One hundred years of neuroradiology in Acta Radiologica: a Swedish perspective.

This year, Acta Radiologica marks its 100th anniversary. In this article, the authors present some of the highlights from the close collaboration between Swedish neuroradiology and Acta Radiologica over the last 100 years.

Detectability of the choroid plexus of the third ventricle with magnetic resonance ventriculography.

PURPOSE: To clarify the detectability of the choroid plexus of the third ventricle (ChPl3V) with magnetic resonance ventriculography (MRVn) employing a steady-state free precession (SSFP) sequence in comparison to surgical endoscopic movies as a golden standard, as we encountered some clinical cases of total agenesis of corpus callosum (ACC) where we could not recognize the choroid plexus of the third ventricle and found no previous article addressing this problem. MATERIALS AND METHODS: This retrospective study included consecutive patients from 2010 to 2016 for whom endoscopic evaluation of the third ventricle was conducted. The anterior portion of the right and left streaks of ChPl3V was evaluated in 8 patients on 16 sites, while the posterior portion of both streaks of ChPl3V was evaluated in 13 patients on 26 sites. Sensitivity of MRVn to visualize ChPl3V with endoscopic movies as the golden standard was calculated. RESULTS: Sensitivity of MRVn in visualizing the anterior portion of ChPl3V was 0.813, and that for the posterior portion 0.692. The anterior portion of ChPl3V was visualized in all cases where no tumor contacted the foramen of Monro. CONCLUSION: MRVn visualizes the anterior portion of ChPl3V with significant sensitivity and the posterior portion with lower one.

The Added Value of Magnetic Resonance Imaging Cisternography and Ventriculography as a Diagnostic Aid in Pediatric Hydrocephalus.

BACKGROUND: Magnetic resonance imaging (MRI) is the "gold standard" method for the evaluation of hydrocephalus. However, diagnosing an obstruction in the ventricular or subarachnoid spaces may pose a challenge for standard diagnostic sequences. In this study, we describe our experience with MRI cisternography (MRIC) or ventriculography (MRIV) for diagnosing or excluding intra- and extraventricular obstructions. Such a differentiation may have a significant impact on choosing the optimal surgical solution. METHODS: We retrospectively collected data on patients undergoing MRIC/MRIV for diagnosing or excluding obstructions in patients with ventriculomegaly. All patients had MRI suggesting an obstruction, but without a clear cause. RESULTS: Five children aged 1-17 years were included (3 females). Four underwent an MRIV, and 1 underwent an MRIC. Three children presented with headaches and had a suspected prior endoscopic third ventriculostomy (ETV) failure, and 2 presented with macrocephalus and increasing head circumferences. MRIV showed a patent ETV stoma in 2 cases, one of which had a T2 SPACE MRI showing no flow void through the stoma, and a closed stoma in 1 case with a flow void above and below the stoma on T2 SPACE MRI. MRIV and MRIC differentiated between two cases with panventriculomegaly, one of which had an obstruction at the level of the Liliequist membrane, and another with no identifiable obstruction. CONCLUSIONS: MRIC and MRIV have a complementary role to MRI in assessing selected patients with hydrocephalus suspected of being secondary to an obstruction, but with no clear obstruction location.

Takotsubo cardiomyopathy triggered by status epilepticus: case report and literature review.

Takotsubo cardiomyopathy (TC) is acute stress-induced cardiomyopathy with characteristic transient wall motion abnormalities. TC has a clinical presentation similar to an acute coronary syndrome, including chest pain or dyspnoea, ECG changes and elevated cardiac enzymes. TC often occurs after emotional stress. There are approximately 50 TC cases reported related to seizure activity, and our review revealed 15 articles which were associated with status epilepticus. This condition can be a serious complication of seizures. We report a case of TC after status epilepticus in a patient who had been seizure-free for 20 years.

Bedside Iohexol Ventriculography for Patients with Obstructive Colloid Cysts: A Protocol to Identify Auto-Fenestration of the Septum Pellucidum.

OBJECTIVE: Patients with hydrocephalus secondary to third ventricular colloid cysts can require bilateral external ventricular drain (EVD) placement while awaiting surgery. However, some patients could develop auto-fenestration of the septum pellucidum (AFSP) and only require 1 EVD. We evaluated our experience with bedside iohexol ventriculography and staged EVD placement for patients with obstructive hydrocephalus. METHODS: We retrospectively identified 34 patients who had been treated for third ventricular colloid cysts (2013-2016). The preoperative and postoperative data, including age, sex, colloid cyst size, preoperative hydrocephalus, preoperative EVD placement, preoperative iohexol ventriculography, operative approach, intraoperative findings, and postoperative ventriculoperitoneal shunt requirements, were reviewed. RESULTS: Hydrocephalus was found in 23 patients (68%) on initial presentation. Nine patients (26%) had EVDs placed before surgery. Six patients (18%) underwent iohexol ventriculography after insertion of a right-sided EVD. Five patients (15%) demonstrated no evidence of ventricular communication. Four patients (67%) required left-sided EVD placement. One patient (17%) had robust communication between the lateral ventricles after intraventricular iohexol injection, which was managed with a single EVD. AFSP was observed during surgical resection of this patient's colloid cyst. One other patient who did not undergo preoperative EVD placement was noted to have AFSP intraoperatively, resulting in 2 of 34 patients (6%) with AFSP in our series. CONCLUSIONS: A subset of patients with obstruction at the foramina of Monro can develop AFSP. Iohexol ventriculography after unilateral EVD placement allows clinicians to assess for the presence of AFSP and identify patients who can be treated with a single EVD before surgery.

The use of clinical examination and cranial ultrasound in the diagnosis and management of post-hemorrhagic ventricular dilation in extremely premature infants.

OBJECTIVES: The objective of this study is to describe clinical and ultrasound changes in a cohort of premature newborns with post-hemorrhagic ventricular dilation (PHVD), and to correlate these changes with outcome. STUDY DESIGN: Premature newborns <29 weeks gestational age (GA) and ≤ 1,500 g birth weight with intraventricular hemorrhage were retrospectively reviewed. Clinical signs and cranial ultrasound (CUS) findings between time after birth and time before first cerebrospinal fluid temporizing intervention were compared with GA-equivalent newborns without interventions. White matter injury was assessed on brain magnetic resonance imaging. RESULTS: Between 2011 and 2014, 64 newborns met inclusion criteria; 23% had PHVD. The growth rates of the ventricles on CUS and the head circumference (HC) were higher in newborns with PHVD (p < 0.01 and p = 0.04, respectively) and correlated inversely with white matter injury (p = 0.006 and p < 0.001, respectively). CONCLUSION: Progression of PHVD in premature newborns as demonstrated by CUS and the HC correlated with outcome. Consistent measurement of these simple parameters will allow for much needed treatment comparisons, to define optimal protocols that decrease the risk of cerebral palsy in extremely preterm populations.

Quantitative Computed Tomography Ventriculography for Assessment and Monitoring of Hydrocephalus: A Pilot Study and Description of Method in Subarachnoid Hemorrhage.

BACKGROUND: There is no facile quantitative method for monitoring hydrocephalus (HCP). We propose quantitative computed tomography (CT) ventriculography (qCTV) as a novel computer vision tool for empirically assessing HCP in patients with subarachnoid hemorrhage (SAH). METHODS: Twenty patients with SAH who were evaluated for ventriculoperitoneal shunt (VPS) placement were selected for inclusion. Ten patients with normal head computed tomography (CTH) findings were analyzed as negative controls. CTH scans were segmented both manually and automatically (by qCTV) to generate measures of ventricular volume. RESULTS: The median manually calculated ventricular volume was 36.1 cm3 (interquartile range [IQR], 30-115 cm3), which was similar to the median qCTV measured volume of 37.5 cm3 (IQR, 32-118 cm3) (P = 0.796). Patients undergoing VPS placement demonstrated an increase in median ventricular volume on qCTV from 21 cm3 to 40 cm3 on day T-2 and to 51 cm3 by day 0, a change of 144%. This is in contrast to patients who did not require shunting, in whom median ventricular volume decreased from 16 cm3 to 14 cm3 on day T-2 and to 13 cm3 by day 0, with an average overall volume decrease 19% (P = 0.001). The average change in ventricular volume predicted which patients would require VPS placement, successfully identifying 7 of 10 patients (P = 0.004). Using an optimized cutoff of a change in ventricular volume of 2.5 cm3 identified all patients who went on to require VPS placement (10 of 10; P = 0.011). CONCLUSIONS: qCTV is a reliable means of quantifying ventricular volume and hydrocephalus. This technique offers a new tool for monitoring neurosurgical patients for hydrocephalus, and may be beneficial for use in future research studies, as well as in the routine care of patients with hydrocephalus.

Explorando el oscuro continente: imagen médica y cerebro / Exploring the dark continent: medical image and brain

Introducción. Hasta finales del siglo XIX, el sistema nervioso central es prácticamente inaccesible a la observación directa. El descubrimiento en 1895 de los rayos X y su posterior aplicación médica constituyen un cambio de paradigma que revoluciona por completo la manera en que se practica la neurología. La posibilidad de visualizar el interior del encéfalo tiene un impacto mayúsculo en la práctica clínica y enriquece el diagnóstico y el tratamiento de patologías cerebrales de una forma hasta entonces inimaginable. Desarrollo. El propósito de este trabajo es describir el nacimiento y el desarrollo de la imagen médica cerebral: partimos del descubrimiento de los rayos X y del inicio de la radiografía hasta llegar a la aparición en la década de los setenta de la tomografía computarizada y la resonancia magnética, técnicas que cambiarían el mundo del diagnóstico por imagen. En este breve recorrido por la historia de la neurorradiología también se incluye el origen de la angiografía y otras técnicas actualmente en desuso, pero que en su momento constituyeron una auténtica revolución; tal es el caso de la ventriculografía o la neumoencefalografía. Conclusiones. Los procedimientos y técnicas descritos en este artículo han permitido visualizar el interior del cerebro, facilitando el diagnóstico y el tratamiento de múltiples procesos neurológicos (AU)

Introduction. Until the late 19th century, direct observation of the central nervous system was practically impossible. The discovery of X-rays in 1895 and their subsequent application in the field of medicine brought about a shift of paradigm that completely revolutionised the way in which neurology was practised. The possibility of viewing the inside of the brain had a pronounced impact on clinical practice, and enriched the diagnosis and treatment of brain pathologies in a manner that was unimaginable up until then. Development. The aim of this study is to describe the birth and development of medical imaging of the brain, from the discovery of X-rays and the early days of radiography to the appearance of computerised tomography and magnetic resonance in the 60s, both of which are techniques that were to change the world of diagnostic imaging forever. This brief overview of the history of radiology also includes the origins of angiography and other techniques that are no longer in use, but which were ground-breaking innovations in their time, such as ventriculography or pneumoencephalography. Conclusions. The procedures and techniques described in this article made it possible to view the inside of the brain, thereby facilitating the diagnosis and treatment of a number of neurological processes (AU)

Linear relationship found by magnetic resonance imaging between cerebrospinal fluid volume and body weight in dogs.

Despite numerous studies on cerebrospinal fluid (CSF) and its importance during hydrocephalus or myelography, no reliable values exist about its overall volume in dogs. In this study, our aim was to measure the intracranial (IC) volume of CSF in dogs and assess its possible relationship with body size and the symmetry of the lateral ventricles. We ran a 3D magnetic resonance imaging (MRI) sequence on the central nervous system of 12 healthy, male mongrel dogs between 3-5 years of age and 7.5-35.0 kg body weight. A validated semiautomatic segmentation protocol was implemented to segment the CSF and measure its volume. Values for the volume of the ventricular compartment were between 0.97 and 2.94 ml, with 62.1 ± 11.7% in the lateral ventricles, 17.6 ± 4.9% in the third ventricle, 4.9 ± 1.6% in the aqueductus mesencephali and 15.5 ± 6.6% in the fourth ventricle. In 11 cases a significant asymmetry was found between the lateral ventricles. The results suggest that it may be normal for a dog to have one of the lateral ventricles 1.5 times larger than the other. The correlation between body weight and CSF volume was linear, indicating that the current dosage protocols for myelography, based on a hypothetical proportional relationship with body weight, may have to be revised.

Correlations of atrial diameter and frontooccipital horn ratio with ventricle size in fetal ventriculomegaly.

OBJECTIVE Fetal ventriculomegaly (FV), or enlarged cerebral ventricles in utero, is defined in fetal studies as an atrial diameter (AD) greater than 10 mm. In postnatal studies, the frontooccipital horn ratio (FOHR) is commonly used as a proxy for ventricle size (VS); however, its role in FV has not been assessed. Using image analysis techniques to quantify VS on fetal MR images, authors of the present study examined correlations between linear measures (AD and FOHR) and VS in patients with FV. METHODS The authors performed a cross-sectional study using fetal MR images to measure AD in the axial plane at the level of the atria of the lateral ventricles and to calculate FOHR as the average of the frontal and occipital horn diameters divided by the biparietal distance. Computer software was used to separately segment and measure the area of the ventricle and the ventricle plus the subarachnoid space in 2 dimensions. Segmentation was performed on axial slices 3 above and 3 below the slice used to measure AD, and measurements for each slice were combined to yield a volume, or 3D VS. The VS was expressed as the absolute number of voxels (non-normalized) and as the number of voxels divided by intracranial size (normalized). A Pearson correlation coefficient was used to measure the strength of the relationships between the linear measures and the size of segmented regions in 2 and 3 dimensions and over various gestational ages (GAs). Differences between correlations were compared using Steiger's z-test. RESULTS Fifty FV patients who had undergone fetal MRI between 2008 and 2014 were included in the study. The mean GA was 26.3 ± 5.4 weeks. The mean AD was 18.1 ± 8.3 mm, and the mean FOHR was 0.49 ± 0.11. When using absolute VS, the correlation between AD and 3D VS (r = 0.844, p < 0.0001) was significantly higher than that between FOHR and 3D VS (r = 0.668, p < 0.0001; p = 0.0004, Steiger's z-test). However, when VS was normalized, correlations were not significantly different between AD and 3D VS (r = 0.830, p < 0.0001) or FOHR and 3D VS (r = 0.842, p < 0.0001; p = 0.8, Steiger's z-test). For GAs of 24 weeks or earlier, AD correlated more strongly with normalized 3D VS (r = 0.902, p < 0.0001) than with FOHR (r = 0.674, p < 0.0001; p < 0.0001, Steiger's z-test). After 24 weeks, there was no difference in correlations between linear measures (AD or FOHR) and 3D VS (r > 0.9). Correlations of linear measures with VS in 2 and 3 dimensions were similar, and inclusion of the subarachnoid space did not significantly alter results. CONCLUSIONS Findings in the study support the use of AD as a measure of VS in fetal studies as it correlates highly with both absolute and relative VS, especially at early GAs, and captures the preferential dilation of the occipital horns in patients with FV. Compared with AD, FOHR similarly correlates with normalized VS and, after a GA of 24 weeks, can be reported in fetal studies to provide continuity with postnatal monitoring.

Neuroendoscopic Approach to Intracranial Ependymal Cysts.

BACKGROUND: Intraparenchymal cysts without communication to the ventricles or the subarachnoid space are named ependymal or epithelial cysts. The estimated ratio of their incidence compared with arachnoid cysts is 1:10. Neurologic deficit can occur when the cyst exerts mass effect on its surroundings. We evaluated the success rate of endoscopic fenestration of intracranial ependymal cysts. METHODS: Our prospectively maintained endoscopy database was screened for all cases of ependymal cysts. The charts were retrospectively reviewed for symptoms, surgery, postoperative course, and complications. Magnetic resonance imaging scans performed before and after surgery were analyzed. RESULTS: We identified 6 patients harboring an intracranial ependymal cyst. The cyst location was frontoparietal, parietal, occipital, or mesencephalic. Patients presented with several symptoms according to the location of the cyst (i.e., epilepsy, hemiparesis, diplopia, hemianopsia). All patients were treated by navigation-guided endoscopic fenestration of the cyst to the ventricular system. Two complications occurred: a cerebrospinal fluid leak, which was managed surgically by wound revision without the need for cerebrospinal fluid shunting, and a chronic subdural hematoma, which occurred 6 weeks after surgery and required burr hole evacuation. Follow-up period ranged from 6 months to 9 years. Magnetic resonance imaging revealed that all cysts decreased in size. Symptoms improved in all patients. CONCLUSIONS: Endoscopic fenestration of ependymal cysts to an adjacent ventricular cavity is a treatment option with excellent long-term results and minimal morbidity. It should be considered as the therapy of choice to avoid craniotomy and shunt dependence.

Oclusión congénita del foramen de Monro como causa de hidrocefalia unilateral. A propósito de un caso / Congenital obstruction of the foramen of Monro causing unilateral hydrocephalus. A propos of a case

La hidrocefalia aislada del ventrículo lateral puede ser provocada por la oclusión unilateral del foramen de Monro. Las causas más frecuentes son los tumores de los ventrículos laterales o en el área del tercer ventrículo. La estenosis no tumoral es poco frecuente y puede deberse a patologías inflamatorias, vasculares o congénitas. Se presenta el caso de un recién nacido a término diagnosticado prenatalmente de hidrocefalia unilateral. Tras el parto se confirmó en las sucesivas ecografías la dilatación ventricular unilateral motivo por el cual se indicó el tratamiento quirúrgico. El paciente fue sometido a la fenestración del foramen de Monro y septostomía por vía endoscópica, con buena evolución clínica y reducción del tamaño ventricular. Los hallazgos intraoperatorios demostraron la obstrucción por una membrana del foramen de Monro derecho. Se puede conseguir un tratamiento adecuado mediante neuroendoscopia, evitando implantar derivaciones ventriculares (AU)

Isolated hydrocephalus of the lateral ventricle may result from unilateral occlusion of the foramen of Monro. The most common causes are tumours of the lateral ventricles or in the area of the third ventricle. Non-tumoural stenosis of the foramen is rare and can be due to inflammatory, vascular or congenital conditions. A full-term infant was prenatally diagnosed with unilateral hydrocephalus. After birth, progressive unilateral ventricular dilatation was confirmed in successive ultrasounds so surgery was indicated. The patient underwent endoscopic fenestration of the foramen of Monro and septostomy with good postoperative clinical evolution and reduction of ventricular size. Intraoperative findings demonstrated membranous obstruction of the right foramen of Monro. A successful treatment can be accomplished through a neuroendoscopic approach avoiding the use of ventricular shunts (AU)

Colocación endoscópica por vía occipital de catéteres ventriculares permanentes: nota técnica / Endoscopic access to occipital lateral ventricle using permanent catheters: technical note

El siguiente trabajo constituye una nota técnica sobre un nuevo proceder endoscópico de colocación de catéteres ventriculares permanente a través del cuerno occipital. Se colocaron 20 catéteres permanentes utilizando el sistema DECK con un endoscopio Hopkins II de 30°, diámetro 2,7 mm y longitud 30 cm, con vainas y canales de trabajos. La posición del catéter fue evaluada por tomografía de cráneo realizada a las 24 horas de la cirugía, obteniéndose una posición a (óptima) en el 95 por ciento de los casos, con una distancia promedio de 10,5 cm desde la tabla externa del hueso occipital al cuerno frontal. En ninguno de los casos disfuncionó el sistema derivativo y un solo paciente presentó como complicación un hematoma del lecho quirúrgico.

The following papers is a technical note about a new endoscopic access to lateral ventricle through occipital horn to place ventricles catheters, 20 patient was operated using Deck System of endoscopy with lens of 30 grades, 2,7 mm of diameter and 30 cm of larger, sheets and working canals including. CT scan was performing 24 hours after surgery and optimal position was obtained in 95 percent. Median distance from occipital bon to frontal horn of the ventricles was 10,5 cm. Any patient present dysfunction of the system and only one patient had a hematoma of the surgical area.

The Pioneering and Unknown Stereotactic Approach of Roeder and Orthner from Göttingen. Part I. Surgical Technique for Tailoring Individualized Stereotactic Lesions.

During the 1950s through the 1970s, Hans Orthner and Fritz Roeder, two German neurologists from Göttingen, developed a sophisticated technique to perform functional stereotactic surgery with outstanding accuracy. They introduced direct air ventriculography performed in the same surgical session as the ablative stereotactic procedure. For individualized surgical targeting, Orthner prepared a stereotactic atlas (>60 brains) with an ingenious brain-slicing device, the Göttinger macrotome. Brains were grouped based on similarity of six different head and ventricle measurements. A brain cluster representing the best match for a patient was selected for stereotactic targeting. Stereotactic lesions were tailored in an individual manner and shaped by stringing together multiple small coagulations following intraoperative test stimulation. This was achieved from a single probe trajectory by using well-engineered string electrodes with calibrated curving and involved laborious calculations. Only high-frequency thermocoagulation was regarded as appropriate for lesioning. With this meticulous technique, the most advanced stereotactic procedures were performed, including bilateral pallidotomy that ultimately could be restricted to the ansa lenticularis and ventromedial hypothalamotomy, the most delicate stereotactic operation performed to date. Outside Göttingen, this technique has only been used by Prof. Dieter Müller in Hamburg, Germany. This elaborate stereotactic approach is widely unknown and deserves to be discussed in a historical context.

Measuring Ventricular Width on Cranial Computed Tomography: Feasibility of Dose Reduction in a Custom-Made Adult Phantom.

PURPOSE: To estimate feasible dose reduction to reliably measure ventricular width in adults with hydrocephalus in follow-up cranial computed tomography (CCT) using a custom-made phantom. MATERIALS AND METHODS: A gelatine-filled adult calvarium with embedded central fibers of two carrots representing the lateral ventricles was used as a phantom. The phantom was scanned 11 times with two CT scanners (LightSpeed Ultra, GE and Somatom Sensation, Siemens), using tube currents of 380/400, 350, 300, 250, 200, 150 and 100 mA, and tube voltages of 140, 120, 100 and 80 kV. The width of the carrots was measured at four sites in consensus decision of two principle investigators blinded to the scan parameters. Values measured at 380/400 mA and 140 kV served as a reference for the width of the ventricles. Measurements received 1 point if they did not differ more than 0.5 mm from the reference values. A maximum score of 4 could be achieved. RESULTS: The relationship between the correct width measurement of the carrots (lateral ventricles) and the radiation dose can be described by a quadratic regression function. Pixel noise increases and accuracy of measurements decreases with a lower radiation dose. Starting from a tube current of 380/400 mA and a tube voltage of 140 kV, the dose can be reduced by 76 % for LightSpeed Ultra and by 80 % for Somatom Sensation provided that a margin of error of 37.5 % (score = 2.5) for correct width measurement of the carrots is accepted. CONCLUSION: Lowering the radiation dose by up to 48 % for LightSpeed Ultra and by 52 % for Somatom Sensation, compared to the standard protocol (120 kV and 400 mA) still allowed reliable measurements of ventricular widths in this model. KEY POINTS: • There is a quadratic relationship between correct width measurements of lateral ventricles and radiation dose in CT. • Reduction of radiation dose results in increased pixel noise and increased error for correct ventricle width measurement. • Due to a considerable attenuation difference between cerebrospinal fluid and brain parenchyma, a dose reduction for the determination of ventricular size in CT seems feasible and should be performed.

Adverse prognosis and distinct progression patterns after concurrent chemoradiotherapy for glioblastoma with synchronous subventricular zone and corpus callosum invasion.

BACKGROUND AND PURPOSE: The subventricular zone (SVZ) and the corpus callosum (CC) invasion status are separately associated with adverse prognosis for glioblastoma. We investigated the prognosis and progression patterns of glioblastoma with and without synchronous SVZ and CC (sSVZCC) invasion. MATERIAL AND METHODS: Glioblastoma patients completing concurrent chemoradiotherapy with temozolomide were retrospectively categorized by the preoperative sSVZCC invasion status. The associations between sSVZCC invasion and the survival and progression patterns were analyzed. RESULTS: In total, 108 patients, including 36 with sSVZCC invasion, were followed for a median period of 60.2 (range 34.2-86.3) months. The median overall survival (OS) of patients with and without sSVZCC were 18.6 and 26.4 months, respectively (p=0.005). Using multivariate analyses with the factors of age, performance, surgery extent, and tumor size, sSVZCC invasion remained significant for a poor OS (hazard ratio, 1.96; 95% confidence interval, 1.19-3.21). The rates of progression at tumor bed, preoperative edematous areas, bilateral hemispheres, and ventricles for tumors with and without sSVZCC invasion were 75% and 63.9% (p=0.282), 41.7% and 9.7% (p<0.001), 47.2% and 13.9% (p<0.001), and 38.9% and 13.9% (p=0.006), respectively. CONCLUSIONS: The sSVZCC invasion status determined the distinct prognosis and progression areas of glioblastoma, which suggests individualized radiotherapy and drug administration strategies.

Z-score-based semi-quantitative analysis of the volume of the temporal horn of the lateral ventricle on brain CT images.

The volume of the temporal horn of the lateral ventricle (THLV) on brain computed tomography (CT) images is important for neurologic diagnosis. Our purpose in this study was to develop a z-score-based semi-quantitative analysis for estimation of the THLV volume by using voxel-based morphometry. The THLV volume was estimated by use of a z-score mapping method that consisted of four main steps: anatomic standardization, construction of a normal reference database, calculation of the z score, and calculation of the mean z score in a volume of interest (VOI). A mean z score of the CT value obtained from a VOI around the THLV was used as an index for the THLV volume. CT scans from 50 subjects were evaluated. For evaluation of the accuracy of this method for estimating the THLV volume, the THLV volume was determined manually by neuroradiologists (serving as the reference volume). A mean z score was calculated from the VOI for each THLV of the 50 subjects by use of the proposed method. The accuracy of this method was evaluated by use of the relationship between the mean z score and the reference volume. The quadratic polynomial regression equation demonstrated a statistically significant correlation between the mean z score and the reference volume of the THLV (R (2) = 0.94; P < 0.0001). In 92 of 100 THLVs (92 %), the 95 % prediction interval of the regional mean z score captured the reference volume of the THLV. The z-score-based semi-quantitative analysis has the potential quantitatively to estimate the THLV volume on CT images.

Surgical Ventricular Entry is a Key Risk Factor for Leptomeningeal Metastasis of High Grade Gliomas.

Leptomeningeal metastasis (LM) of high grade gliomas (HGG) can lead to devastating disease courses. Understanding of risk factors for LM is important to identify patients at risk. We reviewed patient records and magnetic resonance imaging (MRI) of all patients with a first diagnosis of HGG who underwent surgery in our institution between 2008 and 2012. To assess the influence of potential risk factors for LM and the impact of LM on survival multivariate statistics were performed. 239 patients with a diagnosis of HGG and at least 6 months of MRI and clinical follow-up were included. LM occurred in 27 (11%) patients and was symptomatic in 17 (65%). A strong correlation of surgical entry to the ventricle and LM was found (HR: 8.1). Ventricular entry was documented in 137 patients (57%) and LM ensued in 25 (18%) of these. Only two (2%) of 102 patients without ventricular entry developed LM. Median overall survival of patients after diagnosis of LM (239 days) was significantly shorter compared to patients without LM (626 days). LM is a frequent complication in the course of disease of HGG and is associated with poor survival. Surgical entry to the ventricle is a key risk factor for LM.

[Changes in Cerebral Blood Flow and Cognitive Function in Patients Undergoing Coronary Bypass Surgery With Cardiopulmonary Bypass].

PURPOSE: to study effect of coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) on regional cerebral blood flow and cognitive function in patients with ischemic heart disease (IHD). MATERIAL AND METHODS: We included into this study 22 patients with IHD subjected to CABG surgery with CPB. All patients underwent brain SPECT scanning and comprehensive neuropsychological testing 1 day before, 10-14 days and 6 months after surgery. RESULTS: Overall CABG with CPB was followed by reduction of regional cerebral blood flow relative to baseline in frontal and parietal cortex (p < 0.01). Substantial reduction (> 5%) of cerebral perfusion in early postoperative period was observed in 15 patients (68%) while seven patients (32%) had no significant changes of regional cerebral blood flow. Changes of cerebral perfusion correlated with dynamics of cognitive status. Mean measures of immediate verbal memory, delayed memory, and learning decreased after surgery by 25.6 (p = 0.002), 43.3 (p = 0.000003), and 23.1% (p = 0.00000), respectively. Moreover after CABG with CPB patients demonstrated slowing of psychomotor speed by 13.6% (p = 0.03). CONCLUSION: CABG with CPB was associated with reduction of cerebral perfusion leading to cognitive dysfunction. Immediate and delayed verbal and visual memory, learning and psychomotor speed were most sensitive to the negative effects of surgery.