Cortical thickening in remitters compared to non-remitters with major depressive disorder following 8-week antidepressant treatment.

OBJECTIVE: Little is known about the relationship between antidepressant treatment outcomes and underlying neurobiological mechanisms in patients with major depressive disorder (MDD). In this prospective study, we aimed to investigate how cortical thickness and subcortical volumes differed between remitter and non-remitter patients with MDD. METHODS: Fifty-eight patients with MDD with a score of at least 17 on the 17-item Hamilton Depression Rating Scale and free of medication for at least 2 months and 41 healthy controls underwent structural magnetic resonance imaging. At the baseline, patients with MDD started on either selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, or vortioxetine. After 8-week antidepressant treatment, patients with MDD were scanned using the same MRI protocol. Structural images were analyzed using the FreeSurfer software package (version 6.0). RESULTS: Longitudinal analyses showed remitter patients with MDD had significantly greater right cerebral cortex thickening in six significant clusters, including superior temporal cortex, precuneus, rostral middle frontal cortex, pars opercularis (although the cluster extends into the insula), inferior parietal cortex, and supramarginal cortex than in non-remitter patients with MDD. CONCLUSION: Our results suggest that distinct antidepressant treatment-related structural alterations in brain regions implicated in cognition, emotion regulation, and rumination might be associated with treatment outcome.

An adult adrenal neuroblastoma: a case report.

Neuroblastoma of the adrenal gland is an extremely rare tumour in adulthood although it is one of the most common malignancies in childhood. In this report, we present a 52-year-old man who had a left adrenal mass on preoperative imaging. On laboratory, slightly elevated catecholamine metabolites were detected in the urine that was collected over 24 hours. He was operated and the mass was resected in en-block manner along with the regional lymph nodes. The histopathological examination of the specimen revealed the diagnosis of neuroblastoma. He had no metastatic disease at the time of diagnosis and received chemotherapy after the operation. However, the prognosis was poor and he died 10 months after the operation. Although neuroblastoma of adrenal gland is rare in adulthood, it should be considered in the differential diagnosis for patients with adrenal masses.

Antenatally diagnosed neonatal craniopharyngioma.

A case of neonatal craniopharyngioma diagnosed by fetal ultrasonography at 29 weeks and by magnetic imaging at 35 weeks of gestation is presented with clinical and neuroradiologic findings. This is a rare tumor and only 10 cases of neonatal craniopharyngioma have been previously reported .

Capillary telangiectasia of the brain: imaging with various magnetic resonance techniques.

Brain capillary telangiectasia is an incidental vascular malformation found usually in pons and sometimes in extra- pontine sites. Typical MRI features are enhancement on post contrast T1 weighted images and signal loss on gradient echo images. We evaluated 10 patients with various MR techniques. Susceptibility weighted imaging was superior to GRE T2 in showing decreased signal due to susceptibility effects. Diffusion weighted imaging and diffusion tensor imaging proved not useful in the diagnosis.

Diagnostics to look beyond the normal appearing brain tissue (NABT)? A neuroimaging study of patients with primary headache and NABT using magnetization transfer imaging and diffusion magnetic resonance.

OBJECTIVE: Novel diagnostics can allow us to "look beyond" normal-appearing brain tissue (NABT) to unravel subtle alterations pertinent to the pathophysiology of primary headache, one of the most common complaints of patients who present to their physician across the medical specialties. Using both magnetization transfer imaging (MTI) and diffusion weighted imaging (DWI), we assessed the putative microstructural changes in patients with primary headache who display the NABT on conventional magnetic resonance imaging (conventional MRI). METHODS: Subjects were 53 consecutive patients with primary headache disorders (40 = migraine with aura; 9 = tension headache; 4 = cluster headache) and 20 sex- and age-matched healthy volunteers. All subjects underwent evaluation with MRI, MTI, and DWI in order to measure the magnetization transfer ratio (MTR) and the apparent diffusion coefficient (ADC), respectively, in eight and six different regions of interest (ROIs). RESULTS: Compared to healthy controls, we found a significant 4.3 % increase in the average ADC value of the occipital white matter in the full sample of patients (p = 0.035) and in patients with migraine (p = 0.046). MTR values did not differ significantly in ROIs between patients and healthy controls (p > 0.05). CONCLUSIONS: The present study lends evidence, for the first time to the best of our knowledge, for a statistically significant microstructural change in the occipital lobes, as measured by ADC, in patients with primary headache who exhibit a NABT on MRI. Importantly, future longitudinal mechanistic clinical studies of primary headache (e.g., vis-à-vis neuroimaging biomarkers) would be well served by characterizing, via DWI, occipital white matter microstructural changes to decipher their broader biological significance.

Percutaneous anterior odontoid screw fixation.

OBJECTIVE: A technical description of a novel percutaneous technique of anterior odontoid screw fixation is given and the clinical and radiological results of this technique in 5 patients are described. METHOD: The percutaneous anterior odontoid screw fixation technique was described as a cadaveric study in 1999. To the best of our knowledge, no patient series operated on by this technique has so far been presented in the English literature. We have percutaneously operated on 5 patients with unstable odontoid fractures between February 2004 and July 2006. RESULTS: There have not been any complications in our patients. The first four patients showed radiological evidence of fusion in their latest control. CONCLUSIONS: Percutaneous anterior odontoid screw fixation is a minimally invasive and feasible surgical procedure.

Desmoplastic fibroma in humerus.

Desmoplastic fibroma of the bone is a very rare benign tumour, which may be locally aggressive. We report X-ray radiographic and MRI findings of a case of desmoplastic fibroma of the humerus in a 33-year-old man who presented with a slowly enlarging arm mass over years. Desmoid fibroma should be taken into consideration in case of a low T2 signal in a non-sclerotic fibroosseous lesion.

Giant cavernous angioma of the temporal lobe: a case report and review of the literature.

Cavernous angiomas of the central nervous system are angiographically occult vascular lesions and are easily diagnosed by magnetic resonance imaging (MRI). Giant cavernous angiomas (GCA) are rare, with only 11 cases reported in the literature. Imaging appearance of GCAs has not been reviewed previously. We report a GCA of the temporal lobe, and discuss its computed tomography and MRI findings in the view of the literature. Imaging appearance of GCAs is variable. Some GCAs have features that are similar to those of typical cavernous angiomas, whereas some lesions may be purely cystic; and some present with significant contrast enhancement and mass effect, mimicking neoplasms. While the presence of hemosiderin, blood degradation products, and calcification may be helpful in the diagnosis of some cases, the correct diagnosis is not apparent until histopathological evaluation of the specimen is made in many instances.

Diffusion-weighted and conventional MR imaging in neurotrichinosis.

Central nervous system involvement in trichinosis is not rare. Brain lesions in trichinosis have been defined on computed tomography and magnetic resonance imaging (MRI) as multifocal small lesions located in the cerebral cortex and white matter. We present a case of trichinosis with multifocal lesions of the brain detected by MRI and diffusion weighted MRI. Evolutions of these lesions from acute through chronic stages on follow up studies are also presented. This is the first report describing sequential MRI findings and diffusion weighted imaging appearance of brain lesions in trichinosis. Sequential evaluation of conventional and diffusion MR data allowed us to conclude that multifocal lesions in the brain were related to multiple infarctions rather than true inflammatory infiltration of the brain parenchyma.

Islets of meningioma in an acoustic schwannoma in a patient with neurofibromatosis-2: pathology and magnetic resonance imaging findings.

Mixed tumors of the cerebellopontine angle, composed of meningioma and schwannoma components, are extremely rare; so far, only 12 cases have been reported in the literature. They are thought to be exclusively associated with neurofibromatosis-2. We present a mixed tumor of schwannoma and meningioma in a patient with neurofibromatosis-2 and discuss the pathology and magnetic resonance imaging (MRI) findings in relation to the literature. Review of the literature shows that a typical MRI pattern has not been established for mixed tumors and it seems unlikely that a meningioma component can be differentiated within a schwannoma preoperatively.

van der Knaap's leukoencephalopathy: report of five new cases with emphasis on diffusion-weighted MRI findings.

We present five new cases of van der Knaap's leukoencephalopathy, which is a rare abnormality characterized by infantile-onset white matter disease with swelling and mild clinical course. Based on the very rare histopathological data, this disease is considered a vacuolating myelinopathy with peripherally located intralamellar vacuoli. Although approximately 70 cases have so far been published, there are very limited data in the literature regarding diffusion-weighted imaging (DWI) findings of this recently discovered entity. In this paper, in addition to MRI, MRS and DWI findings in three patients are shown, apparent diffusion coefficient (ADC) maps are calculated, and ADC measurements made from various regions of interest are documented. MRI showed diffuse swelling and areas of T2 high signal in supratentorial white matter, sparing the cortex and central gray matter structures. MRS findings indicated some degree of neuronal loss. DWI and ADC maps showed increased diffusion rates, suggesting a different type of tissue damage than that would be expected in vacuolating myelinopathies. We believe that DWI and ADC mapping would be of help in providing a baseline for monitoring the progression of the disease.

The role of isotropic diffusion MRI in children under 2 years of age.

Our objective was to determine the contribution of diffusion MR imaging to standard MR imaging in the neuroradiological evaluation of children less than 2 years of age. Echo-planar diffusion MR imaging was added to standard MR exams in 75 consecutive patients under the age of 2 years. Single-shot echo-planar spin-echo T2 weighted images (EPSE-T2) were acquired. Isotropic diffusion-weighted images (DWI), attenuation coefficient maps (ACM), and apparent diffusion co-efficient (ADC) maps were calculated offline from images obtained with diffusion gradients (b = 1000 s/mm2) in three orthogonal directions. Two neuroradiologists determined if EPSE-T2, DWI, or ACM contributed new information to spin-echo proton density (SE PD) and T2 studies. In 15 of 18 abnormalities detected in 8 patients with symptoms less than 1 week in duration, DWI and/or ACM added information to SE PD and T2. Diffusion sequences detected five new lesions, showed six lesions with greater conspicuity, and identified four lesions with different diffusion character. In patients with symptoms of more than 7 days duration, diffusion studies added no information. Isotropic diffusion MR contributed to lesion detection and characterization in infants when symptoms were less than 1 week in duration. Diffusion MR is useful in patients with leukodystrophies, metabolic disorders, and patients with acute ischemic lesions.