Can neuroimaging differentiate PFO and AF-related cardioembolic stroke from the other embolic sources? Clinical-radiological correlation on a retrospective study.

PURPOSE: The aim of this retrospective study was to map the specific ischemic lesion patterns of distribution in patent foramen ovale-related stroke (PFO-stroke) and atrial fibrillation-related stroke (AF-stroke) in patients with idiopatic ischemic stroke. MATERIALS AND METHODS: 750 ischaemic strokes were screened on basis of diagnostic imaging and tests: patients with known causes were excluded. 171 patients with unknown cause were selected and divided in two groups: AF-stroke (43 patients) and PFO-stroke (128 patients). Vascular territories of ischemic involvement were divided into four classes in each group: the anterior cerebral artery, the middle cerebral artery, the vertebro-cerebral artery (including the posterior cerebral artery) and multisite (MS) involvement. RESULTS: Infarcts in vertebro-basilar territory and multisite represented each one about 32% of infarcts in PFO-stroke group and their involvement are more frequent than AF-stroke group (p = 0.03). Ischemic lesions in PFO-group were predominantly cortical (34.3%), and in AF-group cortical-subcortical (60.4%). Multisite pattern of ischemic lesion was more frequent in patients with severe degree of right to left shunts (37.5%). CONCLUSION: In clinical practice, PFO may be considered a cause of cortical stroke on the basis of radiological findings, when VB vascular territory or MS brain involvement is present in younger patients (<50 age).

Prognostic value of relative cerebral blood volume in patients with recurrent glioblastoma multiforme treated with bevacizumab.

BACKGROUND: The aim of this study was to assess whether the early monitoring of the effects of bevacizumab in patients with recurrent glioblastoma multiforme (GBM) using perfusional dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) before and after the beginning of antiangiogenic therapy is predictive of treatment response. METHODS: Thirteen patients with recurrent GBM underwent perfusion MRI with relative cerebral blood volume (rCBV) mapping before (T0) and after the beginning (T1) of bevacizumab treatment. Recurrence Regions of Interest (RoIs) were positioned on the enhancing component of tumoral tissue revealed by postcontrast T1-weighted images. The rCBV measurements on the corresponding maps were made before and after the start of the antiangiogenic therapy. The Cox proportional hazards model and the Kaplan-Meier method were used with the log-Rank Test to establish whether pre- and postbevacizumab rCBV predicted progression-free survival (PFS). We tried to assess if there was a correlation between rCBV at T0 and rCBV at T1 using the Pearson's correlation coefficient. RESULTS: In the univariable analysis, rCBV was significantly predictive of PFS at T0 (HR=5.3, P=0.003) and at T1 (HR=4.14, P=0.04). Similarly, in the multivariate Cox model analysis, rCBV was predictive of PFS at T0 (HR=4.4, P=0.04) and T1 (HR=4.2, P=0.02). PFS was longer in patients whose rCBV was less than 4.50 mL/100g at T0 and less than 1.83 mL/100g at T1 than in patients with higher rCBV values. There was a moderate positive correlation between rCBV at T0 and rCBV at T1 (P=0.032, R=0.546). CONCLUSIONS: Despite the limited number of enrolled patients, rCBV assessed using DSC-MRI through the parameter rCBV is proved reliable in predicting the effects of antiangiogenic treatment in patients with recurrent GBM.

Computed tomography perfusion and computed tomography angiography in vasospasm after subarachnoid hemorrhage.

BACKGROUND: The aim of the study was to evaluate the effectiveness and reliability of a combined computed tomography angiography (CTA) and computed tomography perfusion (CTP) approach in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage. METHODS: Nineteen patients with clinical signs of arterial vasospasm and positive transcranial Doppler (TCD) were enrolled and underwent CTP. Mean time transit (MTT), cerebral blood flow (CBF) and cerebral blood volume (CBV) values of 20 standardized ROI (regions of interest) were analyzed, and CTA used to measure the gauge of 26 arterial ramifications. CTA measurements were compared with those taken upon hospitalization. Of the 19 patients, 11 were scheduled for digital subtraction angiography (DSA), performed less than 12 hours after execution of the CTA-CTP protocol. The results were compared with findings of DSA and/or clinical follow-up and CT or TCD. RESULTS: Computed tomography angiography diagnosis of vasospasm was confirmed in all cases (100% sensitivity and 100% specificity), while CTP yielded 3 false negatives (70% sensitivity and 100% specificity). All patients sent for endovascular treatment had received diagnostic confirmation of vasospasm by angiography. CTP thresholds proved reliable in both diagnosis and indicating treatment. CONCLUSIONS: Combined one-shot CT angiography and CT perfusion represents a valid alternative to DSA in the diagnosis and management of cerebral vasospasm.

An unusual case of ectomesenchymal chondromyxoid tumour of the left tonsillar bed: imaging and histopathologic features.

We describe a case of a rare soft-palatal and parapharyngeal mass in an adult woman. A 71-year-old female presented with a huge mass protruding from the soft palate, complaining about difficulty in swallowing for the past 4 months. After inspection and ear nose and throat fibroscopy, in which the mass appeared regular-shaped and with a regular mucosa, the patient underwent a CT scan and MRI examination. The CT scan showed an oval, not-infiltrating, hypodense mass including a discrete irregular-shaped central calcification, while the MRI examination confirmed the non-infiltrating growth and showed that around the calcified core, the lesion was surrounded by fat. After surgical removal, the histopathologic diagnosis was that of an "ectomesenchymal chondromyxoid tumour". Ectomesenchymal chondromyxoid tumour is a rare benign neoplasm arising from the tongue. Although only 45 cases have been reported in the literature, there are several unique features that define this lesion. Ours is the first case with a complete CT scan and MRI with diffusion imaging description.

Staging of Primary Abdominal Lymphomas: Comparison of Whole-Body MRI with Diffusion-Weighted Imaging and (18)F-FDG-PET/CT.

Background. The purpose of this study was to compare the accuracy of whole-body MRI with diffusion-weighted sequences (WB-DW-MRI) with that of (18)F-FDG-PET/CT in the staging of patients with primary gastrointestinal lymphoma. Methods. This retrospective study involved 17 untreated patients with primary abdominal gastrointestinal lymphoma. All patients underwent (18)F-FDG-PET/CT and WB-DW-MRI. Histopathology findings or at least 6 months of clinical and radiological follow-up was the gold standard. The Musshoff-modified Ann Arbor system was used for staging, and diagnostic accuracy was evaluated on a per-node basis. Results. WB-DW-MRI exhibited 100% sensitivity, 96.3% specificity, and 96.1% and 100% positive and negative predictive values (PPV and NPV), respectively. The sensitivity, specificity, and PPV and NPV of PET/CT were 95.9%, 100%, and 100% and 96.4%, respectively. There were no statistically significant differences between the two techniques (p = 0.05). The weighted kappa agreement statistics with a 95% confidence interval were 0.97 (0.95-0.99) between the two MRI readers and 0.87 (0.82-0.92) between the two methods. Conclusions. WB-DW-MRI appears to have a comparable diagnostic value to (18)F-FDG-PET/CT in staging patients with gastrointestinal lymphoma.