Individual variation of tentorial notch morphometry in a series of neurocritical patients.

BACKGROUND: Cadaveric studies on humans have shown anatomical variabilities in the morphometric characteristics of the tentorial notch. These anatomical variations could influence the worsening of neurocritical patients. OBJECTIVES: 1) To investigate the morphometric characteristics of the tentorial notch in neurocritical patients using computed tomography (CT); 2) To investigate the correlation between tentorial notch measurements by CT and by magnetic resonance imaging (MRI); and 3) To analyze the individual variability of the tentorial notch anatomy seen in neurocritical patients. METHODS: Prospective series of neurocritical patients was examined. An imaging protocol for measurements was designed for CT and MRI. The level of the agreement of the measurements from CT and MR images was established. According to the measurements found, patients were divided into different types of tentorial notch. RESULTS: We studied 34 neurocritical patients by CT and MRI. Measurements of the tentorial notch via CT and MRI showed significant agreement: concordance correlation coefficient of 0.96 for notch length and 0.85 for maximum width of tentorial notch. Classification of tentorial notch measurements according to the criteria established by Adler and Milhorat, we found the following: 15 patients (58%) corresponded to a "short" subtype; 7 (21%) to "small"; 3 (9%) to "narrow"; 2 (6%) to "wide"; 2 (6%) to "large"; 1 (3%) to "long"; and 4 (12%) to "typical". CONCLUSIONS: The anatomical variability of the tentorial notch could be detected in vivo by means of CT scan and MRI. Good agreement between the measurements made using these two imaging methods was found.

Unión cráneo-cervical - anatomía normal y correlación con imágenes / Cranio Cervical Junction - Anatomy and Imaging Correlation

La solicitud de estudios de imagen en pacientes con trauma cervical es muy frecuente en la práctica diaria. Esa patología es causa relativamente frecuente de discapacidad en pacientes jóvenes junto con el trauma encéfalo craneano. En un porcentaje no despreciable de los casos, las lesiones traumáticas comprometen la unión cráneo- cervical y en esos pacientes, la morbi-mortalidad es más significativa. La transición entre el cráneo y el raquis se basa en un conjunto de estructuras óseas relacionadas por articulaciones muy móviles y estabilizadas por un grupo de ligamentos y músculos que le brindan al mismo tiempo gran solidez. Para una correcta interpretación de los estudios de imagen de uso corriente en la clínica, es fundamental un sólido conocimiento anatómico de la unión cráneo-cervical y sus componentes. Es el objetivo de esta revisión, sistematizar la anatomía de la unión cráneo-cervical con especial énfasis en sus ligamentos, analizar la fisiología de sus movimientos y el concepto de estabilidad para luego realizar una correlación con tomografía computada multi-detector y resonancia magnética.

The request of imaging techniques in patients with cervical spine trauma is very common in clinical practice. Cervical trauma is a relatively common cause of disability in young patients. In a significant percentage of cases traumatic injuries compromise the cranio-cervical junction with more important morbidity and mortality in this group of patients. The transition between the skull and the spine is based on a set of bony structures, high mobility joints, and stabilization mechanism formed by a group of ligaments and muscles. A solid anatomical knowledge of the cranio-cervical junction and its components is essential for a correct interpretation of current high resolution imaging studies. The goal of this review is highlight the anatomy of the cranio-cervical junction with special emphasis on the ligaments, analyze the biomechanics of their movements and the concept of stability. At last but not leastwe will establish a correlation with multidetector computed tomography and high-resolutionmagnetic resonance imaging.

Current imaging follow-up of non-Hodgkin lymphoma exposes patients to significant radiation but does not detect asymptomatic relapses.

The standard approach to the follow-up of lymphoma includes computed tomography (CT) every 6-12 months for the first 2 years and, then, as clinically indicated. Recent evidence suggests that most relapses are detected clinically, outside scheduled CT which, on the other hand, increases risk of second malignancies and cost. In early-stage lymphomas, involved site CT instead of full body CT may be a reasonable alternative to reduce radiation dose. We analyzed whether regular CT surveillance detects asymptomatic relapses in a single-center Uruguayan early stage non-Hodgkin lymphoma (NHL) population. We evaluated utility of full body CT halfway and at the end-of-treatment evaluation and calculated the radiation exposure. In our study, CT surveillance added nothing to clinical follow-up. Moreover, 44% of our patients received a cumulative effective dose that doubles the risk of malignancies. Involved-site CT scan would be enough to monitor response during treatment in early stage NHL.

Enfermedad de Marchiafava-Bignami, a propósito de un caso clínico-imagenológico / Clinical and imaging issues - Marchiafava-Bignami’s disease, case report

RESUMEN: Arch Med Interna 2013 - 35(3):105-108 La Enfermedad de Marchiafava-Bignami descripta a principios del siglo XX en bebedores de vino tinto y posteriormente en consumidores de otras bebidas alcohólicas, es una de las complicaciones menos frecuentes de los alcoholistas crónicos, su reconocimiento ha sido puesto en evidencia en los últimos tiempos debido a la Resonancia Magnética (RM). Lamentablemente el pronóstico, no ha variado sustancialmente debido a que no existe una terapéutica específica.

ABSTRACT: Arch Med Interna 2013 - 35(3):105-108 The Marchiafava-Bignami disease described at the beginning of the twentieth century, in red wine drinkers and consumers subsequently spirits, is a less common complication of chronic alcoholics, their recognition has been highlighted in recent times due to the Magnetic Resonance (MR). Unfortunately the prognosis has not changed substantially since there is no specific therapy.

Anatomo-radiological correlation of the superior aspect of the temporal lobe (planum supratemporale)

The superior aspect of the temporal lobe or planum supratemporale (PS) forms the inferior limit of the sylvian fissure. It is related to the frontal, parietal and insular lobes, and with the sylvian vessels (arteries and veins). Recognition of the portions of PS in imaging studies, such as MRI or cranial CT, is important for neuroradiologists, neurologists and neurosurgeons. We used 10 formalin-fixed cerebral hemispheres. We injected red latex into the arterial system in one. We made horizontal, coronal and sagittal cuts in 7 hemispheres, and performed white matter dissection in two. We compared the anatomical specimens with MRI, cranial CT and cerebral angiographies. The PS can be divided into three portions from front to back: the planum polare (PP), Heschl’s gyrus (HG) and the planum temporale (PT). PP and PT are flat, and HG is elevated. The obliquity of HG is oriented in such a way that it delineates the location of the ventricular atrium. The three parts of PS can be readily identified in MRI, but a certain degree of brain atrophy facilitates its identification in CT. In cerebral angiography, the different segments of the middle cerebral artery serve as a guide for recognizing the anatomical structures of the temporal lobe and insular region. Anatomical knowledge is of paramount importance to recognize the different parts of the PS in radiological studies. This anatomicimage-based knowledge can be applied in surgical planning (AU)

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