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AIM: To explore the value of quantitative texture analysis of conventional magnetic resonance imaging (MRI) sequences using artificial neural networks (ANN) for the differentiation of high-grade gliomas (HGG) and low-grade gliomas (LGG). MATERIALS AND METHODS: A total of 181 patients, 97 with HGG (53.5%) and 84 with LGG (46.5%) with brain MRI having T2-weighted (W) fluid attenuation inversion recovery (FLAIR), and contrast-enhanced T1W images were enrolled in the present study. Histogram parameters and high-order texture features were extracted using manually placed regions of interest (ROIs) on T2W-FLAIR and contrast-enhanced T1W images covering the whole volume of the tumours. The reproducibility of the features was assessed by interobserver reliability analyses. The cohort was divided into training (n=121) and test partitions (n=60). The training set was used for attribute selection and model development, and the test set was used to evaluate the diagnostic performance of the pre-trained ANNs in discriminating HGG and LGG. RESULTS: In the test cohort, the ANN models using texture data of T2W-FLAIR and contrast-enhanced T1W images achieved an area under the receiver operating characteristic curve (AUC) of 0.87 and 0.86, respectively. The combined ANN model with selected texture features achieved the highest diagnostic accuracy equating 88.3% with an AUC of 0.92. CONCLUSIONS: Quantitative texture analysis of T2W-FLAIR and contrast-enhanced T1W enhanced by ANN can accurately discriminate HGG from LGG and might be of clinical value in tailoring the management strategies in patients with gliomas.
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Neoplasias Encefálicas/patología , Glioma/patología , Interpretación de Imagen Asistida por Computador/métodos , Imagen por Resonancia Magnética/métodos , Redes Neurales de la Computación , Adulto , Anciano , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND AND PURPOSE: Treatment of ruptured blister-like aneurysms is technically challenging. This study aimed at analyzing the safety and efficacy of the Flow-Redirection Endoluminal Device (FRED) in the treatment of ruptured blister-like aneurysms. MATERIALS AND METHODS: In a retrospective multicenter study, all patients treated with the FRED due to a ruptured intracranial blister-like aneurysm between January 2013 and May 2019 were analyzed. The primary end points for clinical safety were mRS 0-2 at 6 months after treatment and the absence of major ipsilateral stroke or death. The primary end points for efficacy were the absence of rebleeding after treatment and complete angiographic occlusion according to the O'Kelly-Marotta classification at 6 months after treatment. RESULTS: In total, 30 patients with 30 ruptured blister-like aneurysms were treated. Immediate complete aneurysm obliteration (O'Kelly-Marotta classification D) with the FRED was achieved in 10 patients (33%). Of the 26 patients with follow-up, complete obliteration was achieved in 21 patients (80%) after 6 months and in 24 patients (92%) in the final follow-up (median, 22 months). Twenty-three patients (77%) achieved mRS 0-2 at 6 months. Major stroke or death occurred in 17%. Two patients died due to pneumonia, and 2 patients died due to infarction following cerebral vasospasm. There was no case of rebleeding after FRED implantation. There was 1 case of delayed asymptomatic stent occlusion. CONCLUSIONS: Treatment of ruptured blister-like aneurysms with the FRED is safe and effective.
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Aneurisma Roto/cirugía , Procedimientos Endovasculares/instrumentación , Aneurisma Intracraneal/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND AND PURPOSE: Serpentine aneurysms are partially thrombosed aneurysms with an eccentrically located tortuous intra-aneurysmal vascular channel. The large size, distinctive neck anatomy, and supply of the brain parenchyma by the outflow tract pose technical challenges in treatment. The aim of this study was to discuss the endovascular treatment results and illustrate the dynamic nature of serpentine aneurysms. Spontaneous transformation of saccular and fusiform aneurysms into serpentine morphology, along with a case of serpentine-into-fusiform aneurysm transformation during follow-up, is presented. MATERIALS AND METHODS: A retrospective analysis from 3 institutions revealed 15 patients with serpentine aneurysms who underwent diagnostic evaluation and endovascular treatment. Nine of the 15 patients underwent endovascular occlusion of the parent vessel with detachable balloon or coils. Six of the 15 patients underwent aneurysm and parent artery occlusion with coiling. RESULTS: In 11 patients, improvement or resolution of symptoms was achieved by an endovascular approach without any treatment-related morbidity. Morbidity related to treatment in the immediate postoperative period was seen in 3 patients, with resolution of the deficits at long-term follow-up in 2 patients and persistence of a mild deficit in 1 patient. Endovascular treatment failed to achieve resolution of symptoms in a case with a basilar tip aneurysm treated by aneurysm coiling. CONCLUSIONS: Serpentine aneurysms are dynamic structures with spontaneous transformation possible from a saccular or fusiform shape into a serpentine configuration. An endovascular approach by parent vessel occlusion or intra-aneurysmal occlusion is a successful treatment technique for serpentine aneurysms.
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Embolización Terapéutica/métodos , Procedimientos Endovasculares/métodos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/patología , Aneurisma Intracraneal/terapia , Adolescente , Adulto , Anciano , Angiografía Cerebral , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: Flow diverters are emerging as an endovascular treatment alternative for proximally located intracranial aneurysms. However, treatment of aneurysms at and beyond the circle of Willis is not well-established. We assessed the clinical safety and efficacy of the Flow Re-Direction Endoluminal Device Jr (FRED Jr) dedicated to small-vessel diameters between 2.0 and 3.0 mm. MATERIALS AND METHODS: This was a multicenter observational clinical study of 42 patients with 47 aneurysms treated by a flow-direction technique with the FRED Jr. The primary end point for clinical safety was the absence of death, major or minor stroke, and TIA. The primary end point for treatment efficacy was complete and near-complete occlusion according to the O'Kelly-Marotta grading scale at follow-up after 1, 6, and 12 months. RESULTS: The FRED Jr deployment was technically successful in all cases. In 39/42 (93%) patients, the primary safety end point was reached; in the 3 remaining patients, 1 disabling ischemic stroke, 1 minor stroke with complete recovery at discharge, and 1 TIA were observed. Two asymptomatic, completely reversible side-branch occlusions occurred. Angiographic (DSA or flat panel CT) and clinical follow-up were available after 1 month in 41/47 (87%), 6 months in 27/47 (57%), and 12 months in 11/47 (23%) aneurysms. The primary efficacy end point was reached at 1 month in 27/41 (66%), at 6 months in 21/27 (78%), and at 12 months in 11/11 (100%) aneurysms. CONCLUSIONS: Deployment of the FRED Jr is safe and effective in the treatment of intracranial aneurysms located in small vessels.
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Procedimientos Endovasculares/instrumentación , Aneurisma Intracraneal/cirugía , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Synovial sarcomas are most commonly localized in the extremities, especially the lower thigh and knee areas. Retroperitoneal synovial sarcoma is very rare. We describe the radiological and pathological findings of an adult retroperitoneal synovial sarcoma.
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Neoplasias Retroperitoneales/diagnóstico por imagen , Sarcoma Sinovial/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Femenino , Humanos , Neoplasias Retroperitoneales/patología , Sarcoma Sinovial/patologíaRESUMEN
Solid-pseudopapillary tumour of the pancreas is a rare benign or low-grade malignant epithelial tumour; its association with pancreatic dorsal agenesis has been reported only once before. We present the radiological and histological findings of a case of pancreatic solid-pseudopapillary tumour associated with total pancreatic dorsal agenesis. A 49-year-old woman presented with abdominal pain radiating to the back for several months. Radiological findings showed absence of the dorsal pancreas and an 8 cm x 6 cm diameter tumour arising from the head of the pancreas. She underwent successful complete resection of the tumour. Histopathology revealed a diagnosis of solid-pseudopapillary tumour.
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Páncreas/anomalías , Neoplasias Pancreáticas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Dolor de Espalda/diagnóstico por imagen , Dolor de Espalda/etiología , Dolor de Espalda/cirugía , Femenino , Humanos , Persona de Mediana Edad , Páncreas/diagnóstico por imagen , Pancreatectomía , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/cirugía , Intensificación de Imagen RadiográficaRESUMEN
OBJECTIVES: To report the case of a spontaneous arteriovenous malformation involving the auricula, external auditory meatus, middle ear and part of the petrous apex, and also to provide updated information about its management. CASE REPORT: A 33-year-old woman presented complaining of accelerated growth of a retro-auricular swelling during her latest pregnancy, together with pain, pulsatile tinnitus and ear discharge. An arteriovenous malformation occupying the right auricula, external auditory canal, mastoid process of the temporal bone and the lateral half of the petrous segment was diagnosed, using temporal computerised tomography and magnetic resonance imaging. The lesion was embolised with polyvinyl alcohol particles at angiography. Excision of the arteriovenous malformation nidus was performed. Three years post-operatively, magnetic resonance imaging showed no residual lesion or recurrence at the temporal bone and petrous apex, although a few scanty, serpiginous, vascular remnants had persisted. CONCLUSIONS: In the head and neck, arteriovenous malformations usually occur intracranially; they are rare outside the cranium. To our knowledge, there have been no previously published cases of such an extensive arteriovenous malformation involving the temporal region. Apropos of our case, the definition, clinical findings, diagnostic approaches and therapeutic management of arteriovenous malformations are discussed.
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Malformaciones Arteriovenosas/terapia , Pabellón Auricular/anomalías , Embolización Terapéutica/métodos , Complicaciones Cardiovasculares del Embarazo/terapia , Adulto , Malformaciones Arteriovenosas/diagnóstico , Arteria Carótida Interna/anomalías , Pabellón Auricular/irrigación sanguínea , Femenino , Humanos , Angiografía por Resonancia Magnética , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Acúfeno/etiología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Idiopathic ventral spinal cord herniation is a rare cause of progressive myelopathy that demonstrates unique radiological features. We describe a case of thoracic spinal cord herniation through an anterior dural defect and discuss the characteristic findings on magnetic resonance imaging and computed tomographic myelography. A 36-year-old man presented to our clinic with progressive leg weakness and spasticity in both legs. Magnetic resonance imaging of the thoracic spinal canal demonstrated C-shaped anterior kinking of an atrophied spinal cord and enlarged dorsal subarachnoid space at the T5-T6 level. Computed tomographic myelography showed ventral herniation of the spinal cord and no evidence of an intradural spinal arachnoid cyst. Ventral spinal cord herniation is a commonly misdiagnosed entity. Knowledge of the characteristic imaging appearance of this treatable condition is important for proper diagnosis and treatment.
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Cranial nerve involvement in brucellosis is rare. We present a case of brucellosis presenting with optic neuritis and abducens nerve palsy on the left side. Cerebrospinal fluid findings indicated Brucella meningitis with high protein count, low sugar level and pleocystosis. In addition, Brucella agglutination test (Wright test) was found to be 1/128 in cerebrospinal fluid. Serum agglutination test for Brucella was also positive at 1/1280. This case was diagnosed as brucellosis involving optic and abducens nerves. The patient was treated by ceftriaxone (intravenous), rifampicin (orally) and doxycycline (orally). Two months later the patient's vision acuity in the left eye had moderately improved and the patient's left abducens palsy had almost disappeared. In conclusion, cranial nerve involvement in brucellosis can have good prognosis if anti-Brucella treatment is undertaken early.
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Enfermedades del Nervio Abducens/microbiología , Brucella melitensis/aislamiento & purificación , Brucelosis/microbiología , Meningitis Bacterianas/microbiología , Neuritis Óptica/microbiología , Enfermedades del Nervio Abducens/líquido cefalorraquídeo , Enfermedades del Nervio Abducens/tratamiento farmacológico , Adulto , Brucelosis/líquido cefalorraquídeo , Humanos , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/tratamiento farmacológico , Neuritis Óptica/líquido cefalorraquídeo , Neuritis Óptica/tratamiento farmacológicoRESUMEN
Most carcinoid tumors involve the gastrointestinal tract or respiratory system. Primary hepatic carcinoid tumor is a rare entity. A 46-year-old woman presented with abdominal pain, vomiting, and diarrhea. She was diagnosed with primary hepatic carcinoid tumor based on radiologic and laboratory findings, namely a mass in the fifth segment of the liver and markedly elevated levels of 5-hydroxyindole acetic acid in the urine. Histologic and immunohistochemical findings of the resected liver segment showed a malignant carcinoid tumor of the liver. This case is of interest because of the rarity of this neoplasm. This report describes the case and reviews the clinical features, radiologic findings, and treatment in previously reported cases.
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Tumor Carcinoide/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Tumor Carcinoide/cirugía , Femenino , Humanos , Neoplasias Hepáticas/cirugía , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodosRESUMEN
OBJECTIVE: To report three cases of intradural spinal tuberculosis (TB) by calling attention to atypical forms of spinal TB. SETTING: A University Hospital, Istanbul, Turkey. METHODS: Histopathological, radiological, surgical and physical examination findings of three patients with spinal TB were retrospectively reviewed. RESULTS: Based on histopathological, surgical and radiological findings, diagnosis of intramedullary abscess had been made in the first case and early and late phases of arachnoiditis in the other two patients, respectively. The clinical outcome was evaluated as satisfactory for the patient with intramedullary abscess who had been treated with medical and surgical interventions. The remaining two patients with arachnoiditis, who had been treated by shunting or simple decompression, had a relatively less favorable clinical outcome. CONCLUSION: Spinal TB, in its atypical forms, is a rare clinical entity and low index of suspicion on the part of the surgeon may result in misdiagnosis such as neoplasm. In cases presenting with an intraspinal mass lesion, possibility of a tuberculous abscess and/or a granuloma should be considered in the differential diagnosis.
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Duramadre/patología , Tuberculosis de la Columna Vertebral/patología , Tuberculosis de la Columna Vertebral/cirugía , Adulto , Niño , Duramadre/microbiología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Radiografía , Estudios Retrospectivos , Resultado del Tratamiento , Tuberculosis de la Columna Vertebral/diagnóstico por imagen , TurquíaRESUMEN
The clinicopathological features of two cases of capillary haemangioma of the spinal cord are described. The presenting symptoms were similar to those of common intradural, intramedullary tumours or tumour-like mass lesions. Radiological features of these two lesions resembled other vascular lesions of the spinal cord. The patients underwent surgery, and recoveries were good. Histologically, the lesions resembled capillary haemangioma of superficial tissues that are composed of lobules of small capillaries with feeding vessels. A fibrous capsule enveloped the lesions. Capillary haemangiomas of the central nervous system are rare. Awareness of their existence may help the surgeon to avoid misdiagnosis and overtreatment of these benign tumour-like lesions.