Correlation of myo-inositol levels and grading of cerebral astrocytomas

BACKGROUND AND PURPOSE

In a limited number of patients, the level of myo-inositol (MI), as seen by proton magnetic resonance spectroscopy (HMRS), has been shown to differ for gliomas of different histologic grades. We sought to determine if MI levels correlate with cerebral astrocytoma grade.

METHODS

Five control subjects, 14 patients with low-grade astrocytoma, 10 patients with anaplastic astrocytoma, and 10 patients with glioblastoma multiforme (GBM) underwent single-volume HMRS with an echo time of 20 ms. Twenty-five patients had received surgery, chemotherapy, and/or radiation therapy previously. Using the curve-fitting program supplied by the manufacturer, peak areas for n-acetyl aspartate (NAA), choline (Cho), and MI were normalized with respect to the peak area of creatine (Cr). Ratios for MI/Cr, Cho/Cr, and NAA/Cr were obtained for each lesion and retrospectively compared with the histologic grade of the lesion.

RESULTS

Levels of MI/Cr were higher (0.82 +/- 0.25) in patients with low-grade astrocytoma, intermediate (0.49 +/- 0.07) in control subjects, and lower in patients with anaplastic astrocytoma (0.33 +/- 0.16) and GBM (0.15 +/- 0.12).

CONCLUSION

Our study shows a trend toward lower MI levels in the presence of anaplastic astrocytomas and GBMs compared with those of low-grade astrocytomas. MI levels may have implications in the grading of cerebral astrocytomas.

Colloid cyst of the third ventricle: imaging-pathologic correlation

Colloid cysts are relatively rare intracranial lesions located in the rostral aspect of the third ventricle. They may produce acute hydrocephalus, brain herniation, and lead to death. Although the clinical and imaging features of colloid cysts are well known, their etiology and the factors responsible for their imaging features continue to be a subject of debate. We present the imaging-pathologic correlation of a patient with a colloid cyst as well as data supporting the fact that the presence of cholesterol is probably responsible for the MR imaging features exhibited by some colloid cysts.

Inter-laboratory comparison of liquid chromatographic techniques and enzyme-linked immunosorbent assay for the determination of surfactants in wastewaters

Seven laboratories participated in an inter-laboratory comparison exercise within the framework of the PRISTINE, SANDRINE and INEXsPORT European Union Projects. Solid-phase extraction (SPE) methodologies were used for the extraction of target analytes from wastewaters. The analytical strategies were based on liquid chromatography (LC) coupled to mass spectrometric (MS) or to fluorescent (FL) detection in all cases with the exception of one laboratory using a test-tube enzyme-linked immunosorbent assay kit. Samples were spiked with the surfactants nonylphenolpolyglycol ether, coconut diethanolamide, linear alkylbenzene sulfonate, nonylphenolpolyglycol ether sulfate, alkylpolyglycol ether and secondary alkane sulfonate. After enrichment on previously conditioned SPE cartridges, the SPE cartridges were distributed among the participating laboratories without the information about the amount of spiked surfactants. In addition, SPE cartridges loaded with a real-world environmental sample containing a tannery wastewater were also analyzed. The results of the programme showed that SPE followed by LC-MS techniques are reliable for the surfactants determination at submicrogram to microgram per liter levels in wastewaters. Inter-laboratory precision values were calculated as the reproducibility relative standard deviation (RSD(R)) which was determined from the reproducibility standard deviation (sR) and the average concentration at a particular concentration level. When data from all laboratories were pooled, the RSD(R) values ranged from 5.1 to 28.3% for the determination of target analytes. The most accurate result corresponded to that given for linear alkylbenzene sulfonates. Taking into account that different methodologies were used (including non-chromatographic techniques) and the complexity of the samples analyzed, it can be considered that acceptable reproducibility values were obtained in this inter-laboratory study.

Fish oil reduces cholesterol and arachidonic acid levels in plasma and lipoproteins from hypercholesterolemic chicks

The value of fish oil for prevention and/or treatment of human atherosclerosis has not been fully established. This study shows that replacement of saturated fat in young chick diet with menhaden oil produced a significant reversion of the hypercholesterolemia previously induced by coconut oil feeding. Fish oil also produced a clear decrease of plasma triacylglycerol levels. Coconut oil increased the percentages of 12:0 and 14:0 fatty acids, while menhaden oil increased those of 20:5 n-3 and 22:6 n-3. Percentages of 20:4 n-6, 18:2 n-6 and 18:1 n-9 significantly decreased by fish oil addition to the diet. Total cholesterol, phospholipid and protein contents of high and low density lipoproteins increased by coconut oil feeding. When coconut oil was replaced by menhaden oil, total cholesterol was significantly reduced in high, low and very low density lipoproteins. All chemical components of VLDL were decreased by menhaden oil feeding. Our results show a strong hypocholesterolemic effect of menhaden oil when this fat was supplemented to hypercholesterolemic chicks. The clear decrease found in arachidonic acid content of chick plasma and lipoproteins may contribute to the beneficial effects of fish oil consumption by lowering the production of its derived eicosanoids.

Imaging in isolated sacral tuberculosis: a review of 15 cases

OBJECTIVE

To review imaging studies of isolated involvement of the sacrum due to tuberculosis and determine the role of imaging in the diagnosis and management of these patients.

DESIGN AND PATIENTS

A retrospective analysis of 15 cases of isolated sacral tuberculosis imaged with MR imaging was performed. The CT images were also reviewed where available, and the various lesion characteristics were identified. We also reviewed the medical records in an attempt to determine the impact of the imaging studies on the management of these patients.

RESULTS

Fifteen patients (5 male, 10 female) presented with symptoms of 3-15 months' duration. Chronic localized backache with muscle spasm was the commonest presenting symptom; discharging sinuses with abscess formation was found in six patients, five of whom were children. MR imaging of the sacrum revealed a hypointense marrow signal on T1-weighted images and hyperintense signal on T2-weighted images in 14 of 15 patients, the S2 vertebra being always involved. CT revealed osteolytic changes in the sacrum in all the five patients in whom CT was performed. All patients showed marked clinical improvement within 1 year of anti-tuberculous chemotherapy.

CONCLUSION

Isolated tuberculosis of the sacrum is uncommon but should be suspected in patients presenting with chronic low backache or children with discharging sinuses/abscesses and showing sacral destruction on CT or MR imaging. MR imaging can identify cases and enables early institution of antituberculous chemotherapy.

Radiographic findings in tuberculosis of the calvarium

We reviewed the pattern of involvement of the calvarium by tuberculosis (TB) in five patients and the role of imaging in its management. Four patients presented with localised scalp swelling and one with generalized seizures. Radiographs revealed lucent lesions with minimal surrounding sclerosis in the frontal (2), parietal (2) and occipital (1) bones. CT showed lesions involving the entire thickness of the calvarium and accompanying contrast-enhancing soft tissue. The patient presenting with seizures had a ring-enhancing lesion in the parietal lobe in addition to the extra-axial lesions. Although radiographs in all cases demonstrated calvarial TB, CT showed the extent of the defect, involvement of adjacent soft tissues, and in one case an intra-axial lesion. Radiographs suffice for follow-up of these patients.

Perception of head orientation

There are two visual components to gaze: head orientation and orientation of the eyes relative to the head. This study explores the accuracy with which subjects can discriminate head orientation when the eyes are centered in the head. Discrimination thresholds averaged 1.9 degrees of head rotation for base head orientations of 0 degree and 15 degrees, but discrimination was markedly poorer around a 30 degrees head orientation. Results were independent of spatial frequency and size over a 4-fold range. Neither negative contrast nor head inversion affected discrimination. Experiments dissociating the internal features from head outline revealed the presence of two main cues to discrimination: deviation of the head profile from bilateral symmetry, and deviation of nose orientation from vertical. Simulations show that model V4 units revealed in previous experiments with Glass patterns can extract the relevant head orientation information. The data are consistent with neurological data indicating a selective loss of face recognition in prosopagnosia with spared gaze discrimination.

Increased frequency of mutations in DNA from infertile men with meiotic arrest

In diverse organisms from yeast to mice, mutations in numerous genes required for DNA repair may lead to defects in meiosis. Although it is likely that meiosis is conserved throughout evolution, little is known about the genetics of meiosis in humans even though meiotic arrest associated with azoospermia is common. In this work, we compared the sequence fidelity of a polymorphic marker amplified from DNA of two groups of patients: those with testis biopsy suggesting meiotic arrest and those with normal spermatogenesis who were obstructed. We demonstrated that mutations are more common in DNA from testicular tissue derived from men with meiotic arrest than in DNA from testicular tissue derived from men with normal spermatogenesis and physical obstruction (P < 0.05). No mutations were observed in blood tissue from either group of men. This suggests the possibility that defects in genes required in DNA repair could contribute to meiotic arrest in men just as has been observed in other organisms.

Effects of contrast material on single-volume proton MR spectroscopy

BACKGROUND AND PURPOSE

Administration of contrast material before proton MR spectroscopy may allow more accurate placement of the volume of interest, particularly in tumors; yet, some data have suggested that contrast material may alter the results of MR spectroscopy. To determine the validity of this contention, we performed pre- and postcontrast MR spectroscopy in patients with brain tumors and compared the results with those obtained from a phantom.

METHODS

Ten patients with astrocytomas were examined with single-volume MR spectroscopy before and after administration of contrast material. Voxel placement was identical for all studies. Peak area, peak height, and width at half maximum were measured for N-acetyl aspartate (NAA), creatine (Cr), and choline (Cho) in all studies. A phantom containing a 10 mmol concentration of NAA, Cr, and Cho was prepared in phosphate-buffered saline and mixed with contrast concentrations varying from 0.1 to 1.0 mmol. The phantom was studied by MR spectroscopy with the same parameters as used for the clinical studies.

RESULTS

No significant differences were found between the pre- and postcontrast MR spectroscopy studies for the three parameters measured. In phantom studies, there was a significant decline in the Cho peak area and height and an increase in the width at half maximum as the concentration of contrast material increased from 0.1 to 1.0 mmol. NAA and Cr peaks showed no significant changes in peak height or area.

CONCLUSION

Contrast material may be administered before clinical MR spectroscopy without affecting its interpretation.

MRI in a patient with the Worster-Drought syndrome

We describe a patient with the Worster-Drought syndrome (congenital suprabulbar paresis), thought to be a failure of development of the corticobulbar tracts. MRI showed bilateral perisylvian cortical dysplasia.

Diffuse leptomeningeal oligodendrogliomatosis: radiologic/pathologic correlation

We present the radiologic and pathologic findings in a boy who presented with diffuse leptomeningeal enhancement and whose clinical status deteriorated over the course of 5 years. During this period, MR images showed progression of the enhancement in the subarachnoid spaces, formation of intraaxial cysts, and hydrocephalus. Autopsy findings revealed diffuse oligodendroglioma throughout the leptomeninges of the brain and spine, with no definite intraaxial focus. The radiologic and pathologic features of diffuse leptomeningeal oligodendrogliomatosis are reviewed.

Proton MR spectroscopy in children with bipolar affective disorder: preliminary observations

BACKGROUND AND PURPOSE

Bipolar affective disorder (BPAD) can have its onset during childhood, but the diagnosis may be difficult to establish on the basis of clinical findings alone. Our purpose was to determine whether proton MR spectroscopy can be used to identify abnormalities in the brain of children with BPAD.

METHODS

Ten children, ages 6 to 12 years, underwent clinical testing to establish the diagnosis of BPAD. After a drug washout period, all patients underwent MR spectroscopy in which a TE of 135 was used along with a single-voxel placement in both frontal and temporal lobes during a single session. Peaks from N-acetylaspartate (NAA), choline (Cho), glutamate/ glutamine (Glu/Gln), and lipids were normalized with respect to the creatine (Cr) peak to obtain ratios of values of peak areas. These data were compared with those obtained in 10 non-age-matched control subjects. To corroborate our data, five children with BPAD also underwent 2D MR spectroscopic studies of the frontal lobes with parameters similar to those used in the single-volume studies.

RESULTS

All children with BPAD had elevated levels of Glu/Gln in both frontal lobes and basal ganglia relative to the control group. Children with BPAD had elevated lipid levels in the frontal lobes but not in the temporal lobes. Levels of NAA and Cho were similar for all locations in both groups. Two-dimensional MR spectroscopic studies in five children with BPAD confirmed the presence of elevated lipids in the frontal lobes.

CONCLUSION

Our preliminary observations suggest that MR spectroscopy may show abnormalities in children with BPAD not found in unaffected control subjects. It remains to be established whether these abnormalities are a signature of the disease and can be used as a screening test.

Contrast-enhanced 3D FISP MR angiography of the aortic arch ostia: preliminary results

PURPOSE

The goal of this work was to evaluate three-dimensional (3D) contrast-enhanced MR angiography (MRA) for the detection of ostial stenoses of the aortic arch.

METHOD

Sixteen patients with suspected carotid atherosclerotic disease prospectively underwent digital subtraction angiography of the aortic arch followed by contrast-enhanced MRA using a 3D fast imaging with steady-state precession (FISP) technique (TR = 5 ms, TE = 2 ms, flip angle = 30 degrees). Three neuroradiologists blindly measured stenoses on the catheter angiograms and MRA. Evaluation included the ostia of the innominate, left carotid, and left subclavian arteries. Any significant disagreement on catheter angiography was resolved by consensus. The MRA grades of each of the three observers were then compared with the consensus grades of the contrast angiogram.

RESULTS

Forty-eight vessels were scored, of which five had significant stenoses. MRA demonstrated 100% sensitivity, 89% specificity, 52% positive predictive value, and 100% negative predictive value. The Bowker test for symmetry indicated no significant difference between conventional angiography and MRA scores (p = 0.32-0.75), and there was good agreement between the three observers (weighted kappa = 0.75-0.86).

CONCLUSION

Contrast-enhanced 3D FISP MRA may be a useful imaging modality for the detection of significant stenoses at the ostia of the major aortic arch branches.

The ability of tumor volume to predict local control in surgically treated squamous cell carcinoma of the supraglottic larynx

PURPOSE

Pretreatment CT volumetric measurement of the primary tumor has been shown to be a predictor of local control in patients with laryngeal carcinoma treated with radiation therapy (RT) alone. A direct association has been demonstrated between tumor volume of supraglottic squamous cell carcinoma (SGSCCA) and local control. However, the association between tumor volume of SGSCCA and local control has not been investigated in patients treated surgically. The purpose of this study was to determine the relationship between SGSCCA tumor volume and local control in patients treated surgically.

MATERIALS AND METHODS

Primary site tumor volume was calculated from pretreatment CT studies in 37 laryngeal supraglottic carcinomas treated surgically. All patients had clinical follow-up for evidence of recurrent tumor along the surgical margins at the primary site for a minimum of 2 years after completion of treatment. Statistical analysis consisted of Mantel-Haenszel chi-square tests and Fisher's exact test.

RESULTS

Overall local control rate was 92% (33 of 37). Tumor volume was significantly associated with local control (p <. 05). Local control rate for tumors with volumes <16 cc was 94% (32 of 34) (p <.05).

CONCLUSIONS

Pretreatment CT volumetric analysis is useful for predicting local control in patients with SGSCCA carcinoma treated surgically.

CT evaluation of prosthetic ossicular reconstruction procedures: what the otologist needs to know

Postoperative otologic evaluation of patients who have undergone ossicular reconstruction is often difficult. However, thin-section computed tomography (CT) can help determine the type of prosthesis used for reconstruction and adequately assess for complications that may be causing postoperative conductive hearing loss. A variety of prostheses may be used in ossicular reconstruction (eg, stapes prosthesis, incus interposition graft, Applebaum prosthesis, Black oval-top prosthesis, Richards centered prosthesis, Goldenberg prosthesis) and can usually be identified at CT by their shapes and locations. Several causes of prosthetic failure are readily demonstrated at CT, including recurrent cholesteatoma and otitis media, formation of granulation tissue or adhesions, and various mechanical problems (eg, subluxation, dislocation, extrusion, fracture, bending). Perilymphatic fistula can be difficult to identify at CT but may be suggested by the presence of pneumolabyrinth, unexplained middle ear effusion, or fluid accumulation within the mastoid air cells. The presence of soft tissue within the oval window niche 4-6 weeks following surgery may indicate poststapedectomy granuloma or fibrosis. Familiarity with the normal and abnormal CT appearances of ossicular prostheses will enable the radiologist to assist the otologist in identifying patients in whom revision surgery is most appropriate.

Diffusion-weighted MR imaging offers no advantage over routine noncontrast MR imaging in the detection of vertebral metastases

BACKGROUND AND PURPOSE

Diffusion-weighted MR imaging of the spine has been used to differentiate benign from pathologic vertebral body compression fractures. We sought to determine the utility of diffusion-weighted MR imaging in the detection of vertebral metastases and to compare it with conventional noncontrast T1- and T2-weighted MR imaging.

METHODS

Fifteen patients with metastases to the spine were studied using conventional MR imaging and diffusion-weighted imaging. Blinded review of all images was undertaken, and patients were categorized according to whether they had focal or multiple lesions. The signal intensity of the lesions was compared on T1-, T2- (fast spin-echo), and diffusion-weighted images.

RESULTS

In five patients with focal disease, metastases were hypointense on T1-weighted images; hypointense (n = 2), isointense (n = 1), or hyperintense (n = 2) on T2-weighted images; and hypointense (n = 3) or hyperintense (n = 2) on diffusion-weighted images with respect to presumed normal bone marrow. In 10 patients with disease in multiple sites, all lesions were hypointense on T1-weighted images; hypointense (n = 2), isointense (n = 4), hyperintense (n = 2), or mixed (n = 2) on T2-weighted images; and hypointense (n = 5), hyperintense (n = 3), or mixed (n = 2) on diffusion-weighted images with respect to presumed normal bone marrow.

CONCLUSION

As used in this study, diffusion-weighted MR imaging of the spine showed no advantage in the detection and characterization of vertebral metastases as compared with noncontrast T1-weighted imaging, but was considered superior to T2-weighted imaging.

An in vitro model of ischemic-like stress in retinal pigmented epithelium cells: protective effects of antioxidants

We have developed a model of in vitro cell oxidative stress in bovine retinal pigment epithelium cells exposed to a ischemia-like condition obtained by interference with glucose utilization through both oxidative phosphorylation and glycolysis. This resulted in a statistically significant decrease of the intracellular ATP levels, which reflects a bioenergetic decline similar to that associated with mitochondrial damage or loss in normal post-mitotic cells aging in vivo. This new model of cellular oxygen stress seems adequate for investigation of the protective action of antioxidants, in agreement with our finding of a statistically significant increase in the ATP levels over the values of the non-treated samples in retinal pigment epithelium cells exposed to the above oxygen stress in medium supplemented with 300 microM vitamin C or 10 mM N-acetylcysteine.

Hypoplasia of the bony canal for the cochlear nerve in patients with congenital sensorineural hearing loss: initial observations

PURPOSE

To evaluate the length and width of the bony canal of the cochlear nerve in patients with congenital sensorineural hearing loss (SNHL) who have "normal" findings at thin-section computed tomography (CT) of the temporal bone.

MATERIALS AND METHODS

The authors retrospectively evaluated the length and width of the bony canal for the cochlear nerve in two groups of patients. The first group was composed of 33 patients with profound SNHL and no demonstrable abnormality at thin-section CT. The control group was composed of 50 patients who underwent temporal bone CT for causes unrelated to SNHL. The mean value +/- SD was calculated for both cohorts. Statistical analysis consisted of the nonparametric Wilcoxon rank sum test with the NPAR1WAY program.

RESULTS

The length and width of the bony canal for the cochlear nerve were significantly smaller in patients with SNHL than in the control group (P <.05)

CONCLUSION

The hypoplastic bony canal for the cochlear nerve in patients with SNHL may be indicative of a previously unrecognized embryologic malformation of the cochlear nerve.

Cerebral infarctions: evaluation with single-axis versus trace diffusion-weighted MR imaging

OBJECTIVE

Our purpose was to determine the usefulness of single-axis diffusion-weighted imaging versus trace diffusion-weighted imaging in the evaluation of cerebral infarctions.

SUBJECTS AND METHODS

Twenty-six patients harboring 34 infarctions were examined using single-axis and trace diffusion-weighted imaging within 48 hr of the onset of symptoms. Two neuroradiologists who were not aware of the clinical findings reviewed all images obtained with both techniques and noted the following: type of infarction (small [<15 mm] versus territorial), location of infarction, presence of infarction (seen only on single-axis images, seen only on trace images, seen on both), lesion conspicuity (better on single-axis images, better on trace images, or equal on both), and lesion size (larger on single-axis images, larger on trace images, or equal on both). Differences in opinion were resolved by consensus.

RESULTS

Of the 18 small and 16 territorial infarctions, all were identified on both single-axis and trace imaging. Lesion conspicuity was judged to be slightly better on trace images for both types of infarctions. Lesion size was judged to be larger on single-axis images for territorial infarctions.

CONCLUSION

Both single-axis and trace diffusion-weighted imaging showed all small and territorial cerebral infarctions. Both types of infarctions were slightly larger on single-axis images but this did not affect correct interpretation in any case. The single-axis technique provided sufficient information for the diagnosis of cerebral infarction in our clinical settings.

Imaging in pituitary tuberculosis

Tuberculosis of the pituitary gland is extremely uncommon and may masquerade as a nonfunctional pituitary neoplasm. We describe imaging findings in three patients with pituitary tuberculosis and review the pattern of involvement and importance of imaging in its management. An accurate diagnosis was found to be important in these cases as antituberculous chemotherapy was curative.

Imaging of orofacial clefting disorders

This article discusses the imaging and clinical features of patients with facial clefts. Patients with facial clefts are classified according to interocular distance. Typing of facial clefts is emphasized to determine which patients need to undergo not only imaging, but also imaging of the brain, to assess associated intracranial anomalies. The genetics, treatment, and implications that these clefting disorders have on the growth of the face are also discussed.

Imaging of the pediatric orbit

This article addresses the embryology of the eye, the imaging of common congenital malformations involving the globe, and imaging features of common retro-ocular masses. Clinical entities resulting in alterations in the size and contour, and those producing leukokoria, also are discussed.

Imaging of congenital anomalies of the branchial apparatus

One of the most challenging topics for radiologists is congenital anomalies arising from abnormal embryogenesis of the branchial apparatus. Defects of the branchial apparatus result in a spectrum of anomalies that includes fistulas, sinuses, cysts, temporal bone anomalies, craniofacial malformations, and systemic disorders. A better understanding of the various radiologic abnormalities is aided by an understanding of their embryonic origins. This article reviews the spectrum of abnormalities that are secondary to anomalous embryogenesis of the branchial arches.