Intracranial inflammatory pseudotumor: case report and review of the literature.

OBJECTIVE: Inflammatory pseudotumor is an uncommon lesion of unknown etiology most frequently involving the lungs and orbits. Primary intracranial inflammatory pseudotumors are exceptionally rare. Herein, we report a case of inflammatory pseudotumor that arises from the central nervous system in a 25-year-old man. MATERIAL AND METHOD: The patient presented with numbness in his right arm and right leg. Computed Tomography and Magnetic Resonance Imaging demonstrated a left fronto-parietal lobulated mass with intense contrast enhancement and perilesional edema mimicking a high grade glioma or metastasis. The lesion was removed by complete surgical resection. RESULTS: Pathologic examination showed spindle cell proliferation in a collagenous background with dense infiltrates of mononuclear inflammatory cells.The spindle cells were diffusely immunopositive for vimentin and focally positive smooth muscle actin but the cells did not show glial fibrillary acidic protein, epithelial membrane antigen, synaptophysin, S-100 protein, anaplastic lymphoma kinase-1 protein and CD1a immunoreactivity. Based on the morphologic and immunohistochemical findings, the diagnosis of inflammatory pseudotumor was made. After surgery, the symptoms had disappeared. No recurrence was observed at the eleven-month follow-up. CONCLUSION: Although rare, inflammatory pseudotumor of central nervous system is important in the differential diagnosis of the tumor-like intracranial lesions. We discuss the etiopathogenetic, diagnostic and therapeutic issues related to this entity, and review the literature.

Leiomyoma of the seminal vesicle mimicking tumoral extension of prostatic carcinoma.

Leiomyoma of the seminal vesicle is an extremely rare tumour. The diagnosis of this entity is important when it co-exists with prostatic carcinoma, since it can simulate tumour extension from prostate or bladder cancer on MR imaging and lead to overstaging. In this report, we describe a 74-year-old man with a leiomyoma of the seminal vesicle that mimics tumour extension from co-existent prostatic cancer on T2-weighted MR imaging. To our knowledge, this is the first description of imaging findings of concurrent leiomyoma of the seminal vesicle and prostatic carcinoma.

Is the lateral angle of the internal acoustic canal sexually dimorphic in non-adults? An investigation by routine cranial magnetic resonance imaging.

The lateral angle of the internal acoustic canal is one of the measurements of petrous bone that has been previously studied for sex estimation, mostly in adults. We aimed at evaluating the effects of age, side, and sex on the lateral angle of the internal acoustic canal in pediatric patients. Pediatric routine cranial MRI studies were retrospectively investigated for this study. The lateral angle was measured on T2-weighted axial images when the anterior and posterior lips of the meatus and the cochlea were clearly visible on the same image. The data were evaluated for age, side and sex-related changes. Although 552 temporal bones from 273 patients were inspected, due to exclusion criteria lateral angle could be satisfactorily measured only in 101 temporal bones from 58 patients. The measurements did not differ significantly between sexes. An age-related, statistically significant decrease was observed for the entire pediatric sample studied, as well as for the males, but not for females. The measurements did not differ from side to side. The significant age-related decrease in lateral angle in male pediatric patients that was not detected in female counterparts may be the reflection of a sex-related difference in temporal bone development during childhood. Routine cranial MRI data may help investigators study age and sex-related changes in lateral angle in children.

Intraosseous meningioma: appearance on bone scintigraphy over five years.

While meningiomas are common intradural tumors, such lesions only rarely arise outside of the meninges. All meningiomas, however, may slowly enlarge causing concern for malignancy. We report the appearance of an intraosseous meningioma in the patient with a history of breast carcinoma where the lesion progressively enlarged over a period of 5 yr to reach approximately three times the original size.

Iodine-131 contamination from thyroid cancer patients.

High-dose radioactive iodine therapy using 131I is the treatment of choice for patients with thyroid cancer following thyroidectomy. Because of the large amount of activity which is excreted during hospitalization, contamination hazard from 131I excretion via perspiration, saliva, breath and urine may arise. In eight patients treated with doses of 131I ranging from 3.7 to 14.8 GBq (100-400 mCi), activity levels were measured in room air, from room surfaces, the toilet, the patients' exhaled breath, skin, saliva and toothbrushes, and the gloves used by medical staff. Thyroid bioassays were also performed on medical staff personnel caring for these patients both before and two days after administration of the treatment dose. Removable activity from the skin was positively correlated with treatment dose and reached a maximum at 24 hr post-therapy. Removable activity from room surfaces exceeded the level of contamination which requires clean-up in a restricted area during the patient's hospitalization. Thyroid bioassays on medical staff showed no significant uptake 2 days after treatment. The relatively high activities present in the saliva, urine and on the skin of these patients emphasizes the need for all individuals coming in contact with these patients to be made aware of the contamination hazard present.

Diffusion into human intervertebral disks studied with MR and gadoteridol.

PURPOSE: To determine the feasibility of measuring diffusion into human intervertebral disks by means of MR imaging with an intravenous nonionic gadolinium complex (gadoteridol). METHODS: In 18 patients undergoing lumbar spine MR imaging, signal intensity was measured in the intervertebral disks after a dose of 0.1 mmol/kg and after a supplemental dose of 0.2 mmol/kg. RESULTS: Signal intensity in the intervertebral disks increased with both gadoteridol doses. A greater increase was consistently achieved with the 0.3 mmol/kg (total) dose than with the 0.1 mmol/kg dose. The increase was greater near the endplates than in the midportion of the disk. CONCLUSION: Diffusion into human intervertebral disks can be detected with MR imaging after intravenous administration of gadoteridol. MR imaging with a paramagnetic contrast medium can be used to study diffusion into disk cartilage in vivo and noninvasively.

Functional MR of frontal lobe activation: comparison with Wada language results.

PURPOSE: Our purpose was to determine the utility of functional MR imaging in conjunction with a word-generation paradigm in the assessment of language lateralization. METHODS: Functional MR imaging and Wada testing for language lateralization was performed in patients with complex partial seizures during the performance of word-generation tasks. A language lateralization quotient was calculated from the number of activated pixels in the right and left hemispheres. A language laterality score was derived from the Wada results as the percentage of correct responses during right internal carotid artery injection minus the percentage of correct responses during left internal carotid injection. A correlation coefficient between the functional MR imaging results and the Wada language laterality scores was calculated. RESULTS: In 13 patients, hemispheric dominance based on Wada testing was confirmed by functional MR imaging during silent word generation. The Wada laterality scores varied from 100 to -100 and the functional MR imaging scores varied from 100 to -10. The language lateralization scores determined by functional MR imaging correlated significantly with the language lateralization scores derived from Wada testing. CONCLUSION: Functional MR imaging performed during word generation is an accurate method for lateralizing language function in patients with complex partial epilepsy.

SPET and three-phase planar bone scintigraphy in adult patients with chronic low back pain.

Among adults, low back pain (LBP) persisting for more than 3 months is a common complaint. A variety of imaging modalities including bone scintigraphy have been recommended as appropriate for the investigation of chronic LBP, even when there is no reason to suspect that the pain is due to tumour, infection or inflammatory arthritis. In this chronic LBP population, the diagnostic benefit of bone SPET, together with planar flow study, blood pool and delayed three-phase imaging, was assessed, Altogether, 2108 consecutive adult patients were entered into the chronic LBP bone scintigraphy database. Retrospective exclusion of patients with a history of tumour, infection or inflammatory arthritis reduced the population to 1390, of whom 916 underwent a lumbosacral spine flow study and blood pool imaging in addition to planar and SPET bone scintigraphy. The diagnostic benefit of these imaging studies was tabulated and compared. In addition, a retrospective chart review of the patients with renal and other soft tissue abnormalities identified by a flow study and blood pool imaging was undertaken with a view to documenting any changes in treatment planning over the 6 months following the nuclear medicine studies. Of the lumbosacral spine abnormalities, 44.1% were seen equally well on planar and SPET images, 24.0% better on SPET, 31.4% only seen on SPET, and 0.4% only seen on planar imaging. The distribution of abnormalities identified on SPET images in the lumbar spine was divided between vertebral bodies (36.1%), lamina or pedicles (which included frequent sites of increased uptake in the articular facets and pars interarticularis) (53.8%), spinous processes (8.7%) and transverse processes (1.3%). For the flow study and blood pool imaging, there was a 16.7% rate of positive studies. However, there were no documented changes in treatment planning because of these positive findings. In conclusion, when used to examine adult patients with chronic LBP, SPET detects significantly more scintigraphic abnormalities than planar imaging. The addition of a flow study and blood pool imaging as part of these LBP examinations results in a significant benefit. However, the clinical utility of such flow study and blood pool imaging studies cannot be confirmed.

Misleading imaging results in the diagnosis of parathyroid cysts.

Enlarged cystic parathyroid glands, whether hyperfunctioning or nonfunctioning, are rare and their accurate preoperative diagnosis is a difficult task. The authors report two cases of patients with cystic neck masses studied by Tl-201-Tc-99m pertechnetate subtraction scintigraphy, computerized tomography, and ultrasonography. The diagnostic consensus of preoperative studies was that these lesions were thyroid nodules or parathyroid adenomas. Surgical removal and histopathologic examination of these masses revealed a cystic parathyroid gland and a cystic parathyroid adenoma, respectively. When a fluid-filled lesion in the neck deep to the lower pole of the thyroid gland is encountered, the possibility of a parathyroid cyst should be considered so that further diagnostic tests can be properly performed.

Effect of gallium nitrate therapy on Ga-67 scintigraphic detection of lymphoma: case report.

Ga-67 and abdominal CT scans of a 72-year-old woman who had malignant lymphoma before, during, and after gallium nitrate/hydroxyurea combination therapy are presented. Disappearance of Ga-67 uptake by the tumor during this treatment despite continuing CT evidence of disease and reappearance of Ga-67 scan abnormalities after cessation of therapy suggests that caution should be exercised when interpreting results of Ga-67 scintigraphy for the detection of tumor viability during gallium nitrate/hydroxyurea therapy.

Fused pelvic kidney drained by a single ureter.

A case of fused pelvic (discoid) kidney drained by a superiorly inserted single ureter is presented. This is the twentieth case of fused pelvic kidney, and the fifth case in which drainage was carried out by a single ureter, to be reported in the English literature. The diagnosis and treatment of this condition is discussed and the relevant literature is reviewed.

MR Spectroscopy Findings in Lhermitte-Duclos Disease. A Case Report.

Lhermitte-Duclos disease (LDD) is a rare hamartomatous focal or diffuse enlargement of the cerebellum with unclear etiology. The characteristic magnetic resonance imaging (MRI) appearance consists of a non-enhancing mass in the cerebellar hemisphere with a striated pattern. The slow growing behavior of this benign lesion is characteristic. In a few reports on magnetic resonance spectroscopy (MRS) findings in LDD, a decreased level of N-acetyl aspartate, increased level of lactate and near normal level of choline were described. The information obtained from MRS is useful to confirm the relatively benign hamartomatous nature of the lesion. This paper reports a case of LDD and describes the MRI and MRS findings.

Multiple sclerosis and coexisting intradural extramedullary spinal cord tumour: a case report.

We report the coexistence of multiple sclerosis (MS) and an intradural extramedullary spinal cord tumour in a 46-year-old woman with a 2-year history of MS. The patient presented with right hemitrunk and lower extremity paraesthesias, urinary incontinence, and intermittent lower right back and abdominal pain, which did not respond to pulse steroid therapy. A spinal magnetic resonance imaging (MRI) study revealed an intradural extramedullary spinal cord tumour in the lower thoracic spine, later diagnosed as schwannoma. We call attention to this rare association of MS and a spinal cord tumour, and emphasize the need for scrutiny of new and uncommon symptoms during the follow-up of MS patients.

Pedal radiocolloid lymphoscintigraphy in demonstration of a post-surgical lymphatic leak.

Radiocolloid lymphoscintigraphy is a very effective diagnostic procedure for dynamic evaluation of lymphatic flow. In this case report, the use of radiocolloid lymphoscintigraphy in detection of a post-surgical lymphatic leak is presented. Dynamic pedal lymphoscintigraphy with Tc 99m-antimony trisulfide colloid clearly demonstrated the site of the leak.

Technetium-99m sestamibi uptake in human breast carcinoma cell lines displaying glutathione-associated drug-resistance.

An in vitro study was designed to evaluate the uptake of sestamibi (MIBI) in P-glycoprotein (Pgp) and glutathione-associated (GSH) multidrug-resistant (MDR) cell lines. MIBI uptake was studied in various human breast carcinoma cell lines, i.e. in wild-type (MCF7/wt) cells, in adriamycin-resistant (MCF7/adr) cells which express Pgp and in melphalan-resistant (MCF7/mph) cells with increased levels of GSH. The effects of buthiomine sulphoximine (BSO) and verapamil on MIBI uptake were also studied in the MCF7/mph and MCF7/adr cells respectively. The cells were incubated for 1 h with a dose of 0.1 MBq thallium-201 and technetium-99m MIBI. Both MIBI and 201Tl uptakes were higher for MCF7/mph cells than for the other cells studied. The mean MIBI uptake in MCF7/adr cells was significantly lower than that in MCF7/wt cells (1.9%+/-0.5% vs 3. 1%.0.6%; P <0.01). Verapamil treatment increased the MIBI uptake in MCF7/adr cells (to 2.6%.0.3%; P <0.05). Treatment of MCF7/mph cells with BSO resulted in a significant reduction in GSH content (from 243.2+/-81.1 nmol/mg protein to 17.6+/-4.4 nmol/mg protein; P <0. 001). However, MIBI uptake in BSO-treated and untreated MCF7/mph cells was similar (4.43%+/-0.5% and 5.93%+/-1.7%, respectively; P >0. 1). This study suggests that the uptake of MIBI is not diminished by glutathione-associated drug resistance and that MIBI uptake in a tumour sample does not necessarily indicate that a cancer is sensitive to drugs.