Diagnostic Accuracy of T1-Weighted Dynamic Contrast-Enhanced-MRI and DWI-ADC for Differentiation of Glioblastoma and Primary CNS Lymphoma.

BACKGROUND AND PURPOSE: Glioblastoma and primary CNS lymphoma dictate different neurosurgical strategies; it is critical to distinguish them preoperatively. However, current imaging modalities do not effectively differentiate them. We aimed to examine the use of DWI and T1-weighted dynamic contrast-enhanced-MR imaging as potential discriminative tools. MATERIALS AND METHODS: We retrospectively reviewed 18 patients with primary CNS lymphoma and 36 matched patients with glioblastoma with pretreatment DWI and dynamic contrast-enhanced-MR imaging. VOIs were drawn around the tumor on contrast-enhanced T1WI and FLAIR images; these images were transferred onto coregistered ADC maps to obtain the ADC and onto dynamic contrast-enhanced perfusion maps to obtain the plasma volume and permeability transfer constant. Histogram analysis was performed to determine the mean and relative ADCmean and relative 90th percentile values for plasma volume and the permeability transfer constant. Nonparametric tests were used to assess differences, and receiver operating characteristic analysis was performed for optimal threshold calculations. RESULTS: The enhancing component of primary CNS lymphoma was found to have significantly lower ADCmean (1.1 × 10-3 versus 1.4 × 10-3; P < .001) and relative ADCmean (1.5 versus 1.9; P < .001) and relative 90th percentile values for plasma volume (3.7 versus 5.0; P < .05) than the enhancing component of glioblastoma, but not significantly different relative 90th percentile values for the permeability transfer constant (5.4 versus 4.4; P = .83). The nonenhancing portions of glioblastoma and primary CNS lymphoma did not differ in these parameters. On the basis of receiver operating characteristic analysis, mean ADC provided the best threshold (area under the curve = 0.83) to distinguish primary CNS lymphoma from glioblastoma, which was not improved with normalized ADC or the addition of perfusion parameters. CONCLUSIONS: ADC was superior to dynamic contrast-enhanced-MR imaging perfusion, alone or in combination, in differentiating primary CNS lymphoma from glioblastoma.

Multiple personality as a borderline state.

A case of multiple personality is presented. The primary personality met DSM-III criteria for borderline personality disorder, and displayed several "lower level" borderline defenses as well. The secondary personalities showed other borderline characteristics. Seen as a whole, the patient manifested a more complete spectrum of borderline features than did any of the personalities viewed individually. It is postulated that some patients with multiple personality may be a subset of borderlines, in whom the splitting of self and object representations is so severe that the disparate representations are partitioned and manifested in different "personalities." The importance of preoedipal, as opposed to oedipal, psychopathology suggests that multiple personality may be more properly considered a borderline condition than an hysterical condition.

Posttraumatic stress disorder in Vietnam veterans: a review.

Primary care physicians may encounter patients having posttraumatic stress disorder (PTSD) related to combat experience before they come to the attention of the mental health system. Specific criteria for making the diagnosis of PTSD are now available. Effective psychiatric treatment, particularly group therapy and pharmacotherapy, is now available. Posttraumatic stress disorder can be an important diagnostic consideration in several problems that may be seen by primary care physicians, including multiple somatic complaints, sleep disturbance, substance abuse, and behavior disorders. It is important that such cases be recognized and referred for psychiatric treatment.