Diffusion Tensor Imaging in brain tumors: A study on gliomas and metastases.

PURPOSE: To explore the role of Diffusion Tensor Imaging in preoperative glioma grading, as well as in differentiation between gliomas and metastatic brain tumors. We measured diffusion tensor variables in enhancement and edema regions, which were compared between the different subject groups. MATERIALS AND METHODS: We performed DTI in 48 patients (11 Low Grade Gliomas, 27 High Grade Gliomas, 10 Single Metastatic brain tumors). We measured FA, λ1, λ2, λ3, ADC, Cl, Cp, Cs, RA, and VR in enhancing portions of tumors and edema regions. Additionally, ratios of enhancement to edema values were created for each variable. RESULTS: In peritumoral edema, Cl and RA were proven to be significantly different in pair-wise comparisons, in addition to ADC, Cp, Cs and VR in enhancement regions. Enhancement to edema values were significantly different as well. CONCLUSION: Diffusion tensor indices could be used for the differentiation between low and high grade gliomas, as well as for distinction between gliomas and metastases.

Imaging of peripheral nerve sheath tumors with pathologic correlation: pictorial review.

Peripheral neurogenic tumors include neurilemoma, neurinoma, and malignant peripheral nerve sheath tumors. All neurogenic tumors share common imaging features. Although differentiation between them is difficult, neurogenic origin can be suggested from their imaging appearances, including fusiform shape, relation to the nerve, "split-fat" sign, associated muscle atrophy and intrinsic imaging characteristics including "target sign" as well as from lesion location along a typical nerve distribution. Our purpose is to make an overview of imaging findings of each type of peripheral nerve sheath tumor with emphasis on characteristic signs and correlate with histologic features. Morton's neuroma and intraneural ganglion are also included as tumors of nerve origin.

Sublingual hypoglossal neurilemmoma. Case report.

Neurilemmomas of the peripheral segment of the hypoglossal nerve are extremely uncommon neoplasms. A rare case of hypoglossal neurilemmoma located in the sublingual space is reported and the differential diagnosis of sublingual mass lesions is discussed.

Spontaneous intracranial hypotension: clinical and neuroimaging findings in six cases with literature review.

Spontaneous intracranial hypotension (SIH) is an uncommon but increasingly recognized syndrome. Orthostatic headache with typical findings on magnetic resonance imaging (MRI) are the key to diagnosis. Delayed diagnosis of this condition may subject patients to unnecessary procedures and prolong morbidity. We describe six patients with SIH and outline the important clinical and neuroimaging findings. They were all relatively young, 20-54 years old, with clearly orthostatic headache, minimal neurological signs (only abducent nerve paresis in two) and diffuse pachymeningeal gadolinium enhancement on brain MRI, while two of them presented subdural hygromas. Spinal MRI was helpful in detecting a cervical cerebrospinal fluid leak in three patients and dilatation of the vertebral venous plexus with extradural fluid collection in another. Conservative management resulted in rapid resolution of symptoms in five patients (10 days-3 weeks) and in one who developed cerebral venous sinus thrombosis, the condition resolved in 2 months. However, this rapid clinical improvement was not accompanied by an analogous regression of the brain MR findings that persisted on a longer follow-up. Along with recent literature data, our patients further point out that SIH, to be correctly diagnosed, necessitates increased alertness by the attending physician, in the evaluation of headaches.

Tolosa-Hunt syndrome with sellar erosion: case report.

The so-called Tolosa-Hunt syndrome consists of painful ophthalmoplegia caused by chronic nonspecific inflammation of the cavernous sinus and/or superior orbital fissure, responsive to steroid therapy. We present a case with the unusual feature of sellar erosion, in which angiography. CT and MRI suggested this idiopathic condition.

Albendazole treatment of cerebral hydatid disease: evaluation of results with CT and MRI.

We report a case of cerebral hydatid disease demonstrated by CT and MRI, treated with albendazole. Follow-up showed complete disappearance of the cysts with residual focal calcification on CT and presumed gliosis on MRI.

MRI appearance of pulmonary Wegener's granulomatosis with concomitant splenic infarction.

The MRI appearance of pulmonary lesions in a patient with Wegener's granulomatosis is presented. Pulmonary involvement was characterized by multiple solid and cavitated nodules connected to vessels. Transbronchial biopsy demonstrated typical findings of granuloma. The spleen presented diffuse low signal intensity and an enhancing capsule on T1-weighted images, and inhomogeneously high signal intensity on T2-weighted images. This appearance of diffuse infarction could result from the vasculitis caused by Wegener's disease.

Value of MRI in the diagnosis of non-clival, non-sacral chordoma.

OBJECTIVE: To determine the MR features of non-sacral, non-clival chordoma and to describe a MR prototype of the lesion. DESIGN AND PATIENTS: We reviewed the MR findings of 10 patients with a histologically proven chordoma (6 cervical spine, 1 thoracic spine, 3 lumbar spine). There were three female and seven male patients. Age ranged from 12 to 66 years with a mean age of 44.6 years. The MR images were reviewed for signal intensity (SI) and morphology. RESULTS: All lesions showed a soft tissue extension spanning several vertebral segments. Most of the lesions exhibited a so-called collar button appearance (sagittal images). Two cases of cervical chordoma displayed a "dumbbell morphology" (axial images) or "mushroom" appearance without bone involvement and with enlargement of the neuroforamen mimicking a neurogenic tumor. Although the region of the nucleus pulposus is the last part of the fetal notochord in the adult to involute, disks were surprisingly spared in all patients. Eight of 10 patients showed heterogeneous SI on all sequences. The overall SI of all lesions was isointense or slightly higher than that of muscle on T1-weighted images. All lesions exhibited high SI on T2-weighted images. After gadolinium contrast administration there was a moderate enhancement in most cases. CONCLUSIONS: Although the SI on MR imaging is not specific, chordoma should be considered when a destructive lesion of a vertebral body is associated with a soft tissue mass with a collar button or mushroom appearance and dumbbell morphology, spanning several vertebral segments and sparing the disk(s).

[Tracheobronchomegaly (Mounier-Kuhn syndrome): roentgen findings and tracheal stent instrumentation]. / Tracheobronchomegalie (Mounier-Kuhn-Syndrom): Röntgenbefunde und tracheale Stentinstallation.

Tracheobronchomegaly is a rare disorder of the lower respiratory tract characterised by marked dilatation of the trachea and the central bronchi associated with recurrent respiratory tract infections. However, some patients with tracheobronchomegaly are not detected because the symptoms are overlooked if chest radiographs alone are used for diagnosis. We encountered two cases of tracheobronchomegaly that were not diagnosed by chest radiographic examinations but were shown clearly with CT. We believe that patients with recurrent pulmonary infection must be examined with the use of CT.

[Boerhaave syndrome: a rare cause of acute thoracic pain]. / Boerhaave-Syndrom: Seltene Ursache akuter Brustschmerzen.

In a 74-year old female patient suffering from acute thoracic pain, vomiting, and dyspnoea, the diagnosis of Boerhaave's syndrome was made. After medical treatment the patient was dismissed in a sufficiently satisfactory condition. If symptoms like vomiting, severe thoracic pain, pneumomediastinum, pneumothorax or hydropneumothorax on the left side occur, a rupture of the oesophagus should be taken into account especially in case of abuse of alcohol. The early diagnosis is decisive for the course of the disease and a lethality reduction.

[Preoperative embolization for extensive facial hemangiomas]. / Die präoperative Embolisierung von ausgedehnten Hämangiomen.

An extensive hemangioma of the lower face is discussed as an example illustrating the use of therapeutic--particularly preoperative--arterial embolization in the treatment of extensive facial hemangiomas. In this procedure a thrombusinducing material is inserted into the lumen of a blood vessel to occlude this vessel, and thus to reduce blood flow to the lesion. This promising technique opens up new possibilities in the treatment of extensive hemangiomas of the maxillofacial region. It may be used either as a definite therapy or as pretreatment procedure enabling a safer and simpler surgical approach.

Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient.

DESIGN: Single case report. OBJECTIVE: To report a rare case of cytomegalovirus (CMV)-associated transverse myelitis (TM) in the immunocompetent host. SETTINGS: Collaboration between a Neurology and Radiology University Department in Greece and a Molecular Virology Department in Cyprus. PATIENT: A 16-year-old male student developed an acute febrile illness followed shortly by TM, that resulted in paraplegia over 24 h. Rapid clinical improvement was followed by complete recovery in 2 months. Extensive laboratory work-up excluded other possible causes of TM and showed no evidence of an immunocompromised state. Antiviral serological data, identification of the viral genome by polymerase chain reaction and serial spinal cord magnetic resonance imaging findings, supported the diagnosis of CMV-associated TM in a non-immunocompromised patient. CONCLUSIONS: Our case further indicates that CMV infection should be included in the differential diagnosis of TM of uncertain etiology, in the immunocompetent patient. Clinical, immunological and neuroimaging findings indicate that post-infectious immune mediated inflammation, seems the most probable pathogenetic mechanism in this case.

Reversible brain atrophy and subcortical high signal on MRI in a patient with anorexia nervosa.

Anorexia nervosa (AN), usually seen in young girls, is characterised by severe emaciation induced by self-imposed starvation. Enlargement of the ventricular system and sulci has been reported, as has high signal on T2-weighted images. We present a case with atrophic changes and high signal on T2-weighted images, which resolved completely following weight gain.