algorithm in patients with cholangiopathies. MRCP has its value not only in subjects with unsuccessful or contraindicated ERCP, but also in subjects with temporary cholestasis with negative ultrasound finding.

Horizontal sub-surface flow constructed wetland with pulsing water level.

A constructed wetland with horizontal sub-surface flow at Dolni Mesto (Czech Republic) was put into operation in 1999 and treats municipal wastewater from 522 PE. The total area of vegetated beds of 2,646 m2 is divided into two parallel sections of equal size, each with two beds in series. Between two periods of water discharge there is no outflow from the bed. During the period of September 1999-September 2000 one bed was operated with a pulsing water level while the other one was not pulsing, i.e., was operated as regular sub-surface flow in order to evaluate the effect of pulsing on treatment efficiency, especially on removal of NH4-N. Between September 1999 and February 2000 the pulse was 8 cm, for the rest of the experimental period the pulse was 15 cm. The results indicate a positive effect of pulsing on removal of BOD5 (annual average of 53%), COD (30%) and NH4-N (27%) as compared to non-pulsing beds. For SS, a decrease in removal effect by 30% was observed. This is probably due to the higher outflow velocity of discharged water from pulsing beds which can flush out settled particles. The results also indicate that a pulsing level of 15 cm was more efficient than 8 cm.

Distribution of Mn, Al, Cu and Zn in a constructed wetland receiving municipal sewage.

A constructed wetland at Nucice near Prague, Czech Republic, has been in operation since 1996 and the system is designed to treat sewage from 650 PE together with stormwater. The total area of the beds planted with Phalaris arundinacea and Phragmites australia is 3,224 m2 (two beds 62 x 26 m each). Pea gravel (8/16 mm) is used as a filtration material. During the period 1998-1999, removal of Mn, Al, Cu and Zn from wastewater and distribution of the metals in sediments and plants were studied. Metals were measured in three vertical profiles of the filtration bed (0-15, 15-30 and 30-60 cm) and at four locations along the longitudinal profile of the bed (5, 16, 32, 48 m from the inlet). Metal concentrations in plant tissues (roots, stems, leaves) of Phalaris arundinacea were measured along the longitudinal profile of the bed at the same locations as for sediments. The results showed that the retention of metals is high (up to 98%) with the major decrease in metal concentrations within the first 5 metres of the bed. The major decrease in metal concentration in the filtration material was observed in the inlet zone between 5 and 16 metres. In Phalaris tissue, metal concentrations decreased in the order roots > stems > leaves but statistically significant differences varied among the studied metals.

Chronic liver disease: relaxometry in the brain after liver transplantation.

Relaxometry revealed changes in the basal ganglia in T(1) and T(2) relaxation times due to liver disease. Manganese is probably responsible for T(1) and T(2) shortening (as the concentration is known to be higher in both the liver and blood due to hepatic cirrhosis). The aim of this study was to follow possible recovery after liver transplantation by MR relaxometry. Together with a group of 20 healthy volunteers we scanned 53 patients before and after liver transplantation (some of them repeatedly). Both T(1) and T(2) values were evaluated in the basal ganglia, thalamus, and frontal white matter. T(1) relaxation time was shortened by approx. 20-25% compared to the control group, probably the result of manganese deposition in the brain caused by hepatic cirrhosis. After liver transplantation the relaxation time recovered gradually with almost normal values reached approx. 2 years after surgery. T(1) recovery was observed in all evaluated structures. Similar results were observed with T(2) relaxation in the basal ganglia and thalamus. In the white matter T(2) remained low even 2 years after surgery.

Bacterial dynamics in the sub-surface constructed wetland.

Constructed wetlands have been shown to be capable of removing a wide variety of contaminants, including bacterial pollution. However, only limited information exists on the distribution of bacteria on roots of macrophytes growing in constructed wetlands. Constructed wetland with sub-surface horizontal flow at Nucice near Prague, Czech Republic, was put in operation in 1996. The system treats municipal sewage from 650 PE and the total area of the beds, planted with Phalaris arundinacea and Phragmites australis in alternate stripes perpendicular to the flow direction, is 3,224 m2 (2 beds 62 x 26 m each). Pea gravel (8/16 mm) was used as a filtration material. During the period 1998-1999, distribution of total aerobic and anaerobic bacteria, coliform bacteria and fecal streptococci was monitored in wastewater as well as on roots of both macrophyte species. Counts of bacteria on root surface in the system at Nucice indicate that there is a steep decrease in bacterial numbers within the first few metres of the bed and that there is significantly more bacteria on roots of Phragmites as compared to Phalaris. There was no statistically significant influence of the season on the bacterial counts on roots of macrophytes.

Biota participating in wastewater treatment in a horizontal flow constructed wetland.

During the period 1996-1997, three constructed wetlands with sub-surface horizontal flow were investigated. All systems are designed to treat municipal sewage from small villages (150, 200 and 300 PE). The survey included microscopical identification of organisms in both wastewater and filtration substrate. The organisms were used as an indication of oxygen conditions (aerobic, anoxic and anaerobic) in the particular microenvironment. Saprobiological terms characterizing different levels of saprobity were employed to characterize inflowing wastewater, filtration bed and outflowing water. The occurrence of organisms was correlated with BOD5 values in particular profiles. It has been found that the biocenosis in the inflowing wastewater differs from those found in the filtration bed and water outflowing from the vegetated beds. The organisms were grouped into those living under anaerobic and anoxic conditions and those living under aerobic conditions. More than 70 species of bacteria, amoebae, ciliates, rotifers, colorless flagellates, cyanobacteria and algae were found and the most important 45 species were figured in a plate together with saprobiological information for each species. Biota of the inflowing water is usually restricted to bacteria, ciliata and colorless flagellata while the organisms found in outflowing water as well as in periphyton growing on outflow structures indicate 2-3 levels better quality.

Constructed wetlands for wastewater treatment in the Czech Republic.

The first constructed wetland (CW) for wastewater treatment was built in the Czech Republic in 1989. This recent survey shows that at the end of 1999 101 systems are in operation and several more are under construction. 95 CWs are designed with sub-surface horizontal flow, 6 systems are hybrid with a combination of vertical and horizontal flow beds. Most systems (56) were designed for the treatment of municipal and domestic sewage while 38 CWs were designed for the treatment of wastewater from combined sewer systems. The most commonly used size of vegetated beds is 1,001-2,500 m2 (31 systems) followed by the area between 51-250 m2 (19%). The area of vegetated bed of the largest system is 4,493 m2. Size distribution is quite evenly spread from very small systems (PE = 3 or 4) up to 1,000 PE. However, most systems (44) were sized to treat wastewater from sources between 101 and 500 PE. The most commonly used macrophyte is Common reed (Phragmites australis) which is used in 34 systems as a monotypic stand and in 44 systems in combination with other macrophytes, most frequently with Reed canarygrass (Phalaris arundinacea) (31 systems) and cattails (Typha spp.) (8 systems).

Temperature dependence of polymer-gel dosimeter nuclear magnetic resonance response.

The purpose of this study was to find a physical-mathematical description capable to correct a polymer-gel dosimeter relaxation rate R2-dose response for different temperatures. Four different modifications of polymer-gel dosimeters were used in this study. Samples with polymer-gel dosimeter in glass test vessels were homogeneously irradiated by 60Co gamma photons. A multi-echo sequence with 16 equidistant echoes was used for evaluation of irradiated polymer-gel dosimeters. The sequence parameters were as follows: TR 2000 ms, TE 22.5-360.0 ms, slice thickness 5 mm, FOV 255 mm, one acquisition. The proposed description recommends to subtract R2 response of the nonirradiated dosimeter from the total R2-dose response. The relaxation rate for the irradiated dosimeter can be expressed as a function of temperature and dose. The temperature dependence has an exponential behavior in the measured range. The proposed description allows to correct the measured NMR R2-dose responses for different temperatures.

Differentiation between hemosiderin- and ferritin-bound brain iron using nuclear magnetic resonance and magnetic resonance imaging.

MRI is an optimal clinical (research) tool to provide information on brain morphology and pathology and to detect metal ions that possess intrinsic magnetic properties. Non-heme iron is abundantly present in the brain in three different forms: "low molecular weight" complexes, iron bound to "medium molecular weight complexes" metalloproteins such as transferrin, and "high molecular weight" complexes as ferritin and hemosiderin. The total amount and form of iron may differ in health and disease, and MRI can possibly quantify and monitor such changes. Ferritin-bound iron is the main storage form of iron and is present predominantly in the extrapyramidal nuclei where its amounts normally increase as a function of age. Ferritin is water soluble and shortens both, T1 and T2 relaxation, with as result a signal change on the MR images. Hemosiderin, a degradation product of ferritin, is water-insoluble with a stronger T2 shortening effect than ferritin. The larger cluster size of hemosiderin and its water-insolubility also explain a lack of significant T1-shortening effect on T1-weighted images. Using both in vitro specimens and intact brain tissue in vivo we demonstrate here that MRI may be able to distinguish between ferritin- and hemosiderin-bound iron.

Treatment of postherpetic trigeminal neuralgia with the gamma knife.

OBJECT: Postherpetic neuralgia is a syndrome characterized by intractable pain. Treatment of this pain has not yet been successful. Patients with postherpetic neuralgia will therefore benefit from any progress in the treatment strategy. The authors performed gamma knife radiosurgery (GKS) as a noninvasive treatment for postherpetic trigeminal neuralgia (TN) and evaluated the success rate for pain relief. METHODS: Between 1995 and February 1999, six men and 10 women were treated for postherpetic TN; conservative treatment failed in all of them. The median follow up was 33 months (range 8-34 months). The radiation was focused on the root of the trigeminal nerve in the vicinity of the brainstem (maximal dose 70-80 Gy in one fraction, 4-mm collimator). The patients were divided into five groups according to degree of pain relief after treatment. A successful result (excellent, very good, and good) was reached in seven (44%) patients and radiosurgery failed in nine (56%). Pain relief occurred after a median interval of 1 month (range 10 days-6 months). No radiation-related side effects have been observed in these patients. CONCLUSIONS: These results suggest that GKS for postherpetic TN is a relatively successful and safe method that can be used in patients even if they are in poor condition. In case this method fails, other treatment options including other neurosurgical procedures are not excluded.

Initial experience with gamma knife radiosurgery for advanced glaucoma.

OBJECT: The authors assessed the affect of gamma knife radiosurgery on patients with glaucoma. METHODS: Fifteen eyes in 14 patients were treated with gamma knife radiosurgery during a 14-month period. Ocular pain was alleviated in all patients and intraocular pressure was decreased. There were no early side effects. CONCLUSIONS: Further studies are needed to elucidate the best treatment parameters, long-term results, and some of the pathophysiological effects.

Gamma knife radiosurgery of the brain stem cavernomas.

Over 6 years (1992-1998) 26 patients with brain stem cavernomas were treated using the Leksell gamma knife in Prague. 25 patients had a follow up of 6-66, median 24 months. Annual risk of bleeding before radiosurgery was 4%. After gamma knife treatment sudden impairment of neurodeficit reported as rebleeding was observed in 4 patients at 6-51 months, median 16.5 months, after radiosurgery. This represented a 6.8% risk of rebleeding after radiosurgery, which is not significantly different from the risk before radiosurgery. MRI or CT was performed in 24 patients 6-48, median 24, months after radiosurgery. There were no signs of rebleeding in any of the patients, nor any increase of the cavernoma. A decrease of cavernoma size was observed in 8 (33%) of patients. Temporary collateral edema after radiosurgery was detected in 5 (21%) of patients 3-12, median 11, months after radiosurgery. Neurodeficit was observed in 21 of 26 patients before radiosurgery. Improvement of the neurodeficit was detected in 9 (43%) of them 6-36, median 8, months after radiosurgery. Temporary morbidity caused by collateral edema or rebleeding occurred in 7 patients (28%) and permanent morbidity remained in 2 patients (8%). 2 patients died because of rebleeding 6 and 51 months after radiosurgery and the third patient for unrelated reason. Radiosurgery of the brain stem cavernomas was indicated when there was bleeding in the history or progressive neurodeficit and microsurgery was considered too risky. Leksell gamma knife radiosurgery of cavernomas has proved its low morbidity and zero mortality. In case of an insufficient effect of radiosurgery, or if the protective effect from rebleeding comes too late, morbidity and mortality can correspond to the natural course of the disease, as it was left without any treatment.

[Radiosurgical treatment of hypophyseal adenomas with the gamma knife: results in a group of 163 patients during a 5-year period]. / Radiochirurgické lécení adenomu hypofýzy gama nozem: výsledky u souboru 163 nemocných získané v intervalu 5 let.

BACKGROUND: Gamma knife radiosurgery of pituitary adenomas is considered to be very perspective. It can be a very useful complement of traditional microsurgery, pharmacotherapy or fractionated radiotherapy which are seldom a sufficient treatment on their own. The modern radiosurgery does not offer the experience representative enough in this indication. We can offer results of medium long follow-up for tumor growth and hormonal hypersecretion of pituitary adenomas in a relatively large series of patients. METHODS AND RESULTS: We have analyzed a group of 163 patients with pituitary adenoma treated with gamma knife during 5 years and followed 12-60 months, median 24 months after irradiation. An antiproliferative effect has been achieved in 1-2 years using the minimal dose to the margin 16-35 Gy, median 20 Gy in all our patients who were controlled by MRI (n = 126 patients). One half of these adenomas evidently decreased their size. Our effective antiproliferative dose was safe for the surrounding structures. The hormonal normalization has been achieved at 50.4% from 133 hypersecreting adenomas (39/91 = 43% of acromegalics, 11/13 = 85% of patients with Cushing's disease, 2/9 = 22% of patients with Nelson's syndrome, 11/18 = 61% of prolactinomas). The median latency was 12 months. The minimal dose to the margin was 10-45 Gy, median 35 Gy. Rare side effects were provoked only by increasing the dose to influence the hypersecretion-the development of partial hypopituitarism in 3.1% of patients, the panhypopituitarism in 0.6% of patient and there was 1 hemianopic visual field defect (0.6%). CONCLUSIONS: Radiosurgery by gamma knife has a similar value for pituitary adenomas as microsurgery has with different distribution of advantages and drawbacks. This makes it suitable for the combined treatment where pharmacotherapy has its place under special conditions. Fractionated radiotherapy has now a marginal importance.

Comparison of MR spectroscopy and MR imaging with contrast agent in children with cerebral astrocytomas.

We studied 33 patients with astrocytomas of different grades (68 examinations) by magnetic resonance imaging (MRI) and proton MR spectroscopy ((1)H-MRS). We found that in 80% of the spectra, the presence of signals in the area of 0.8-1.5 ppm, assigned to lipids/lactate in (1)H-MR spectra, correlated with signal enhancement after Gd-DTPA administration. We suggest that visibility of lipid/lactate signals could be due to blood-brain barrier damage, which is characterized by contrast agent enhancement.