Long-standing myoclonic hand tremor as an isolated symptom of hypertrophic olivary degeneration.

Hypertrophic olivary degeneration (HOD) is a rare condition caused by lesions of the dentato-rubro-olivary pathway, usually bilateral. We presented a case of a 64-year old male with HOD caused by a unilateral, posterior pontine cavernoma. The patient has not developed the typical palate myoclonus until recently. Isolated hand myoclonus with coexisting asterixis was present for years. This case shows unique HOD symptomatology and emphasizes the important role of MRI in the differential diagnosis of monomelic myoclonus.

The value of different diffusion-weighted magnetic resonance techniques in the diagnosis of middle ear cholesteatoma. Is there still an indication for echo-planar diffusion-weighted imaging?

PURPOSE: The aim of the study was to analyse the value of 2 different diffusion-weighted imaging (DWI) techniques (echo-planar imaging [EPI] and on-echo-planar imaging [non-EPI]) in the diagnosis of cholesteatoma. MATERIAL AND METHODS: Our material consisted of 32 subjects suspected of cholesteatoma, who underwent magnetic resonance imaging of the temporal bone using both EPI and non-EPI DWI. Two independent readers retrospectively analysed magnetic resonance images. Intra- and interobserver agreements as well sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of both DWI sequences were assessed. RESULTS: Using non-EPI DWI all cholesteatomas were correctly diagnosed by both readers with no false negative nor inconclusive cases and with only one false positive result. Non-EPI DWI revealed high interobserver agreement (k = 1) and high correlation with histopathological results (r = 0.895). EPI DWI misdiagnosed 27-31% of cholesteatomas (false negative results), showing also significantly low interobserver agreement (k = 0.373) and low correlation with histopathological results (r = 0.328 for reader 1 and r = 0.267 for reader 2). Non-EPI DWI revealed very high sensitivity (100%), specificity (83.3%), NPV (100%), and PPV (96.3%) in comparison to EPI DWI, which showed lower sensitivity (69.2%), specificity (66.6-83.3%), NPV (33.3-38.4%), and PPV (90.0-94.7%). CONCLUSIONS: Non-EPI DWI with high sensitivity, specificity, and interobserver agreement is a very reliable technique in detecting middle ear cholesteatoma regardless of the pre- or postoperative state of the ear, and it should entirely replace EPI DWI in clinical practice.

The Impact of Common Epidemiological Factors on Gray and White Matter Volumes in Magnetic Resonance Imaging-Is Prevention of Brain Degeneration Possible?

Introduction: The aim of the study was to evaluate the impact of multiple risk factors (age, diabetes, hypertension, hyperlipidemia, BMI, smoking, alcohol) on the gray and white matter volumes as well as on the burden of white matter hyperintensities (WMH). Material and Methods: The study group consisted of 554 subjects (age range: 50-69 yrs, F/M: 367/187) recruited from the larger cohort of the Polish fraction of the Prospective Urban Rural Epidemiological (PURE) study. The participants answered questionnaires about their lifestyle, underwent physical and psychological examination (MoCA test), laboratory blood tests followed by brain MRI. Volumetric measurements of the total gray matter (GMvol), total white matter (WMvol) and WHM (WMHvol) normalized to the total intracranial volume were performed using the Computational Anatomy Toolbox 12 (CAT12) and Statistical Parametric Maps 12 (SPM12) based on 3D T1-weighted sequence. The influence of risk factors was assessed using multiple regression analysis before and after correction for multiple comparisons. Results: Older age was associated with lower GMvol and WMvol, and higher WMHvol (p < 0.001). Smaller GMvol volume was associated with higher WMHvol (p < 0.001). Higher WMHvol was associated with hypertension (p = 0.01) and less significantly with hyperlipidemia (only before correction p = 0.03). Diabetes, abnormal BMI, smoking and alcohol intake did not have any significant impact on GMvol, WMvol or WMHvol (p > 0.05). MoCA score was not influenced by any of the factors. Conclusions: Gray matter loss is strongly associated with the accumulation of WMH which seems to be potentially preventable by maintaining normal blood pressure and cholesterol levels.

Cerebral small vessel disease: A review.

Cerebral small vessel disease (CSVD) is the most common, chronic and progressive vascular disease. The changes affect arterioles, capillaries and small veins supplying the white matter and deep structures of the brain. It is the most common incidental finding on brain scans, especially in people over 80 years of age. Magnetic resonance imaging (MRI) plays a key role in the diagnosis of CSVD. The nomenclature and radiological phenotypes of CSVD were published in 2013 based on the unified position of the so-called Centres of Excellence in Neurodegeneration. The disease is characterized by a diverse clinical and radiological picture. It is primarily responsible for stroke incidents, gait disturbances, depression, cognitive impairment, and dementia in the elderly. The CSVD contributes to about 20% of strokes, including 25% of ischemic strokes and 45% of dementias. Common causes of CSVD include arteriosclerosis, cerebral amyloid angiopathy (CAA), genetic small vessel angiopathy, inflammation and immune-mediated small vessel diseases, and venous collagenosis. There is no causal treatment and management is mainly based on combating known risk factors for cardiovascular disease (CVD).

"Cerebral small vessel disease and other influential factors of cognitive impairment in the middle-aged: a long-term observational cohort PURE-MIND study in Poland".

A complex picture of factors influencing cognition is necessary to be drawn for a better understanding of the role of potentially modifiable factors in dementia. The aim was to assess the prevalence and determinants of cognitive impairment, including the role of cerebral small vessel disease (CSVD) in Polish middle-aged cohort. A comprehensive set of clinical (hypertension, coronary heart disease, diabetes mellitus, hyperlipidaemia, body mass index, smoking status, alcohol intake) and socio-demographic data was collected in the PURE study in years 2007-2016, which was the basis for detailed analysis of risk factors of cognitive impairments in years 2016-2018 in the PURE-MIND sub-study. Five hundred forty-seven subjects (age range 39-65, mean 56.2 ± 6.5) underwent neuropsychological assessment with Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT) and Digit Symbol Substitution Test (DSST) followed by brain MRI. Mean MoCA score was 26.29 and 33% participants met criteria for mild cognitive impairment (MCI) (MoCA< 26). Seventy-three percent showed findings related to CSVD. Higher WMH burden and lacunar infarcts were associated with lower MoCA and DSST scores. Severe CSVD was associated with twofold incidence of MCI, and obesity increased its probability by 53% and hypertension by 37%. The likelihood of MCI was reduced in nonsmokers. One factor analysis showed the important role of lower level of education, older age, rural area of residence and hypertension. MCI and CSVD are highly prevalent in the middle-aged population in Poland. A greater importance should be given to potentially modifiable risk factors of dementia which are already present in mid-life.

Multiple fusiform cerebral aneurysms detected after atrial myxoma resection: a report of two cases.

N/A.

Diffusion and perfusion MR patterns of central nervous system lymphomas.

BACKGROUND: Central nervous system lymphomas (CNSLs) are rare tumors which may show variable appearance in standard magnetic resonance imaging (MRI) depending on their origin (primary or secondary) or patients' immunological status. OBJECTIVES: The aim of the study was to analyze imaging patterns of different CNSLs, using diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI). MATERIAL AND METHODS: Our material consisted of 16 CNSLs (14 primary, 2 secondary, 13 immunocompetent, 3 immunodeficient) which underwent magnetic resonance (MR) examinations including DWI and T2* dynamic susceptibility contrast (DSC) perfusion (without a preload in 13 cases, with a preload in 3 subjects). In DWI, apparent diffusion coefficient (ADC), and in PWI, parameters of relative cerebral blood volume (rCBV), relative peak height (rPH) and relative percentage of signal recovery (rPSR) were analyzed within the entire tumor (mean values) and in regions with minimal diffusion (ADCmin) and maximal perfusion values (rCBVmax, rPHmax, rPSRmax). RESULTS: All CNSLs showed low values of ADCmean (0.70 × 10-3), ADCmin (0.54 × 10-3), rCBVmean (0.80), rCBVmax (1.27), rPHmean (1.05), rPHmax (1.59), as well as high values of rPSRmean (1.99) and rPSRmax (2.41). There were no significant differences in rCBVmax, as well as in all ADC, rPH and rPSR values between primary and secondary CNSLs or between tumors in immunocompetent and immunodeficient patients. Dynamic susceptibility contrast PWI with a preload resulted in significantly higher rCBV, rPH and lower rPSR values. CONCLUSIONS: Despite various MR appearances, both primary and secondary CNSLs in immunocompetent and immunodeficient patients show very typical patterns of restricted diffusion and hypoperfusion with signal intensity curves returning above the baseline. Dynamic susceptibility contrast perfusion without a preload is recommended.

Differentiation of glioblastoma multiforme, metastases and primary central nervous system lymphomas using multiparametric perfusion and diffusion MR imaging of a tumor core and a peritumoral zone-Searching for a practical approach.

INTRODUCTION: In conventional MR examinations glioblastomas multiforme (GBMs), metastases and primary CNS lymphomas (PCNSLs) may show very similar appearance. The aim of the study was to evaluate usefulness of multiparametric T2*DSC perfusion and diffusion MR imaging in the preoperative differentiation of these tumors. MATERIAL AND METHODS: Seventy four solitary enhancing tumors (27 GBMs, 30 metastases, 17 PCNSLs) were enrolled in the study. Parameters of cerebral blood volume (rCBV), peak height (rPH), percentage of signal recovery (rPSR) and apparent diffusion coefficient (ADC) were assessed from the tumor core and the peritumoral non-enhancing T2-hyperintense zone. RESULTS: Within the tumor core there were no differences in perfusion and diffusion parameters between GBMs and metastases. Compared to GBMs and metastases, PCNSLs showed significantly lower rCBV and rPH, ADC as well as higher rPSR values. Max rCBV with a cut-off value of 2.18 demonstrated the highest accuracy of 0.98 in differentiating PCNSLs from other tumors. To distinguish GBMs from metastases analysis of the peritumoral zone was performed showing significantly higher rCBV, rPH and lower ADC values in GBMs with the highest accuracy of 0.94 found for max rCBV at a cut-off value of 0.98. CONCLUSIONS: Max rCBV seems to be the most important parameter to differentiate GBMs, metastases and PCNSLs. Analysis of max rCBV within the tumor core enables to distinguish hypoperfused PCNSLs from hyperperfused GBMs and metastases while evaluation of max rCBV within the peritumoral zone is helpful to distinguish GBMs showing peritumoral infiltration from metastases surrounded by pure edema.

The role of diffusion and perfusion magnetic resonance imaging in differentiation of haemangioblastomas and pilocytic astrocytomas.

PURPOSE: Haemangioblastomas (HABLs) and pilocytic astrocytomas (PAs) are brain tumours presenting similar appearance and location in conventional magnetic resonance (MR) imaging. The purpose of our study was to determine whether a detailed analysis of diffusion (DWI) and perfusion (PWI) characteristics can be useful in preoperative differentiation of these tumours. MATERIAL AND METHODS: The study group consisted of biopsy proven six HABLs and six PAs, which underwent preoperative standard MR examinations including PWI and DWI. In PWI relative cerebral blood volume (rCBV) and the shape of perfusion curves (parameters of peak height - rPH and percentage of signal recovery - rPSR) were analysed. All perfusion parameters were measured for the entire tumour core (mean rCBV, mean rPH, mean rPSR) and in regions with maximal values (max rCBV, max rPH, max rPSR). In DWI parameters of apparent diffusion coefficient (ADC) from the entire tumour core (mean ADC) and in regions with minimal values (min ADC) were evaluated. RESULTS: Compared to PAs, HABLs presented significantly higher rCBV and rPH values and lower mean rPSR value. PAs showed significantly lower rCBV and rPH values and higher mean rPSR value. Mean rCBV showed no overlap in the values between HABLs and PAs, and thus it provided the highest accuracy in differentiating between them. Max rPSR, mean ADC, and min ADC did not show any significant differences. CONCLUSIONS: High rCBV values and deep perfusion curves with only partial return to the baseline are characteristic features of HABLs differentiating them from PAs, which show lower rCBV values and perfusion curves overshooting the baseline. Diffusion parameters are not useful in differentiation of these tumours.

The Role of MR Imaging in the Assessment of Clinical Outcomes in Children with X-Linked Adrenoleukodystrophy after Allogeneic Haematopoietic Stem Cell Transplantation.

BACKGROUND: The aim of the study was to analyse MR images of the brain, including advanced MR techniques, such as single voxel spectroscopy (MRS) and diffusion tensor imaging (DTI), in children with X-linked adrenoleukodystrophy (X-ALD) before and after haematopoietic stem cell transplantation (HSCT) and to establish the imaging criteria which may be helpful in the assessment of disease staging, qualification to HSCT and follow-up. MATERIAL/METHODS: Seven boys, aged 5-10 years, (mean 8.14 years) with biochemically proved X-ALD, underwent plain MR imaging with a 1.5 T unit before and after HSCT. Structural images were analyzed using an MRI severity scale (Loes scale). In one patient the follow-up examinations included MRS with the assessment of metabolite ratios (NAA/Cr, Cho/Cr, mI/Cr), as well as DTI with evaluation of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in several white matter tracts. RESULTS: Two boys had an MRI severity score before HSCT equal to <8 points, and after HSCT they showed no clinical or radiological progression. In 5 patients with a higher severity score (from 8 to 16 points, mean 10.9) before HSCT, clinical and radiological progression was observed (MRI severity score from 17 to 25 points, mean 20.9). Follow-up advanced MRI techniques in one boy showed metabolic alterations, as well as decreased FA and ADC values in all evaluated areas. CONCLUSIONS: Children at an early stage of X-ALD (below 8 points in MRI severity scale) are more likely to benefit from HSCT. DTI and MRS seem to be more useful imaging methods to assess the progression of X-ALD.

Central nervous system lymphoma in a 3-year-old male suffering from a severe juvenile xanthogranuloma - the usefulness of perfusion weighted imaging and diffusion weighted imaging in the diagnostics of pediatric brain tumors.

BACKGROUND: Primary Central Nervous System Lymphomas (PCNSLs) are rare, malignant brain tumors derived from lymphocytes B. Juvenile xanthogranuloma (JXG) is a non-Langerhans histiocytic cell disorder in children which mostly affects the skin. Rare fatalities have been reported in extracutaneous manifestation. Brain magnetic resonance imaging (MRI) is a method of choice in the diagnostics of all neoplastic CNS lesions. Perfusion weighted imaging (PWI) and diffusion weighted imaging (DWI) allow for more detailed analysis of brain tumors including the rate of neoangiogenesis and cellularity. We presented a pediatric patient suffering from JXG with CNS involvement and the role of brain MRI including DWI and PWI in the evaluation of brain focal lesions. CASE REPORT: A 3-year-old male with severe JXG underwent two stem cell transplantations with a development of neurological complications. The patient underwent emergency CT and MRI which revealed a non-specific enhancing focal brain lesion. In DWI it showed restricted diffusion while PWI revealed low values of rCBV and the signal intensity curve returning above the baseline level. Advanced MRI techniques such as DWI and PWI suggested PCNSL. Stereotactic biopsy confirmed PCNSL due to Ebstein-Barr virus reactivation. CONCLUSIONS: The use of advanced MRI sequences is important to differentiate brain lesions in pediatric patients. The use of PWI and DWI facilitated the diagnosis of PCNSL. It is important to remember that PCNSLs show a very typical pattern of changes visualized with MRI such as: usually strong homogenous enhancement, restricted diffusion and low perfusion.

Usefulness of perfusion weighted magnetic resonance imaging with signal-intensity curves analysis in the differential diagnosis of sellar and parasellar tumors: preliminary report.

PURPOSE: The most common pituitary tumors are adenomas, which however may be mimicked by other tumors that can show a very similar appearance in plain MRI. The aim of our study was to evaluate the usefulness of perfusion weighted MR imaging (PWI), including signal-intensity curves analysis in the differential diagnosis of sellar/parasellar tumors. METHODS: Forty-one patients with sellar/parasellar tumors (23 macroadenomas, 10 meningiomas, 5 craniopharyngiomas, 1 intrasellar hemangioblastoma, 1 intrasellar prostate cancer metastasis, 1 suprasellar glioma), underwent plain MRI followed by PWI using a 1.5T unit. In each tumor, the mean and maximum values of relative cerebral blood volume (rCBV), as well as the relative peak height (rPH) and the relative percentage of signal intensity recovery (rPSR) were calculated. RESULTS: The high perfusion tumors were: macroadenomas, meningiomas, squamous-papillary type of craniopharyngiomas, hemangioblastoma, glioma and metastasis. The low perfusion neoplasms included adamantinomatous type of craniopharyngiomas. By comparing adenomas and meningiomas, we found statistically significant differences in the mean and maximum rCBV values (p=0.026 and p=0.019, respectively), but not in rPH and rPSR. The maximum rCBV values >7.14 and the mean rCBV values >5.74 with the typical perfusion curve were very suggestive of the diagnosis of meningioma. There were differences between adenomas and other high perfusion tumors in rPH and rPSR values. CONCLUSIONS: PWI can provide additional information helpful in differential diagnosis of sellar/parasellar tumors. In our opinion PWI, as an easy to perform and fast technique should be incorporated into the MR protocol of all intracranial neoplasms including sellar/parasellar tumors.

Intracranial lesions with high signal intensity on T1-weighted MR images - review of pathologies.

In the article we present pathological intracranial substances and lesions, which produce high signal intensity on T1-weighted MR images. Six groups of substances are discussed: 1. Gadolinium - based contrast agents, 2.hemoglobin degradation products (intra- and extra-cellular methemoglobin), 3. lipid-containing lesions (lipoma, dermoid cyst, implanted fatty materials, laminar cortical necrosis), 4. substances with high concentration of proteins (colloid cyst, craniopharyngioma, Rathke's cleft cyst, ectopic posterior pituitary gland), 5. melanin (metastatic melanoma), 6. lesions containing mineral substances such as: calcium (calcifications, Fahr's disease), copper (Wilson's disease) and manganese (hepatic encephalopathy, manganese intoxication in intravenous drug abusers). Appropriate interpretation of signal intensity as well as analysis of location of lesions and clinical symptoms enables planning of further diagnostics and, in many cases, establishing the final diagnosis based on MR examination.

Isolated septic facet joint arthritis as a rare cause of acute and chronic low back pain - a case report and literature review.

BACKGROUND: The most common cause of low back pain is degenerative disease of the intervertebral disc and other structures of the lumbar spine. However, in some cases other less frequent causes of such pain can be seen, for example septic facet joint arthritis. Until now, only 40 cases of such inflammatory changes within the spine have been reported in the literature. The disease is probably underestimated due to improper diagnostic pathway. CASE REPORT: The authors describe a case of a 53-year-old woman who was repeatedly hospitalized during a five-month period because of an acute, severe low back pain, with sphincter dysfunction, partially resembling sciatic symptoms. Physical examinations revealed also focal tenderness in the area of the lumbar spine. Inflammatory markers (ESR - erythrocyte sedimentation rate, CRP - C-reactive protein) were elevated. Conservative analgetic treatment brought only partial and temporary relief of the pain and symptoms. The final accurate diagnosis of isolated septic facet joint arthritis at the level of L5/S1 was established after several months from the onset of the first symptoms, after performing various imaging examinations, including bone scintigraphy as well as CT and MRI of the lumbosacral spine. The patient fully recovered after antibiotic therapy and surgery, which was proven in several follow-up examinations showing no relevant pathology of the lumbar spine. The authors broadly describe the etiology and clinical symptoms of the septic facet joint arthritis as well as the significant role of imaging methods, especially MRI, in diagnostic process. The authors also discuss currently available treatment options, both conservative and surgical. CONCLUSIONS: The diagnostic procedure of septic facet joint arthritis requires several steps to be taken. Establishing a correct diagnosis may be difficult, that is why it is important to remember about rare causes of low back pain and to perform detailed physical examination, laboratory tests and choose appropriate imaging techniques.

Are T2-weighted images more useful than T1-weighted contrast-enhanced images in assessment of postoperative sella and parasellar region?

BACKGROUND: The proper diagnosis and management of patients after surgery for pituitary tumors are of great importance in clinical practice. The purpose of this study was to investigate the magnetic resonance features of the postoperative sella with fast spin echo T2-weighted imaging and to evaluate the benefits of this sequence compared to the classically performed contrast-enhanced T1-weighted imaging at 1.5T unit. MATERIAL/METHODS: The study group consisted of 101 patients who underwent resection of pituitary tumors. There were 58 women (57.4%), aged 22 to 75 (mean age, 52.67 years) and 43 men (42.6%), aged 21 to 79 (mean age, 49 years). In all patients preoperative and multiple postoperative MR studies were performed. Post-contrast T1 and pre-contrast T2 images were interpreted by 2 independent readers (neuroradiologists). RESULTS: Contrast-enhanced T1-weighted imaging was significantly superior to T2-weighted imaging in assessment of infundibulum (p<0.05). There was no statistically significant difference for each of readers between T1- and T2-weighted images regarding to the following features: visualization of residual pituitary gland (p = 0.062 and p = 0.368), contours of pituitary (p = 0.959 and p = 0.265), optic chiasm (p = 0.294 and p = 0.843), and visualization of presence of residual tumor (p = 0.204 and p = 0.169). T2-weighted images were significantly superior to contrast-enhanced T1-weighted imaging with regard to visualization of contours of residual tumors (p<0.05). CONCLUSIONS: T2-weighted images may help to discriminate tumorous from non-tumorous involvement of the postoperative sella and the sphenoid sinus. T2-weighted images are also very useful for a long time after the resection in the postoperative evaluation of the implanted muscle with fascia.

Contribution of perfusion-weighted magnetic resonance imaging in the differentiation of meningiomas and other extra-axial tumors: case reports and literature review.

We present six cases of extra-axial lesions: three meningiomas [including one intraventricular and one cerebellopontine angle (CPA) meningioma], one dural metastasis, one CPA schwannoma and one choroid plexus papilloma which were chosen from a larger cohort of extra-axial tumors evaluated in our institution. Apart from conventional MR examinations, all the patients also underwent perfusion-weighted imaging (PWI) using dynamic susceptibility contrast method on a 1.5 T MR unit (contrast: 0.3 mmol/kg, rate 5 ml/s). Though the presented tumors showed very similar appearance on conventional MR images, they differed significantly in perfusion examinations. The article draws special attention to the usefulness of PWI in the differentiation of various extra-axial tumors and its contribution in reaching final correct diagnoses. Finding a dural lesion with low perfusion parameters strongly argues against the diagnosis of meningioma and should raise a suspicion of a dural metastasis. In cases of CPA tumors, a lesion with low relative cerebral blood volume values should be suspected to be schwannoma, allowing exclusion of meningioma to be made. In intraventricular tumors arising from choroid plexus, low perfusion parameters can exclude a diagnosis of meningioma. In our opinion, PWI as an easy and quick to perform functional technique should be incorporated into the MR protocol of all intracranial tumors including extra-axial neoplasms.

Immunoglobulin D myeloma--problems with diagnosing and staging (own experience and literature review).

Immunoglobulin D (IgD) myeloma is a rare disease accounting for about 2% of all myelomas. The distinctive features are the predominant occurrence in males and young patients, short survival time, uncertain appearance of M-component in serum electrophoresis, predominance of lambda light chains, frequent renal impairment, hypercalcemia and amyloidosis. The aim of the present study was to show diagnostic difficulties resulting from a variety of non-specific initial symptoms and laboratory findings as well as to compare the staging system proposed by Durie and Salmon with the new risk grouping by Shimamoto. Case histories of 7 patients were analyzed retrospectively. Five of them were diagnosed as IgD multiple myeloma (IgD MM), 1 as non-secretory IgD myeloma and 1 as solitary bone IgD plasmocytoma that evolved to an IgD MM. All patients were staged according to the Durie and Salmon classification and the new risk grouping by Shimamoto. We report diagnostic problems with IgD myeloma in our patients, with special emphasis on non-specific rheumatoidal and neurological symptoms in 1 case. There was a very good correlation of the Japanese classification with the severity of the disease and the risk of death. In conclusion, the initial symptoms of IgD myeloma can be very misleading. Wide differential diagnosis, including autoimmunological disorders of the connective tissue, is necessary. The new Japanese risk grouping seems to be of greater prognostic significance for IgD myeloma than the Durie and Salmon staging system.

Evaluation of contrast-enhanced FLAIR sequence in MR assessment of intracranial tumours.

BACKGROUND: Magnetic resonance (MR) has become the most important imaging method in the diagnosis of intracranial tumours. However, conventional MR protocol often fails to obtain all morphological details which are necessary for precise planning of the treatment. Therefore, there are attempts of introducing other MR techniques, to gain new information concerning tumour morphology. One such technique is FLAIR sequence. In previous papers we presented the value of plain FLAIR in patients with intracranial tumours. The aim of the present study was evaluation of contrast enhanced FLAIR (CE FLAIR) in assessment of intracranial tumours. MATERIAL/METHODS: MR examinations, including conventional T1 (pre-and postcontrast) and T2 images, as well as plain and contrast-enhanced FLAIR sequences were performed in 27 patients with intracranial tumours. In all patients the degree and localization of contrast enhancement in post-contrast T1-weighted sequence (CE T1w) and CE FLAIR images have been compared. RESULTS: Contrast enhancement of the tumour in both CE T1-w and CE FLAIR sequences was found in 18 patients. In 5 patients the enhancement was visible only on T1-weighted images, while in 2 cases only on FLAIR images. Among 18 patients, who demonstrated enhancement both in T1-weighted and FLAIR sequences, in 9 cases the effect of enhancement was better on T1-weighted images, in 7-CE FLAIR gave superior results, and in 2 patients - both methods were equivalent. In the whole material in 9 cases CE-FLAIR was superior in 14-inferior and in 4-equal to CE-T1-w. Among 9 cases in which CE- FLAIR was superior, in 7 patients the enhancement concerned the border of the tumour or postoperative cave. CONCLUSIONS: Contrast-enhanced FLAIR has limited value in assessment of intracranial tumours and should be used as a supplementary technique if there are difficulties in evaluation of tumour morphology in other sequences.

[Glucose-6-phosphate dehydrogenase (G6PD) deficiency--a cause of anaemia in pregnant women]. / Niedobór dehydrogenazy glukozo-6-fosforanowej (G6PD) przyczyna niedokrwistosci u kobiet ciezarnych.

Glucose-6-phosphate dehydrogenase (G6PD) is one of the most important cytoprotective enzymes for oxidative stress. The WHO classification of G6PD deficiency, based on enzyme activity and clinical significance, distinguishes five variants. Chronic haemolytic process is rare and the main factors causing haemolysis are: infections, substances derived from plants, drugs with high oxidation-reduction potential, stress, ketoacidosis in diabetes and surgery operations. We report two cases of women belonging to the class 3 of the WHO classification in whom haemolysis occured during pregnancy. One of the patients developed two incidents of haemolytic anaemia. The cause of the first episode, nine months before pregnancy, was probably infection of the urinary tract caused by Escherichia coli, but the influence of the drugs also cannot be excluded. Because of the genetic background of this enzymopathy we also examined members of the patients, families but did not find any evidence of G6PD deficiency among them. The reported cases indicate that haemolytic anaemia caused by G6PD deficiency may occur during pregnancy what can lead to many not only haematological but also serious obstetrical complications such as infertility, fetus malformations and even its death. We also draw attention to several difficulties in diagnosing G6PD deficiency especially during haemolysis.