The T1-dark-rim: A novel imaging sign for detecting smoldering inflammation in multiple sclerosis.

PURPOSE: Paramagnetic rim lesions (PRLs), usually identified in susceptibility-weighted imaging (SWI), are a promising prognostic biomarker of disability progression in multiple sclerosis (MS). However, SWI is not routinely performed in clinical practice. The objective of this study is to define a novel imaging sign, the T1-dark rim, identifiable in a standard 3DT1 gradient-echo inversion-recovery sequence, such as 3D T1 turbo field echo (3DT1FE) and explore its performance as a SWI surrogate to define PRLs. METHODS: This observational cross-sectional study analyzed MS patients who underwent 3T magnetic resonance imaging (MRI) including 3DT1TFE and SWI. Rim lesions were evaluated in 3DT1TFE, processed SWI, and SWI phase and categorized as true positive, false positive, or false negative based on the value of the T1-dark rim in predicting SWI phase PRLs. Sensitivity and positive predictive values of the T1-dark rim for detecting PRLs were calculated. RESULTS: Overall, 80 rim lesions were identified in 63 patients (60 in the SWI phase and 78 in 3DT1TFE; 58 true positives, 20 false positives, and two false negatives). The T1-dark rim demonstrated 97% sensitivity and 74% positive predictive value for detecting PRLs. More PRLs were detected in the SWI phase than in processed SWI (60 and 57, respectively). CONCLUSION: The T1-dark rim sign is a promising and accessible novel imaging marker to detect PRLs whose high sensitivity may enable earlier detection of chronic active lesions to guide MS treatment escalation. The relevance of T1-dark rim lesions that are negative on SWI opens up a new field for analysis.

Primary extraosseous dural chondrosarcoma: a case report.

BACKGROUND: Dural chondrosarcoma is a very rare intracranial tumor, given that meninges do not normally contain cartilaginous tissue from which it can originate. We present a case of primary extraosseous dural chondrosarcoma. CASE PRESENTATION: A 48-year-old woman presented to our tertiary center neurosurgery consultation with progressive headache, vomiting, vertigo, and gait instability of 5 months' duration. An initial brain CT revealed a large parietal mass with gross calcifications and subtle hyperostosis of the inner table. Subsequent brain MRI showed a heterogeneous expansive lesion with a honey-comb enhancement. Discussion of intra- or extra-axial location was warranted, and finally, initial presurgical suspicion of meningioma arose although some atypical imaging features were detected. The differential diagnosis included solitary fibrous tumor-hemangiopericytoma and dural metastasis. Total resection of the lesion was performed, extra-axial origin was confirmed, and pathology resulted in a primary dural chondrosarcoma. CONCLUSION: The importance of this case presentation lies in the unusual nature of the final diagnosis, the brief literature review and differential diagnosis with emphasis on imaging pearls, as well as the useful reminder for physicians to consider less frequent diseases when key findings do not unambiguously lead to the usual suspects.

Satisfacción de los estudiantes de una facultad de medicina peruana / Satisfaction of medical students of a Peruvian school of medicine

Objetivos: Evaluar la satisfacción de los estudiantes de una facultad de medicina peruana en el año 2014. Material y métodos: Estudio descriptivo, observacional y transversal. Se aplicó la encuesta SERVQUAL a una muestra de los alumnos que cursaron el primer semestre del año 2014 en una facultad de medicina peruana. Se calculó la satisfacción restando el promedio de las preguntas de percepción con el puntaje de la expectativa. Se consideró satisfacción a una diferencia mayor o igual a 0. Se usó el paquete estadístico SPSS 18.0 y se analizaron las variables con el modelo de regresión logística multinominal y la prueba de chi cuadrado. Se consideró el valor p <0,05 como estadísticamente significativo. Resultados: De 188 encuestados, 54,8% eran varones. La mayoría provenía del área de Lima Centro (42%), Santiago de Surco y Miraflores (20%). El 100% de los encuestados era soltero y 14,9% eran beneficiarios de subvención económica. El porcentaje de satisfechos fue de 8%; el de insatisfacción leve, 66%; el de moderada, 23% y 3% estuvo muy insatisfecho. Solo se encontró relación estadística entre la edad y los elementos tangibles. Conclusiones: La magnitud de estudiantes satisfechos más grados leves de insatisfacción fue de 73,4%. Las dimensiones con mayor y menor satisfacción fueron la de elementos tangibles y capacidad de respuesta, respectivamente. No parece haber relación significativa con las variables de las personas evaluadas, salvo con la edad en algunas dimensiones. (AU)

Objectives: To determine the satisfaction of medical students of a Peruvian school of medicine in 2014. Methods: Cross-sectional study carried-out among medical students of the first semester of 2014 in whom a SEVQUAL survey was applied. Satisfaction was calculated by subtracting expectation minus perception, with satisfaction defined to a difference above 0. SPSS 18.0 was used with chi square and logistic multinomial regression tests. A p value <0.05 was considered statistically significant. Results: A total of 188 students were surveyed; 54.8% were males; 42% come from Lima Centro; Santiago de Surco and Miraflores (20%); all were ingle and 14% received scholarships. Percentage of satisfaction was 8%; mild no satisfaction was seen in 66%, moderate no satisfaction in 23% and 3% were no satisfied. Only age and tangible elements reached statistical significance. Conclusions: The proportion of satisfied and mild no satisfaction reached 73.4%. Higher no satisfaction was observed with tangible elements and lower no satisfaction with capacity of response. (AU)