Magnetic resonance brain images in schizophrenic and normal subjects: influence of diagnosis and education.

Evidence from computerized tomography (CT) suggests that schizophrenic patients may have smaller brains than normal subjects. Magnetic resonance imaging (MRI), which produces more clearly defined images than CT, was used to measure T1 and brain size of 24 schizophrenic and 24 normal subjects matched for age and sex but not for education. Two transverse images were obtained: slice 1 at the foramina of Monro and slice 2 at the widest part of the lateral ventricles. Adequate T1 instrumental reliability could not be demonstrated. Schizophrenic subjects had smaller right hemispheres (slice 1) and smaller frontal areas (slice 2) than normal subjects. However, when education was taken into account, only the left frontal area (slice 2) was smaller in schizophrenic than in normal subjects. Larger brain areas were associated with better cognitive test scores and fewer neurological signs. Cranial and body size were similar in both diagnostic groups.

Computed tomography of chiasmal optic neuritis.

Three cases of chiasmal optic neuritis are described with bitemporal visual field loss and enlargement of the optic chiasm as demonstrated by computed tomography (CT). Exploratory craniotomies were performed in two of the patients, but no tumor was found. After corticosteroid treatment, all three patients experienced virtually complete restoration of normal vision. Although the CT presentation in these patients was indistinguishable from that of a chiasmal glioma, the clinical presentation of acute visual loss in an older child or adult should suggest chiasmal optic neuritis. A period of observation, with or without a trial of corticosteroids, might permit the latter diagnosis and obviate exploratory craniotomy.

Comparison of computed sonographic tomography and pulse-echo imaging in the head.

Computed sonographic transmission tomograms of infant and adult human cadaver heads are presented and compared with sonographic pulse-echo and x-ray tomograms of the same horizontal planes. The sonographic attenuation tomograms were reconstructed from broadband transmission data obtained using the rotate/translate axial scan mode in much the same way as x-ray tomography is performed. The formalin-fixed infant cadaver head was scanned through the anterior fontanelle using pulse-echo and in a horizontal plane (3.3 cm superior to the Frankfort plane) using both pulse-echo (3.5 MHz and 5 MHz) and transmission sonography (5 MHz). The computed sonographic transmission tomogram revealed superior anatomic detail as compared with the pulse-echo images obtained in the horizontal plane and compared favorably with x-ray scans. The quantitative, noninvasive nature of sonographic tomography shows promise for clinical applicability in the infant. In the adult human cadaver, sonographic tomograms at 750 kHz are presented in both the transskull and excised brain conditions. These scans also offer promise for the possible clinical exploration of the method.

Metrizamide-enhanced computed tomography as an adjunct to metrizamide myelography in the evaluation of lumbar disc herniation and spondylosis.

Eighty patients with operatively proven lumbar disc herniation or lumbar spondylosis were preoperatively evaluated with metrizamide myelography followed by metrizamide-enhanced computed tomography (CT). The x-ray films were reviewed without knowledge of the operative findings, and the patients were subdivided into those with disc extrusions, spondylosis, or recurrent abnormalities. For the group as a whole, CT was correct in 82% and myelography was correct in 77%. Both CT and myelography together were accurate in 91%, a significant improvement (P less than 0.02). The authors conclude that, if both studies are performed, the percentage of cases correctly diagnosed is increased. Therefore, both metrizamide myelography and metrizamide-enhanced CT should be obtained in selected cases. A review of the literature is included.

Radiographic diagnosis of meningioma of the lateral ventricle. Review of 22 cases.

Review of 22 cases of meningioma indicates that this lesion occurs slightly more frequently on the left but without predilection for sex or age of the patient. The presenting symptoms were nonspecific. Plain radiographs of the skull sometimes demonstrated calcification in the tumor, but more often did not. Cerebral angiography frequently showed enlargement and displacement of the anterior choroidal artery on the side of the tumor; the lateral posterior choroidal artery on the side of the tumor was also enlarged and displaced in seven of nine patients who underwent vertebral arteriography. Pneumoencephalography accurately demonstrated the site and size of the lesion, as did radionuclide scanning if the lesion was vascular. Computerized tomographic (TC) scanning also determined the location and size of the tumors, as well as their mass effect and vascularity; CT scanning also demonstrated calcification that was not visible on the plain skull radiographs in two of six patients who underwent CT scanning and had calcification.

Role of intraoperative angiography in the surgical treatment of cerebral aneurysms.

UNLABELLED: The benefit of using intraoperative angiography (IA) during aneurysm surgery is still uncertain. OBJECT: In this prospective study, the authors evaluate the radiographically demonstrated success of surgical treatment in 151 consecutive patients harboring 173 aneurysms who selectively underwent IA examination. The authors also assess the frequency with which IA led to repositioning of the aneurysm clip. METHODS: Intraoperative angiography was used selectively in this series, based on the surgeon's concern about the potential for residual aneurysm, distal branch occlusion, or parent vessel stenosis. Specific variables were analyzed to determine their impact on the incidence of clip repositioning and the accuracy of IA was evaluated by direct comparison with postoperative angiography (PA) in 90% of the cases in which IA was used. CONCLUSIONS: The selective use of IA led to successful treatment as shown by PA, with a low incidence of unexpected residual aneurysm (3.2%), distal branch occlusion (1.9%), and parent vessel stenosis (0%). Intraoperative angiography led to immediate repositioning of the aneurysm clip in 27% of the cases. Anterior cerebral artery aneurysms required clip repositioning less often and superior hypophyseal artery aneurysms required repositioning more often than aneurysms in other locations. Large and giant aneurysms required clip repositioning more often than small aneurysms; however, they were also more likely to display false success on IA as determined by PA. Aneurysms arising along the internal carotid artery were more likely to display successful clipping on IA, as determined by PA, than were aneurysms in other locations. The results of this series support the selective use of IA in the treatment of complex aneurysms, particularly large and giant aneurysms as well as superior hypophyseal artery aneurysms. As measured by PA, IA will improve the outcome of these patients.

Otolaryngologists' role in diagnosis and treatment of orbital pseudotumor.

Patients with pseudotumor of the orbit often present with proptosis, inflammatory changes of the orbital structures, loss of vision, and abnormalities of extraocular motility. Because these signs and symptoms mimic more common disorders of the paranasal sinuses, the otolaryngologist often plays an important role in the diagnosis of this clinical entity. Also, since orbital pseudotumor can be secondary to an inflammatory disease of the paranasal sinuses, appropriate medical and surgical treatment must be rendered by the otolaryngologist. The experience of orbital pseudotumor at Indiana University Medical Center in the Department of Otolaryngology-Head and Neck Surgery is presented. Appropriate diagnostic workup is discussed, including the importance of the CT scan. The differential diagnosis of space-occupying orbital processes is examined. It is important that the otolaryngologist become more familiar with this clinical entity and its appropriate treatment.

Male breast carcinoma and gynecomastia: comparison of mammography with sonography.

Both ultrasonography and x-ray mammography were performed on a male patient who had breast carcinoma. While the x-ray mammographic features were highly suggestive of malignancy, the sonographic findings were subtle. Because of the technical difficulties associated with x-ray mammography of the male breast, ultrasound has been advocated for the evaluation of gynecomastia and breast masses in men. A review of both the ultrasound scans and x-ray mammograms obtained over a three year period of 41 men who had breast enlargement shows the two modalities to be complementary. There was overlap in the appearance of benign and malignant disease on images of each modality alone, and the use of both modalities in the examination of each patient is believed to improve diagnostic accuracy.

Diastematomyelia--rare and unusual features.

Diastematomyelia is an uncommon congenital anomaly of the spine. Four unusual variations of diastematomyelia are presented. These include (1) double diastematomyelia, (2) adult presentation, (3) diastermatomyelia without a septum and unusual termination of two halves of the spinal cord, and (4) recurrence of a fibrous band following removal of an osseous septum.

Cerebral venous angiomas.

Several unusual cases of cerebral venous angiomas as well as some characteristic cases are reported. The characteristic angiographic feature is that of a collection of dilated medullary veins draining into a single large draining vein, which appears first in the early venous phase and persists into the late venous phase of the arteriogram. Computed tomography (CT) was abnormal in 12/13 cases. The draining vein was the most common abnormality identified on CT. Coronal and sagittal reconstruction may be helpful in demonstrating the draining vein. A case of large twin venous angiomas, a case of hemorrhage from a venous angioma, and a case of a venous angioma with an incidentally associated glioblastoma are presented.

Computed tomography of the temporal bone.

Computerized tomography (CT) is useful in otolaryngology, particularly in those patients with pathology of the posterior fossa and skull base. With the current development and improvement of CT scanners, the more detailed anatomy of the temporal bone can now be evaluated. For interpretation, detailed knowledge of the temporal bone and skull base anatomy is essential. The methodology of CT scanning of the temporal bone is presented along with a detailed description of the anatomy both in the axial and the coronal projections. A review of the current CT literature on the temporal bone is with discussion of the advantages and limitations of this diagnostic tool.

Outcome of high-risk neonates with ventriculomegaly.

The authors evaluated 89 infants who had had computed tomography of the head and who were followed-up for a minimum of one year. In a large proportion with moderate ventriculomegaly spontaneous stabilization or regression occurred, with normal developmental outcome in a high percentage of cases. However, there was a statistically significant trend toward lower developmental scores as ventricular size increased. Many infants with ventricular enlargement will not develop progressive hydrocephalus, but their cognitive and psychomotor development may be affected.

Invasive orbital pseudotumor--CT demonstration of extension beyond orbit.

Two cases of orbital pseudotumor are described with computed tomographic (CT) studies showing extension of the pseudotumor beyond the confines of the bony orbit. In one patient with orbital pseudotumor involving the medial rectus muscle, the pseudotumor extended through the medial wall of the orbit into the ethmoid sinus. A second patient had extension of orbital pseudotumor into the infraorbital fissure causing enlargement of the infraorbital fissure and foramen. Both lesions were confirmed by biopsy.

Pitfalls of computed tomography in diagnosis of discitis.

Sixteen patients with discitis from January 1980 through December 1983 underwent 18 CT scans for initial evaluation. In six scans the study produced a false negative result (sensitivity 63%, 11/16). In three of these six the scan was performed at the wrong disc level, and in three the error was interpretive. During the same time period 6 patients had a CT diagnosis of discitis which proved incorrect (positive predictive value 63%), three of which had fractures, two had normal post discectomy changes, and one had a neuropathic arthropathy. These studies were reviewed in a blinded fashion along with 30 CT scans of post operative patients without clinical or laboratory evidence of discitis. The CT findings in the discitis patients were: (a) anterior paravertebral soft tissue swelling with obliteration of paravertebral fat planes, (b) fragmentation or erosions of vertebral end plates, and (c) paravertebral fluid collection (abscess). Both (a) and (b) were seen in 13/15 patients, (a) alone in 1/15, (b) alone in 1/15, and all three (a, b, c) in 2/15. The CT scan is diagnostic of discitis in those with all three findings. In those patients with only (a) or both (a) and (b), the CT can be suggestive of discitis in the proper clinical setting when correlated with plain film findings: however, these CT findings are also observed in other conditions. Involvement of the spinal canal by inflammatory mass was seen in 6/16 patients with discitis. Low attenuation (hypodensity) of the affected disc was not observed.

Cerebral venous angiomas: MR imaging.

Seven patients with angiographically proved cerebral venous angiomas were imaged by magnetic resonance. The venous angioma was identified in all cases. The most characteristic feature was an enlarged transcerebral draining vein (86%), followed by increased signal on T2-weighted images (57%) and decreased signal on T1-weighted images (40%) in adjacent parenchyma. Mass effect was absent in all cases. T2 imaging was more successful in showing the lesions than was T1 imaging.