Cheiro-oral-pedal syndrome as the presenting symptom of brainstem cavernous malformation: a case report.

The rare cheiro-oral-pedal syndrome (COPS) is characterized by sensory disturbances around the corner of the mouth, and in the hand and foot of the same side. The causative lesion is located in the thalamocortical projections, thalamus or brainstem and is usually due to ischemic or hemorrhagic stroke. We report a case of a patient with brain stem cavernous malformations presented as pure COPS with additional sensory disturbance in the thorax. We report this case to raise awareness of these very rare syndromes and demonstrate that mildly presenting symptoms can be caused by an underlying devastating condition.

Diagnostic performance of advanced MRI in differentiating high-grade from low-grade gliomas in a setting of routine service.

OBJECTIVE: To evaluate the usefulness of advanced MRI techniques in differentiating high-grade (HGG) from low-grade gliomas (LGG). MATERIAL AND METHOD: Sixty-four patients with suspected gliomas were prospectively evaluated by conventional and advanced MRI studies including MR spectroscopy (MRS), diffusion tensor imagining (DTI), and dynamic susceptibility contrast (DSC) MRI. The parametric measurements of metabolic profile, cerebral blood volume, flow (CBV, CBF), apparent diffusion coefficient (ADC), fractional anisotropy, and their ratios by internal normalization were analyzed to differentiate LGG from HGG. Histopathologic findings were used as the gold standard. RESULTS: Forty-three cases with pathologically-proven gliomas were included The best discriminating features between HGG and LGG were CBV and CBF of the solid tumoral region (p < 0.05) whereas the minADC/corpus callosum ratio for DTI and the ratio of Cho/Cr for MRS of the solid tumoral region provided the best diagnostic performance (p < 0.05). With a predetermined threshold for each parametric measurement, the combination of all advanced MRI modalities was associated with the best accuracy whereas the combination of DSC MRI and MRS provided the highest specificity. When all parametric measurements were positive, the probability of HGG was 0.889. CONCLUSION: Comprehensive advanced MRI studies provided better diagnostic performance than using conventional MRI alone in the evaluation of gliomas.

Diagnostic performance of perfusion MRI in differentiating low-grade and high-grade gliomas: advanced MRI in glioma, A Siriraj project.

BACKGROUND: To determine the usefulness of the perfusion MRI technique at Siriraj Hospital for differentiating between high- and low-grade gliomas by using pathological results as the gold standard. MATERIAL AND METHOD: The authors prospectively investigated 64 consecutive patients who were suspected as cerebral glioma from prior conventional imaging. Cerebral perfusion study was achieved during the first pass of a bolus of gadolinium-based contrast agent. All post-processing MRI images were interpreted by two board-certified neuroradiologists (more than 10-year-experience), one radiology resident and one well-trained technician, who separately performed and blinded from the pathological results. RESULTS: Forty-four patients diagnosed as glioma were included in this study. There were 26 cases of high-grade and 18 cases of low-grade gliomas. The cerebral blood volume and flow and its ratios had a strong association with the grade of glioma. The areas under the ROC curve for CB K CBVratio (rCBV), CBF and CBF ratio (rCBF) are 0.778, 0.769, 0.769, and 0.772, respectively. On the basis of equal misclassification rates, a cutoff value of 6.15 for CBV (sensitivity, 81.5%; specificity, 64.7%), a cutoff value of 2.38 for the rCBV (sensitivity, 88.9%; specificity, 64.7%), a cutoff value of 0.66 for CBF (sensitivity 81.5%; specificity 70.6%), and a cutoff value of 2.6 for the rCBF (sensitivity, 85.2%; specificity, 70.60%) best discriminated the high and low-grade gliomas. CONCLUSION: Preoperative radiologic grading of gliomas based on conventional MR imaging is sometimes unreliable. The cerebral perfusion measurements can significantly improve the sensitivity and predictive values of radiologic glioma grading. The rCBV measurement is the best parameter for tumor grading due to the highest sensitivity.

Value of diffusion tensor imaging in differentiating high-grade from low-grade gliomas.

OBJECTIVE: To determine the usefulness of diffusion tensor imaging (DTI) in differentiating high-grade glioma (HGG) from low-grade glioma (LGG). MATERIAL AND METHOD: Patients with cerebral gliomas underwent conventional MRI and DTI before surgery. All proven pathologies were classified into two groups, i.e. LGG and HGG. The authors measured fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values in region of interest (ROI) including solid tumoral region, necrotic region, peritumoral edema, contralateral normal appearing white matter (NAWM) and normal corpus callosum as well as calculated ADC ratios. Pairwise comparisons were performed by using the t-test. The ROC curves of imaging parameters were employed to determine the best parameter for differentiating the two entities. RESULTS: Forty-three patients with cerebral gliomas, 17 with LGG and 26 with HGG, no statistical significant difference between LGG and HGG using mean FA values in each ROI. The ADC and minimal ADC values of solid tumoral region and peritumoral edema, the ADC and minimal ADC ratios of solid tumoral region are statistical significant to differentiate HGG from LGG, p < 0.05. The ratio ADC solid tumoral region to normal corpus callosum had highest predictive accuracy to differentiate the two entities with AUC of 0.74. CONCLUSION: The ADC value, minimal ADC value, and ADC ratios of solid tumoral region appeared to be useful for differentiating HGG from LGG.

MDCT imaging findings for characterization pancreatic cystic lesion: differentiation between benign and malignant pattern.

OBJECTIVE: The purpose of the present study was to determine the characteristic imaging findings for diagnosis of the benign or malignant nature of pancreatic cystic lesions by 64 slice multidetector computed tomography (MDCT) for further investigation or treatment. MATERIAL AND METHOD: A retrospective study was performed in 33 patients with pancreatic cystic lesion who underwent 64 slice MDCT to characterize and establish the diagnosis. The patients were enrolled between January 2004 and March 2009. The MDCT scan of abdomen from patients with pancreatic cystic lesion was retrospectively evaluated by two gastrointestinal radiologists without knowledge of the patient's history, clinical data, and final diagnosis. Sensitivity, specificity, accuracy, PPV, and NPV of CT scan for discriminate benign and malignant pancreatic cystic lesion were calculated. Weighted-kappa statistics were used to estimate agreement between readers. RESULTS: Thirty-three patients with pancreatic cystic lesion were included in the present study. Benign pancreatic cystic lesion are pancreatic pseudocyst (n = 16), serous cystadenoma (n = 4) and benign intraductal papillary mucinous neoplasms IPMN (n = 2). Premalignant and malignant pancreatic cystic tumor are mucinous cystic tumor (n = 5) and include solid pseudopapillary epithelial neoplasm of pancreas (n = 3) and malignant intraductal papillary mucinous neoplasms IPMN (n = 3). The final diagnosis was established either by pathological diagnosis (20 patients), EUS with FNA (11 patients) or F/U clinical and imaging findings (2 patients). Pseudopod sign is a helpful finding for diagnosis pancreatic pseudocyst (3/16) and not observed in other types pancreatic cystic lesions. Type of cyst (unilocular, multilocular microcystic, multilocular macrocystic and solid component) is the only finding that has statistical significance for differentiating between the benign and malignant groups (p < 0.005). The overall sensitivity, specificity and accuracy of 64-slice MDCT to discriminate benign and malignant pancreatic cystic lesion were 36.3%, 100% and 78.8%, respectively. In addition, the PPV and NPV were 100% and 75.9%, respectively. CONCLUSION: The 64 sliced MDCT is a noninvasive method that can be used for discriminating between benign and malignant pancreatic cystic lesions, which is an important finding for further investigation and proper treatment.

Cerebral venous thrombosis: diagnosis dilemma.

Cerebral venous thrombosis is increasing common disease in daily practice with sharing clinical nonspecific symptoms. This disorder is potentially lethal but treatable, oftenly it was overlooked in both clinical and radiologic in routine practice. Whenever, clinical suspected, prompt investigation by noninvasive imaging Magnetic resonance (MR) or advanced modilities such as cerebral venous thrombosis (CVT), MRV (MR Venography) will helpful in prompt diagnosis and treatment. These imaging modalities may reveal either direct sign (visualization of intraluminal clot) and indirect signs (paranchymatous change, intracranial hemorrhage). By using of effective treatment will improve the prognosis of the patient. This review summarizes insights into etiology, incidence, imaging modalities and current of the treatment.