Detectability of 18F-choline PET/MR in primary hyperparathyroidism.

PURPOSE: We aimed to evaluate the power of 18F-fluorocholine (FCH) positron emission tomography/magnetic resonance (PET/MR) imaging in unlocalized primary hyperparathyroidism. METHODS: Thirty-four patients were included. In 17/34 patients, PET/MR was performed immediately after a negative 18F-FCH PET/CT. Sensitivity, specificity, positive and negative predictive values were calculated for MR only (blinded to PET data) and PET only (blinded to MR data) findings. RESULTS: 18F-FCH PET/MR was positive in 26/34 (76%) patients. PET/MR was also positive in 12/17 (71%) patients with a negative PET/CT. Among 11/34 (32%) patients where 18F-FCH PET-only and MR-only results were discordant, MR was false positive in 7/11 patients (3/7 of the lesions were not 18F-FCH avid and in 4/7 of them PET and MRI pointed different locations. Postoperative histopathology revealed that 18F-FCH-positive ones were true positives). Sensitivity, specificity, PPV, NPV and accuracy of neck MR evaluated blinded to PET data were 80%, 50%, 70%, 64% and 68%, respectively, and all were calculated as 100% for PET/MR. CONCLUSION: 18F-FCH PET/MR is very effective in preoperative localization of parathyroid adenomas even if 18F-FCH PET/CT is negative. Neck MR alone is insufficient in detecting parathyroid adenomas but PET/MR combination helps in precise localisation.

Evaluation of Extramural Venous Invasion by Diffusion-Weighted Magnetic Resonance Imaging and Computed Tomography in Rectal Adenocarcinoma.

PURPOSE: The aim of this study is to evaluate the diagnostic contribution of diffusion-weighted magnetic resonance imaging (MRI) and computed tomography (CT) to distinguish extramural venous invasion (EMVI) in rectal adenocarcinoma. MATERIALS AND METHODS: Fifty-eight patients who had been diagnosed with rectal adenocarcinoma (30 patients with EMVI and 28 patients without EMVI) were enrolled in the study. Apparent diffusion coefficient (ADC) values of the tumour and the EMVI (+) vein, the lengths of the tumours were measured on MRI. The diameters of the superior rectal vein (SRV)-inferior mesenteric vein (IMV) and distant metastatic spread were evaluated on CT. The ability of these findings to detect EMVI was assessed using receiver operating characteristic (ROC) analysis. Pathology was accepted as the reference test for EMVI. RESULTS: Mean diameters of the SRV (4.9 ± 0.9 mm vs 3.7 ± 0.8 mm) and IMV (6.9 ± 0.8 mm vs 5.4 ± 0.9 mm) were significantly larger (P < .001) and tumour ADC values were significantly lower (0.926 ± 0.281 × 10-3 mm2/s vs 1.026 ± 0.246 × 10-3 mm2/s; P = .032) in EMVI (+) patients. Diameters of 3.95 mm for the SRV (area under the curve [AUC] ± standard error [SE]: 0.851 ± 0.051, P < .001, sensitivity: 93.3%, specificity: 67.9%) and 5.95 mm for the IMV (AUC ± SE: 0.893 ± 0.040, P < .001, sensitivity: 93.3%, specificity: 71.4%) and an ADC value of 0.929 × 10-3 mm2/s (AUC ± SE: 0.664 ± 0.072, P = .032 sensitivity: 76.7%, specificity: 57.1%) were found to be cutoff values, determined by ROC analysis, for detection of EMVI. Distant metastases were significantly more prevalent in EMVI (+) patients (P < .001). CONCLUSION: The measurement of ADC values and SRV-IMV diameters seems to have contribution for diagnosis of EMVI in rectal adenocarcinoma. EMVI (+) patients appear to have higher risks of distant metastases at diagnosis.

Backwash ileitis in ulcerative colitis: Are there MR enterographic features that distinguish it from Crohn disease?

OBJECTIVE: To reveal the MR enterography (MRE) findings that distinguish backwash ileitis (BWI) from terminal ileitis due to Crohn's disease (CD) and to determine the usability of barium studies manifestations (ileocecal valve (ICV) gaping, terminal ileum dilatation) in MRE for the diagnosis of BWI in ulcerative colitis (UC) patients by pointing at the diagnostic performance of these imaging findings. SUBJECTS-METHODS: The study population consisted of patients who were diagnosed as ulcerative colitis (UC), and underwent 1.5 T MRI between August 2011 and November 2017 to rule out small bowel involvement. The matched controls were comprised of Crohn's patients examined at the same period. Ileocolonoscopic/ histopathologic findings were accepted as reference standard. Mural/extramural changes in bowel segments, ileocecal valve (ICV) gaping, terminal ileum dilatation, restricted diffusion and anatomical extent of involvement were evaluated. In UC patients, the association between ICV gaping and terminal ileum dilatation and BWI was assessed by χ2 test. The diagnostic accuracy of these two findings in BWI was determined. RESULTS: Sixty patients were included in the study (30 UC; 30 CD; mean age, 43 years in both groups). Ileocecal valve gaping and terminal ileum dilatation were significantly more frequent among BWI patients (p < 0.001) in UC. Patients with BWI showed a higher rate of pancolitis (88.9%). Median terminal ileum wall thickness was found to be significantly greater in patients with CD (p < 0.001). CONCLUSION: In patients with definite diagnosis of UC, ileocecal valve gaping and terminal ileum dilatation suggest the development of BWI. However, these findings cannot be use to differentiate cause of terminal ileitis in patients with unconfirmed diagnosis and do not give reliable information about the causative factor of ileitis.

Magnetic resonance elastography: basic principles, technique, and clinical applications in the liver.

Magnetic resonance elastography (MRE) is a constantly advancing technique for assessment of stiffness of tissues with newer technology and sequences. It is being increasingly used for the assessment of liver fibrosis. In this article, we discuss the advantages of MRE over biopsy and noninvasive methods such as US elastography in the assessment of liver fibrosis. Image acquisition and interpretation of liver MRE is also discussed.

Intestinal Behçet Disease: Evaluation With MR Enterography-A Case-Control Study.

OBJECTIVE: The purposes of this study were to discern imaging findings that distinguish Behçet disease from small-bowel Crohn disease, to find initial performance estimates for these findings, and to evaluate the diagnostic value of MR enterography (MRE) for detecting intestinal Behçet disease. MATERIALS AND METHODS: The MRE examinations of 30 consecutively registered patients with established intestinal Behçet disease were reviewed by two blinded readers. The frequencies of MRE findings were compared with those obtained for 30 control subjects with small-bowel Crohn disease who were matched for sex and age. The performance estimates were generated with ileocolonoscopic and histopathologic findings as the reference standard. RESULTS: Polypoid pattern and homogeneous mural enhancement were the findings seen more frequently in Behçet disease (p = 0.000) than in Crohn disease (p = 0.003). Stricture formation, long-segment disease, and involvement of more proximal ileal segments favored small-bowel Crohn disease. The ROC AUCs for polypoid pattern and homogeneous mural enhancement in the detection of intestinal Behçet disease were 0.806 and 0.779. The accuracy of MRE was 70.00% (95% CI, 50.60-85.27%); sensitivity, 57.14% (95% CI, 34.02-78.18%), and specificity, 100% (95% CI, 66.37-100%). CONCLUSION: MRE has potential for use as a radiation-free alternative for clarifying the cause of nonspecific gastrointestinal symptoms in patients with known Behçet disease. However, additional studies are needed to determine the actual value of MRE in patients with Behçet disease and to validate the clinical usefulness of the technique in the detection of unknown intestinal Behçet disease.

The effect of magnetic resonance imaging on neural tube development in an early chicken embryo model.

PURPOSE: We aimed to determine whether varying the magnetic field during magnetic resonance imaging would affect the development of chicken embryos and neural tube defects. METHODS: Following incubation for 24 h, we exposed chicken embryos to varying magnetic fields for 10 min to assess the impact on development. Three magnetic resonance imaging devices were used, and the eggs were divided into four groups: group 1 is exposed to 1 T, group 2 is exposed to 1.5 T, group 3 is exposed to 3 T, and group 4, control group, was not exposed to magnetic field. After MRI exposure, all embryos were again put inside incubator to complete 48 h. "The new technique" was used to open eggs, a stereomicroscope was used for the examination of magnified external morphology, and each embryo was examined according to the Hamburger and Hamilton chicken embryo stages. Embryos who had delayed stages of development are considered growth retarded. Growth retardation criteria do not include small for stage. RESULTS: Compared with embryos not exposed to a magnetic field, there was a statistically significant increase in the incidence of neural tube closure defects and growth retardation in the embryos exposed to magnetic fields (p < 0.05). However, although the incidence of neural tube closure defects was expected to increase as exposure (tesla level) increased, we found a higher rate of defects in the 1.5-T group compared with the 3-T group. By contrast, the highest incidence of growth retardation was in the 3-T group, which was consistent with our expectation that growth retardation would be more likely as tesla level increased. CONCLUSIONS: We therefore conclude that the use of magnetic resonance imaging as a diagnostic tool can result in midline closure defects and growth retardation in chicken embryos. We hypothesize that this may also be true for human embryos exposed to MRI. If a pregnant individual is to take an MRI scan, as for lumbar disc disease or any other any other reason, our results indicate that consideration should be given to an avoidance of MRI during pregnancy.

Rectal cancer confined to the bowel wall: the role of 3 Tesla phased-array MR imaging in T categorization.

OBJECTIVE: To determine the diagnostic value of 3 Tesla MR imaging in detection of mucosal (Tis), submucosal (T1) and muscularis propria (T2) invasion in patients with early rectal cancer. METHODS: A total of 50 consecutive patients who underwent 3 Tesla MR imaging and curative-intent intervention for MRI-staged Tis/T1/T2 rectal cancer from March 2012 to December 2016 were included. The radiological T category of each rectal tumour was compared retrospectively with histopathological results assessed according to the tumor, node, metastasis (TNM) classification. The sensitivities, specificities, and overall accuracy rates of 3 Tesla MR imaging for Tis, T1, and T2 cases were calculated using MedCalc statistical software v. 16. RESULTS: The sensitivity, specificity, PPV, NPV of 3 Tesla MR imaging in T categorization for T2 were: 93.7% [95% CI (0.79-0.99)], 77.7% [95% CI (0.52-0.93)], 88.2% [95% CI (0.75-0.94)] and 87.5% [95% CI (0.64-0.96)]; for T1 were 92% [95% CI (0.63-0.99)], 91.8% [95% CI (0.78-0.98)], 80% [95% CI (0.57-0.92)] and 97.1% [95% CI (0.83-0.99)]; for Tis were: 20% [95% CI (0.51-0.71)], 100% [95% CI (0.92-1)], 100%, 91.8% [95% CI (0.87-0.94)], respectively. MR categorization accuracy rates for T2, T1 and Tis were calculated as 88, 92 and 92%, respectively. CONCLUSION: 3 Tesla MR imaging seems to be useful for accurate categorization of T-stage in early rectal cancer, especially for T1 cancers. The method is not a reliable tool to detect Tis cases. The potential for overstaging and understaging of the technique should be realized and taken into consideration when tailoring the treatment protocol for each patient. Advances in knowledge: High-resolution MR with phased-array coil is being increasingly used in the pre-operative assessment of rectal cancer. 3 Tesla high-resolution MR imaging allows improved definition of bowel wall and tumour infiltration.

Successful Bosutinib Experience in an Elderly Acute Lymphoblastic Leukemia Patient with Suspected Central Nervous System Involvement Transformed from Chronic Myeloid Leukemia.

Managing the blast phase in chronic myeloid leukemia (CML) is challenging because limited data are available for elderly patients. The involvement of the central nervous system (CNS) increases the risk of a poor prognosis. Here, we present an elderly blast phase CML patient with suspected CNS involvement who was successfully treated with bosutinib.

MR imaging in diffuse-type hepatocellular carcinoma with synchronous portal vein thrombi.

BACKGROUND/AIMS: Diffuse or continuous multifocal tumors with accompanying portal vein thrombosis yield considerable changes in the magnetic resonance imaging findings of hepatocellular carcinoma. The overlapped imaging findings of these two co-existing pathologies may be confusing. We aimed to evaluate the magnetic resonance imaging findings of widespread hepatocellular carcinoma lesions complicated with portal vein thrombosis. METHODS: Twenty-two patients (20 male, 2 female; mean age: 57 years) with portal vein thrombosis and diffuse-type hepatocellular carcinoma who underwent contrast-enhanced hepatic magnetic resonance imaging in our department between August 2001 and November 2008 were evaluated retrospectively. The unenhanced axial T1-weighted, T2-weighted, and post-contrast early- and late-phase images were reviewed in each patient. RESULTS: On T2-weighted magnetic resonance images, tumors were seen mildly hyperintense in 11 patients and heterogeneously hyperintense in 11 patients. Unenhanced T1-weighted images demonstrated homogeneous hypointensity in 15 patients and heterogeneous hypointensity in 7 patients. Post-contrast early-phase magnetic resonance images showed patchy enhancement in 12 patients, moth-eaten enhancement in 6 patients, strong enhancement in 1 patient, and minimal enhancement in 3 patients. Post-contrast late-phase magnetic resonance images demonstrated heterogeneous washout in all patients. Portal vein thrombosis was present in all patients. The mean diameter of main portal vein thrombi was 27 mm (range: 25-30 mm). Serum alpha-fetoprotein levels were elevated in all patients. CONCLUSIONS: In patients with chronic parenchymal liver disease, when portal vein thrombosis and high serum alpha-fetoprotein values co-exist, careful attention must be paid to the hepatic parenchymal changes, especially on contrast-enhanced images, in order to not overlook diffuse-type hepatocellular carcinoma.

Relationship between levels of serum creatinine and perirenal hyperintensity on heavily T2-weighted MR images.

OBJECTIVE: To determine the frequency of perirenal hyperintensity on heavily T2-weighted images and to evaluate its relationship with serum creatinine levels. SUBJECTS AND METHODS: Axial and coronal single-shot fast spin-echo images which have been originally obtained for MR cholangiopancreatography in 150 subjects were examined by two observers individually for the presence of perirenal hyperintensity. The morphologic properties of perirenal hyperintensity (peripheral rim-like, discontinuous, polar) were recorded. Chi square test was used to test whether the frequencies of bilateral perirenal hyperintensity differ significantly in subjects with high serum creatinine levels and those with normal creatinine levels. This test was also used to compare the frequencies of perirenal hyperintensity in patients with and without renal cysts and in patients with and without corticomedullary differentiation. A p value of less than 0.05 was considered to be statistically significant. RESULTS: The perirenal hyperintensity was identified in 40 of 150 cases (26.6%) on heavily T2-weighted image. Serum creatinine levels were high in 18 of 150 cases (12%). The perirenal hyperintensity was present in 11 of 18 subjects (61%) with high serum creatinine levels and 26 of 132 subjects (19.7%) with normal creatinine levels. The difference of rates in two groups was statistically significant. Odds ratio was 6407 (95% confidence interval 2264 -18,129) . The frequency of perirenal hyperintensity was also significantly higher in subjects with renal cyst or cysts in whom serum creatinine levels were normal (p<0.05) (37.5% vs. 11.8%). CONCLUSION: Perirenal hyperintensities are more frequent in patients with high serum creatinine levels. They are also more common in patients with simple renal cysts.

MR angiography of esophageal mural veins in portal hypertension: a correlation with endoscopic grades of esophageal varices.

BACKGROUND/AIMS: The esophageal mural veins are important for providing blood to the esophageal submucosal varices. The purpose of this study was to investigate any correlation between the diameters of esophageal mural veins as observed on routine contrast-enhanced magnetic resonance angiography and the endoscopic grades of esophageal varices in patients with portal hypertension. METHODS: The images of 57 patients with portal hypertension in whom magnetic resonance portography was performed were evaluated retrospectively. The correlation between the diameter of the esophageal mural veins and the endoscopic grade of the esophageal varices was investigated with Spearman's correlation test. This test was also used to assess the correlation between the grade of esophageal varices and the diameters of the paraesophageal veins. A p value less than 0.05 was considered to be statistically significant. RESULTS: A positive correlation was determined between the diameter of mural veins and the endoscopic grade of the esophageal varices (p=0.022; r=0.363). There was no correlation, however, between the endoscopic grade of the esophageal varices and the diameter of the paraesophageal veins. CONCLUSIONS: A correlation exists between the diameters of the esophageal mural veins and the endoscopic grades of the esophageal varices. Magnetic resonance angiography may give information about the status of the esophageal varices in portal hypertensive patients.

Imaging features of portal biliopathy: frequency of involvement patterns with emphasis on MRCP.

PURPOSE: To investigate the imaging features of portal biliopathy with emphasis on MR cholangiopancreatography (MRCP). The ancillary vascular findings of portal biliopathy were also evaluated by accompanying MR portography, dynamic contrast-enhanced (CE) CT, and dynamic CE MRI studies. MATERIALS AND METHODS: Sixteen patients with portal cavernoma were included in the study. Patients had undergone MRCP (n=16) studies accompanied by MR portography (n=13), dynamic CE CT (n=3) or dynamic CE MRI (n=2) of the liver. Two patients had undergone both dynamic CE CT and dynamic CE MRI. Two radiologists evaluated all the examinations together, retrospectively. MRCP images were analyzed for the presence of biliary stenosis, upstream (prestenotic) dilatation, wavy appearance of the bile ducts, angulation of the common bile duct (CBD), and choledocholithiasis. MR portography, dynamic CE CT and dynamic CE MRI studies were evaluated for the existence of portal cavernomas, and the presence of gall bladder/choledochal varices. RESULTS: All patients had signs of portal biliopathy on MRCP. Frequencies of the biliary findings on MRCP were as follows: biliary stenosis, 93.7%; upstream dilatation, 68.7%; wavy appearance of the biliary tree, 87.5%; angulation of the CBD, 75%. None of the patients had choledocholithiasis. Frequencies of the ancillary vascular findings detected on CE studies were as follows: gall bladder varices, 100%, choledochal varices, 93.7%. CONCLUSION: MRCP features of portal biliopathy in order to their frequencies were as follows: biliary stenosis, wavy appearance of the bile ducts, angulation of the CBD, and upstream dilatation of the bile ducts.

Opposed phase imaging in lumbar disc disease: an option providing faster image acquisition times.

PURPOSE: To investigate the utility of opposed phase imaging (OPI) (in-phase and out-of-phase) in lumbar disc disease. MATERIALS AND METHODS: A total of 127 patients suspected of disc disease were examined with both traditional lumbar spine protocol (fast spin-echo [FSE] T1-weighted, T2-weighted sagittal, and T2-weighted axial) and OPI. Images were evaluated to detect the disc disease and to assess the anatomical clarity of certain spinal structures by two different radiologists using a four-point scale (1 = inadequate, 2 = adequate, 3 = good, and 4 = optimal). Results of two methods in terms of pathologic conditions and anatomical structures were compared. Comparison of the methods and the interpretations of two radiologists were performed by using kappa statistics. The difference among two methods in terms of anatomic clarity was assessed by using Wilcoxon analysis. RESULTS: Disc disease detected by each technique demonstrated concurrence (agreement was 82.4% and 93.1% for two radiologists; P < 0.05). OPI received similar scores with conventional sequences for disc disease (P > 0.05). OPI was optimal in displaying disc, marrow, osteophytes, and hemangiomas, where other structures got higher scores on conventional images (P > 0.05 and P > 0.001). But these structures had equal scores at least in one of the opposed-phase images. Acquisition time for OPI and conventional images were 4.46 and 9.01 minutes, respectively. CONCLUSION: OPI can be a faster backup technique in evaluating the lumbar disc disease. It has a shorter image acquisition time with adequate diagnostic quality. It can be a "time saver" option for busy MR centers or may be used for patients who cannot tolerate longer acquisition times.

Intrabiliary rupture of hepatic hydatid cysts: diagnostic accuracy of MR cholangiopancreatography.

OBJECTIVE: The purpose of this study was to establish the role of MR cholangiopancreatography (MRCP) in the diagnosis of biliary rupture in hepatic hydatid disease. We sought to determine whether the morphologic features of cysts and bile duct abnormalities detected on MRCP are specific enough for identification of intrabiliary rupture. CONCLUSION: If one of the following MRCP findings of apparent connection between hydatid cyst and biliary system, deformation of cyst, focal defect in cyst wall, or beaklike projection extending from cyst wall was present in a patient with hepatic hydatid cyst, the sensitivity of MRCP was 91.7% and the specificity was 82.8% for identification of intrabiliary rupture.

Synovial cyst: an uncommon cause of back pain.

Synovial cyst is an uncommon cause of back pain and radiculopathy. This case report describes the magnetic resonance imaging findings of two lumbar synovial cysts with special emphasis on the differential diagnoses of other extradural cystic lesions.

Cerebral varix simulating a meningioma: use of 3D magnetic resonance venography for diagnosis.

A rare isolated cerebral varix of a superficial convexity cortical vein was described. On conventional magnetic resonance images, the varix was initially interpreted as a meningioma but a subsequent 3D magnetic resonance venography revealed the varix and the associated venous anatomy clearly.

Testicular adrenal rests in a patient with congenital adrenal hyperplasia: US and MRI features.

We present ultrasonographic and magnetic resonance imaging findings of intratesticular adrenal rests in a 16-year-old patient with congenital adrenal hyperplasia. Scrotal ultrasonography showed bilateral well-delineated homogenous hypoechoic lesions located around the mediastinum testis, which were highly vascularized on power Doppler ultrasonography. Relative to normal testicular parenchyma the lesions were iso- or hyperintense on T1-weighted and hypointense on T2-weighted images. T2-weighted images also showed a target-like appearance caused by a more hypointense peripheral halo around the lesions. The lesions enhanced remarkably on post-contrast images. This case suggests that radiological evaluation of testes, even in the presence of normal physical examination findings, should be included in periodical follow-up of patients with congenital adrenal hyperplasia. Magnetic resonance (MR) imaging is useful in demonstrating the lesions, because the contrast resolution better than with ultrasonography.

Evaluation of the splenic vein diameter and longitudinal size of the spleen in patients with Gamna-Gandy bodies.

PURPOSE: The aim of this retrospective study was to compare the splenic vein diameter and longitudinal size of the spleen in patients with portal hypertension in whom Gamna-Gandy bodies were present in their spleen with those of cirrhotic patients without Gamna-Gandy bodies and a control group. MATERIALS AND METHODS: Between July 2001 and February 2006, patients in whom Gamna-Gandy bodies were detected in their spleen and the number of patients who had been undergone magnetic resonance (MR) imaging with the diagnosis of chronic liver disease were determined. A total of 43 cases with Gamna-Gandy bodies were noted. Out of these patients, a case of lymphoma was excluded from the study. Additional 3 cases with splenic vein thrombosis were not included in statistical analysis. Accordingly, the splenic vein diameter and longitudinal size of the spleen in 39 patients (group 1: 12 women, 27 men; mean age, 38.5 years) with portal hypertension in whom Gamna-Gandy bodies were detected in their spleen on T1-weighted gradient-echo MR images between July 2001 and February 2006 were measured. The values obtained were compared with those of 29 cirrhotic patients without Gamna-Gandy bodies (group 2: 14 women, 15 men, mean age 48.2 years) and control group (group 3: 13 women, 18 men, mean age 46.8 years). The differences between the groups were analyzed with ANOVA and student-t test. RESULTS: Gamna-Gandy bodies were detected in 6.3% (42/670) of patients with chronic liver disease. The mean longitudinal axis of the spleen (20.2+/-4.2 cm) in group 1 was significantly greater (p<0.001) than in group 2 (14.4+/-3.9 cm). The mean splenic vein diameter was significantly larger in group 1 (14.3+/-4.0 mm) than those in groups 2 and 3 (11.2+/-3.2 mm and 7.8+/-1.4 mm, respectively). CONCLUSION: The splenic vein diameter and longitudinal size of the spleen in portal hypertensive patients with Gamna- Gandy bodies are significantly larger than that of cirrhotic patients without Gamna-Gandy bodies and that of control group.

Subcutaneous bolus injection of deferoxamine is an alternative method to subcutaneous continuous infusion.

The objective of this study was to compare the short- and long-term efficacy of deferoxamine (DFO) given by subcutaneous (SC) continuous infusion over 10 hours via a pump (n = 10) versus a twice-daily subcutaneous bolus injection of the same overall dose (n = 10) in 20 thalassemic children. Urinary iron excretion was measured in 24-hour urine samples after DFO treatment in the 20 patients. The patients were randomized to two groups: 10 patients continued SC continuous infusion with a pump and the remaining 10 received the same overall dose of DFO by twice-daily SC bolus injection for a year. Serum ferritin levels and T1-weighted spin-echo and T2-weighted fast spin-echo signal intensities of liver and paraspinal muscle were determined at initiation and 1 year after initiation of the therapy. In 12 patients, six from each group, liver biopsies were performed and hepatic iron concentration was determined at initiation of therapy and 1 year after treatment. A similar and significant decrease in ferritin levels and improvement in signal intensities of the liver were observed in response to chelation therapy with DFO in both groups (P < 0.01, within each group). Hepatic iron concentration decreased in all patients in the SC bolus injection group (P < 0.05) and in four patients in the SC continuous infusion group (P > 0.05). Hepatic iron concentration was noted to be slightly increased in two patients in the SC continuous infusion group, which may be due to poor compliance. Based on these results, twice-daily SC bolus injection of DFO is as effective as administration via SC continuous infusion using a pump. Subcutaneous bolus injection, being more convenient for the patient, may be a more preferable method of DFO administration.

Evaluation of petrosal sinus patency with 3-dimensional contrast-enhanced magnetic resonance venography in petroclival meningiomas for surgical strategy.

BACKGROUND: The aim of this study was to perform a detailed anatomical analysis of petroclival venous structures as well as their patencies with 3D contrast-enhanced (CE) magnetic resonance venography (MRV) and to identify the potential contribution of these data to the therapeutic approach. METHODS: Ten patients (8 women and 2 men) with unilateral petroclival meningioma were examined using 3D CE MRV in addition to conventional brain protocol. Both coronal source and multiplanar reconstructed images were evaluated for the anatomical orientation. Patency of the cavernous sinus, superior petrosal sinus (SPS), and inferior petrosal sinus (IPS) was assessed. RESULTS: All the patients had a unilateral meningioma (7 on the right and 3 on the left) at the petroclival region. Both SPS and IPS were visualized with adequate intraluminal contrast enhancement in 6 patients, but IPS was absent in 3 on the lesion side, with a patent superior petrosal sinus as the drainage route. One patient had a partially occluded SPS, with IPS being the main course of cavernous sinus drainage. CONCLUSIONS: Cerebral venous anatomy is a challenge to display with noninvasive methods because of flow dynamics, and CE 3D imaging seems to be the modality of choice to evaluate the variational anatomy and patency, which is essential in petroclival meningiomas. Because the cavernous sinus drains into either IPS or SPS, the patent sinus should be protected in surgery if there is tumoral occlusion of the others.