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Hrushka JM, Camarano JG, Frank T, Campbell GA, Mohanty A. Solitary Metastasis of Colon Adenocarcinoma Mimicking Colloid Cyst of the Third Ventricle. Cureus 2021; 13:e15181. [PMID: 34178502 PMCID: PMC8221407 DOI: 10.7759/cureus.15181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Metastatic lesions to the choroid plexus, although far less common than colloid cysts, can present very similarly both symptomatically and radiographically. Choroid plexus metastases are most common in the lateral ventricles, however, when they occur in the third and fourth ventricles they may cause obstructive hydrocephalus typical of a colloid cyst lesion. Renal cell carcinoma is the most common primary cancer, but many rare primaries have been reported. When patients are presenting with symptoms typical of colloid cysts it is important to consider past oncological history and if past medical history is significant for cancer using MR spectroscopy may be valuable in distinguishing between cystic and metastatic lesions.
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Affiliation(s)
- Jaron M Hrushka
- Neurological Surgery, University of Texas Medical Branch, Galveston, USA
| | - Joseph G Camarano
- Neurological Surgery, University of Texas Medical Branch, Galveston, USA
| | - Thomas Frank
- Neurological Surgery, University of Texas Medical Branch, Galveston, USA
| | | | - Aaron Mohanty
- Neurological Surgery, University of Texas Medical Branch, Galveston, USA
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Takeuchi M, Matsuzaki K, Harada M. Clinical value of N-acetyl mucinous compounds and lipid peaks in differentiating benign and malignant ovarian mucinous tumors by MR spectroscopy. Clin Imaging 2021; 78:127-135. [PMID: 33780785 DOI: 10.1016/j.clinimag.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To retrospectively evaluate the clinical significance of the peaks of N-acetyl mucinous compounds (NAMC) at 2 ppm and lipid at 1.3 ppm in in-vivo proton magnetic resonance (MR) spectroscopy for distinguishing benign and malignant mucinous tumors in patients with ovarian masses. METHODS MR spectroscopy was performed in patients with pathologically diagnosed mucinous ovarian tumors at 3 T MRI system. The peaks of NAMC, lipid, and total choline compounds (tCho) were classified into three classes in comparison with the noise level by visual estimation. The NAMC concentration was quantified relative to unsuppressed water by using LCModel analysis. RESULTS A total of 27 ovarian mucinous tumors in 27 patients were included in this study. The NAMC peak was observed in all 27 mucinous tumors, and the lipid peak was observed in 14 of 27 tumors: 1 of 9 benign tumors (11%), and 13 of 18 malignant tumors (11 borderline malignancies and 7 carcinomas) (72%). The presence of the lipid peak for the diagnosis of malignant mucinous tumor showed generally better diagnostic ability than MR imaging, with a sensitivity of 72%, specificity of 89%, accuracy of 78%, PPV of 93%, and NPV of 62%. The concentration of the NAMC in malignant mucinous tumors tended to be higher than that in benign mucinous tumors, but there was no statistically significant difference. CONCLUSIONS The bimodal peaks of NAMC and lipid are suggestive of malignant mucinous tumors, and the presence of the lipid peak may be useful in distinguishing benign from malignant ovarian mucinous tumors.
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Affiliation(s)
- Mayumi Takeuchi
- Department of Radiology, Tokushima University, 3-18-15, Kuramoto-cho, Tokushima zip: 7708503, Japan.
| | - Kenji Matsuzaki
- Department of Radiological Technology, Tokushima Bunri University, 1314-1, Shido, Sanuki-city, Kagawa zip: 7692193, Japan.
| | - Masafumi Harada
- Department of Radiology, Tokushima University, 3-18-15, Kuramoto-cho, Tokushima zip: 7708503, Japan.
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Kalfas F, Scudieri C. Endodermal Cysts of the Central Nervous System: Review of the Literature and a Case Report. Asian J Neurosurg 2020; 15:989-996. [PMID: 33708675 PMCID: PMC7869303 DOI: 10.4103/ajns.ajns_322_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/30/2020] [Accepted: 08/13/2020] [Indexed: 11/04/2022] Open
Abstract
Context Endodermal cysts are rare benign developmental cysts lined by mucin-secreting and/or ciliated, cuboidal, or columnar epithelium of probably endodermal origin. Aims Endodermal cysts are rarely intracranial, frequently located in the posterior fossa. Supratentorial location is the most infrequent and only few cases are reported in the literature, included our case. Settings and Design The authors report a case of intracranial supratentorial endodermal cyst with a review of the literature. Subjects and Methods A 40-year-old woman was admitted to our department because of progressive gait disorder for 3 months due to right brachial and crural motor deficit associated to right crural sensory disorder (tactile hypesthesia) and right Babinski response at neurological examination due to an endodermal cyst located in the left frontoparietal convexity. Discussion Total resection of endodermal cysts is recommended, despite their location and adhesion to the surrounding structures, due to its high risk of recurrence. Fenestration of the cystic content into the subarachnoid cistern may cause obstructive hydrocephalus or chemical meningism. Results Although rare, surgeons should be aware that these lesions must be differentiated clinically, radiologically, and histologically from other supratentorial cystic lesions.
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Affiliation(s)
- Fotios Kalfas
- Department of Neurosurgery Padua University Hospital, Padua, Italy
| | - Claudia Scudieri
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.,Department of Neurological Surgery, Galliera Hospitals, Genova, Italy
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Phadke RV, Naik S, Udiya A, Shetty GS, Singh V, Bhoi SK. Role of MR spectroscopy in diagnosis of intracranial neuroenteric cyst. Childs Nerv Syst 2018; 34:1791-1794. [PMID: 29679196 DOI: 10.1007/s00381-018-3802-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 04/09/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Neuroenteric cysts are rare benign endodermal lesions of the central nervous system that result from incomplete resorption of neuroenteric canal and mostly found in cervical and upper thoracic spinal canal. Intracranial neuroenteric cysts are extra axial and commonly located anteriorly in the posterior cranial fossa. MRI demonstrates variable intensity within the lesion on T1, T2W, and DWI sequences. METHODS Three cases of posterior fossa non-enhancing cystic lesions of variable signal intensity underwent MRI with MR spectroscopy, where MR spectroscopy demonstrated dominant peak at 2 ppm, mimicking normal Nacetyl aspartate (NAA). CONCLUSION MR spectroscopy in addition to conventional MRI may help in differentiating intracranial neuroenteric cyst from its close differentials.
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Affiliation(s)
- R V Phadke
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, 226014, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India.
| | - Alok Udiya
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, 226014, India
| | - Gurucharan S Shetty
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, 226014, India
| | - Vivek Singh
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, 226014, India
| | - Sanjeev Kumar Bhoi
- Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
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Tamrazi B, Nelson MD, Blüml S. MRS of pilocytic astrocytoma: The peak at 2 ppm may not be NAA. Magn Reson Med 2016; 78:452-456. [PMID: 27529659 DOI: 10.1002/mrm.26374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/07/2016] [Accepted: 07/18/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine whether the chemical shift of residual N-acetylaspartate (NAA) signal in pilocytic astrocytomas (PA) is consistent with the position of the NAA peak in controls. METHODS MR spectra from 27 pediatric World Health Organization (WHO) grade I pilocytic astrocytoma patients, fifteen patients with WHO grade II and high-grade (III-IV) astrocytomas, and 36 controls were analyzed. All spectra were acquired with a short echo time (35 ms), single voxel point-resolved spectroscopy sequence on clinical 3 tesla scanners. Fully automated LCModel software was used for processing, which included the fitting of peak positions for NAA and creatine (Cr). RESULTS The chemical shift difference between the NAA and Cr peaks was significantly smaller (by 0.016 ± 0.005 parts per million, P < 1e-10) in PAs than in controls and was also smaller than what was observed in infiltrative astrocytomas. CONCLUSION The chemical shift position of the residual NAA peak in PAs is not consistent with NAA. The signal likely originates from an N-acetyl group of one or more other chemicals such as N-acetylated sugars. Magn Reson Med 78:452-456, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Benita Tamrazi
- Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, Los Angeles, California, USA
| | - Marvin D Nelson
- Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, Los Angeles, California, USA
| | - Stefan Blüml
- Department of Radiology, Children's Hospital Los Angeles/Keck School of Medicine of USC, Los Angeles, California, USA.,Rudi Schulte Research Institute, Santa Barbara, California, USA
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Aghakhanyan G, Lupi G, Frijia F, Hlavata H, Lombardo F, De Cori S, Canapicchi R, Vannozzi R, Montanaro D. Delayed post-traumatic fronto-ethmoidal sinus mucocele evaluated with short and long TE MR spectroscopy. Neuroradiol J 2013; 26:693-8. [PMID: 24355189 DOI: 10.1177/197140091302600613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/27/2013] [Indexed: 11/16/2022] Open
Abstract
Mucoceles are slow-growing, benign, expansile, mucoid-filled masses developing after obstruction of the sinus ostium. Late post-traumatic mucoceles are relatively rare entities and the literature is limited to single case reports. We describe an unusual case of post-traumatic fronto-ethmoidal mucocele, evaluated with computed tomography (CT), magnetic resonance imaging (MRI) and proton MR-spectroscopy ((1)H-MRS). As a contribution to the diagnostic work-up of the mucocele, (1)H-MRS demonstrates a dominant peak at 2.0 ppm at long echo time (TE) and an additional component at 3.8 ppm at short TE due to mucus glycoprotein compounds of the mucocele.
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Affiliation(s)
- Gayane Aghakhanyan
- Institute of Life Sciences, Scuola Superiore Sant'Anna; Pisa, Italy - Neuroradiology Unit, CNR/Tuscany Region G. Monasterio Foundation; Pisa, Italy -
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Hingwala DR, Radhakrishnan N, Kesavadas C, Thomas B, Kapilamoorthy TR, Radhakrishnan VV. Neuroenteric cysts of the brain-comprehensive magnetic resonance imaging. Indian J Radiol Imaging 2013; 23:155-63. [PMID: 24082482 PMCID: PMC3777327 DOI: 10.4103/0971-3026.116579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neuroenteric cysts are developmental cysts that should be differentiated from other, more common non-neoplastic cysts as well as cystic neoplasms. While these lesions may have varied imaging findings, T1 hyperintense prepontine lesion due to mucinous/proteinaceous content is characteristic. Location and imaging characteristics aid in formulating the correct diagnosis of neuroepithelial/neuroenteric cysts. Magnetic resonance spectroscopy (MRS) has the specific finding of N-Acetyl Aspartate (NAA)-like peak at 2.02 ppm which is not seen in other cystic lesions. In this study, we aim to discuss the imaging findings of these lesions on conventional and advanced MRI findings and provide radiologic-pathologic correlation. We also briefly describe the pathogenesis, embryology and radiological differential diagnoses of these cysts.
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Affiliation(s)
- Divyata R Hingwala
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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N-Acetyl peak in proton MR spectroscopy of metastatic mucinous adenocarcinoma of brain. Clin Neuroradiol 2012; 23:153-6. [DOI: 10.1007/s00062-012-0137-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 01/27/2012] [Indexed: 12/15/2022]
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Preliminary observations and clinical value of N-acetyl resonances in ovarian tumours using in-vivo proton MR spectroscopy at 3T. Eur Radiol 2011; 21:2640-6. [DOI: 10.1007/s00330-011-2215-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 06/08/2011] [Accepted: 07/02/2011] [Indexed: 11/28/2022]
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N-Acetyl peak in MR spectra of intracranial metastatic mucinous adenocarcinomas. Magn Reson Imaging 2010; 28:1390-4. [PMID: 20797831 DOI: 10.1016/j.mri.2010.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 04/16/2010] [Accepted: 06/25/2010] [Indexed: 11/20/2022]
Abstract
Absence of N-acetylaspartate (NAA) is one important diagnostic criterion of MR spectroscopy (MRS) that may suggest that an intracranial mass lesion is a metastasis. We report two cases of histopathology-confirmed intracranial metastatic mucinous adenocarcinoma, which predominantly showed a large metabolite peak at 2.0 ppm, mimicking an NAA peak of normal brain tissue. This finding could be of help in the interpretation of MRS in cases of intracranial enhancing mass lesions, metastases or gliomas.
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Kesavadas C, Santhosh K, Thomas B, Gupta AK, Kapilamoorthy TR, Bodhey N, Pendharker H, Patro S. Signal changes in cortical laminar necrosis-evidence from susceptibility-weighted magnetic resonance imaging. Neuroradiology 2009; 51:293-8. [PMID: 19159922 DOI: 10.1007/s00234-009-0497-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 01/08/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Two types of infarcts can be identified depending on the circumstances leading to its generation-infarcts with pannecrosis and infarcts with selective neuronal loss. Cortical laminar necrosis (CLN) can occur due to various etiologies of which infarctions and hypoxia are the commonest. Infarction results in pannecrosis whereas hypoxia and incomplete infarction result in selective neuronal loss with the presence of viable cells, glial proliferations, and deposition of paramagnetic substances. We investigated patients with CLN with susceptibility-weighted imaging (SWI), a technique highly sensitive to even traces of paramagnetic agents or hemorrhagic components. METHODS We retrospectively reviewed medical records of patients diagnosed with CLN as per standard criterion. Demographic characteristics and etiologies were recorded. Findings in magnetic resonance images including SWI were analyzed. RESULTS We identified 11 patients with CLN, six males and five females with age range of 4-64 years. Etiologies included hypoxia in two patients and infarction in the nine patients. SWI detected diffuse linear hypointensities along the gyral margins in CLN due to hypoxic ischemic encephalopathy. Linear dot like hypointensities were identified in one patient with infarction. CONCLUSION CLN due to hypoxic ischemic encephalopathy display linear gyral hypointensities and basal ganglia hypointensities that are identifiable in SWI and may represent mineralization. This might be related to iron transport across the surviving neurons from basal ganglia to the cortex, which is not possible in complete infarction. SWI may be helpful in understanding the pathophysiological aspects of CLN due to complete infarction and hypoxia.
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Affiliation(s)
- Chandrasekharan Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
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Santhosh K, Thomas B, Varma L, Sandhyamany S, Kesavadas C, Appukuttan P, Srinivas G, Gupta AK, Kapilamoorthy T, Unnikrishnan M. Metabolite signature of developmental foregut cyst on in vivo and in vitro1H MR spectroscopy. J Magn Reson Imaging 2008; 28:493-6. [DOI: 10.1002/jmri.21428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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