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Gonçalves FG, Manteghinejad A, Rimba Z, Khrichenko D, Viaene AN, Vossough A. Diffusion Analysis of Intracranial Epidermoid, Head and Neck Epidermal Inclusion Cyst, and Temporal Bone Cholesteatoma. AJNR Am J Neuroradiol 2024:ajnr.A8376. [PMID: 38866433 DOI: 10.3174/ajnr.a8376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND AND PURPOSE Intracranial epidermoid tumors, temporal bone cholesteatomas, and head and neck epidermoid inclusion cysts are typically slow-growing, benign conditions arising from ectodermal tissue. They exhibit increased signal on DWI. While much of the imaging literature describes these lesions as showing diffusion restriction, we aimed to investigate these qualitative signal intensities and interpretations of restricted diffusion with respect to normal brain structures. This study aimed to quantitatively evaluate the ADC values and histogram features of these lesions. MATERIALS AND METHODS This retrospective study included children with histologically confirmed diagnoses of intracranial epidermoid tumors, temporal bone cholesteatomas, or head and neck epidermoid inclusion cysts. Lesions were segmented, and voxelwise calculation of ADC values was performed along with histogram analysis. ADC calculations were validated with a second analysis software to ensure accuracy. Normal brain ROIs-including the cerebellum, white matter, and thalamus-served as normal comparators. Correlational analysis and Bland-Altman plots assessed agreement among software tools for ADC calculations. Differences in the distribution of values between the lesions and normal brain tissues were assessed using the Wilcoxon rank sum and Kruskal-Wallis tests. RESULTS Forty-eight pathology-proved cases were included in this study. Among them, 13 (27.1%) patients had intracranial epidermoid tumors, 14 (29.2%) had head and neck epidermoid inclusion cysts, and 21 (43.7%) had temporal bone cholesteatomas. The mean age was 8.67 (SD, 5.30) years, and 27 (52.9%) were female. The intraclass correlation for absolute agreement for lesional ADC between the 2 software tools was 0.997 (95% CI, 0.995-0.998). The intracranial epidermoid tumor, head and neck epidermoid inclusion cyst, and temporal bone cholesteatoma median ADC values were not significantly different (973.7 versus 875.7 versus 933.2 ×10-6 mm2/s, P = .265). However, the ADCs of the 3 types of lesions were higher than those of 3 normal brain tissue types (933 versus 766, × 10-6 mm2/s, P < .0001). CONCLUSIONS The ADC values of intracranial epidermoid tumors, temporal bone cholesteatomas, and head and neck epidermoid inclusion cysts are higher than those of normal brain regions. It is not accurate to simply classify these lesions as exhibiting restricted diffusion or reduced diffusivity without considering the tissue used for comparison. The observed hyperintensity on DWI compared with the brain is likely attributable to a relatively higher contribution of the T2 shinethrough effect.
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Affiliation(s)
| | - Amirreza Manteghinejad
- Department of Radiology (A.M., Z.R., D.K., A.V.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Zekordavar Rimba
- Department of Radiology (A.M., Z.R., D.K., A.V.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dmitry Khrichenko
- Department of Radiology (A.M., Z.R., D.K., A.V.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Angela N Viaene
- Division of Anatomic Pathology (A.N.V.), Children's Hospital of Philadelphia, Pennsylvania
| | - Arastoo Vossough
- Department of Radiology (A.M., Z.R., D.K., A.V.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine (A.V.), University of Pennsylvania, Philadelphia, Pennsylvania
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Alghamdi AM, Alghamdi AM, Hamzah A, Alsahafi AH, Adas R, Samkari A, Lary A. Intracranial Cysts: A Single-Institution Experience With 27 Surgically Managed Cases. Cureus 2024; 16:e64606. [PMID: 39144859 PMCID: PMC11324331 DOI: 10.7759/cureus.64606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 08/16/2024] Open
Abstract
Introduction Intracranial cysts (ICs) are rare pathologies that are often found incidentally during radiological examinations. They may appear in various brain regions and are categorized as normal, congenital, traumatic, or tumor-associated variants. ICs can be asymptomatic or cause symptoms, such as headaches, visual impairments, or seizures, depending on their size and location. Severe complications include obstructive hydrocephalus, loss of consciousness, and intracranial bleeding. Surgical excision is the most accepted type of management in most ICs. Objectives This study aimed to evaluate 27 surgically managed ICs in a tertiary hospital focusing on their clinical, radiological, histopathological, surgical outcomes, and prognosis to enhance understanding and management of these rare, benign cysts. Methodology This retrospective cohort study included 27 surgically managed ICs with pathological confirmation in King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia, from May 2016 to May 2023. All extracranial and nonsurgically managed cysts have been excluded from this study. Data on demographics, clinical presentations, radiological features, surgical outcomes, and follow-up were retrospectively extracted and analyzed. MRI and CT scans were reviewed to determine cyst characteristics. Surgical outcomes and postoperative complications were recorded. Data were collected via Google Forms and analyzed using the JMP Pro software. Ethical approval was obtained from King Abdullah International Medical Research Center, Jeddah, Saudi Arabia. Results The study included 27 ICs: 11 (40.74%) colloid cysts, six (22.22%) epidermoid cysts, five (18.51%) adamantinomatous craniopharyngiomas, two (7.40%) neuroepithelial cysts, and one each of Rathke's cleft cyst (3.70%), xanthogranuloma (3.70%), and dermoid cyst (3.70%). All 27 cases were surgically managed (100.00%), with gross total resection achieved in 14 (51.85%) cases. Only 12 cases (44.44%) did not develop any surgical complications. Twenty-two cases (81.48%) experienced an improvement in the preoperative presenting symptoms. During the follow-up, only three cases (11.11%) had evidence of recurrence. Conclusion This study analyzed 27 ICs of various histopathological types. Each type showed distinct clinical and radiological features. Surgical management generally improved preoperative symptoms with low mortality and recurrence rates, although complications were common. Identifying specific radiological features is crucial for an accurate preoperative diagnosis and optimal surgical outcomes.
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Affiliation(s)
- Abdulaziz M Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulkarim M Alghamdi
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Abdulaziz Hamzah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulrahman H Alsahafi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Reem Adas
- Department of Radiology, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Alaa Samkari
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ahmed Lary
- Department of Neurosurgery, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
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3
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Kiss-Bodolay D, Hautmann X, Lee KS, Rohde V, Schaller K. Intracranial Epidermoid Cyst: A Volumetric Study of a Surgically Challenging Benign Lesion. World Neurosurg 2024; 185:e1129-e1135. [PMID: 38493891 DOI: 10.1016/j.wneu.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Intracranial epidermoid cysts are rare, benign tumors. Nevertheless, the microsurgical removal of these cysts is challenging. This is due to their capacity to adhere to the neurovascular tissue, as well as the associated difficulties in microsurgically peeling off their capsular wall hidden in dead angles. To better understand the rate of recurrence after surgical intervention, we have performed preoperative and postoperative volumetric analysis of epidermoid cysts, allowing the estimation of their growth rate after resection. METHODS Imaging data from 22 patients diagnosed and surgically treated for an intracranial epidermoid cyst between 2000 and 2022 were retrospectively collected from 2 European neurosurgical centers with microsurgical expertise. Volumetric analysis was performed on magnetic resonance imaging data. RESULTS Average cyst volume at diagnosis, before any surgery, measured in 12 patients was 28,877.6 ± 10,250.4 mm3 (standard error of the mean [SEM]). Estimated growth rate of incompletely resected epidermoids after surgery was 1,630.05 mm3 ± 729.95 (SEM). Assuming linear growth dynamics and normalizing to postoperative residual volume, the average postoperative growth rate corresponded to 61.5% ± 34.3% (SEM) of the postoperative residual volume per year. We observed signs of recurrence during a radiologic follow-up period of 6.0 ± 2.8 years (standard deviation) in more than 50% of our patients. CONCLUSIONS Due to their slow-growing nature, epidermoid cysts can often reach a complex multicompartmental size before resection, even in young patients, thus requiring complex approaches with challenging capsular resection, which implies a high risk of nerve and vascular injury per se. Tumor recurrence may be predicted on the basis of postoperative volumetry.
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Affiliation(s)
- Daniel Kiss-Bodolay
- Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Xenia Hautmann
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Kok Sin Lee
- Department of Basic Neurosciences and the Center for Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Karl Schaller
- Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Albadr F, Aldosari HS, Alsaber NS, Aljurayyad AS, Shabi W, Aldusaymani SM. Orbital Intradiploic Epidermoid Cyst: A Case Report of a Rare Entity. Cureus 2024; 16:e52072. [PMID: 38213936 PMCID: PMC10782477 DOI: 10.7759/cureus.52072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 01/13/2024] Open
Abstract
Cranial epidermoid cysts are relatively rare. More frequently reported in middle-aged men with a wide variety of signs and symptoms such as headache, seizures, cerebellar and cranial nerve deficits/visual disturbance. The approach for surgical removal of the cyst depends on its size and location. In addition, a multidisciplinary team must be involved due to the common occurrence of misdiagnosis. We present the unusual age of presentation for intradiploic epidermoid cysts. A 14-year-old boy is complaining of a 2-month history of painless progressive swelling of the right eyebrow. Magnetic resonance imaging revealed an intradiploic cystic mass within the right frontal bone. The cystic mass was removed, and histological examination confirmed the diagnosis of an epidermoid cyst. This case illustrated the potential of developing intradiploic epidermoid cysts in pediatrics.
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Affiliation(s)
- Fahad Albadr
- Radiology and Medical Imaging/Neuroradiology, King Saud University Medical City/College of Medicine, King Saud University, Riyadh, SAU
| | - Hamdan S Aldosari
- Medicine, King Saud University Medical City/College of Medicine, King Saud University, Riyadh, SAU
| | - Naif S Alsaber
- Medicine, King Saud University Medical City/College of Medicine, King Saud University, Riyadh, SAU
| | - Abdulaziz S Aljurayyad
- Medicine, King Saud University Medical City/College of Medicine, King Saud University, Riyadh, SAU
| | - Wejdan Shabi
- Radiology and Medical Imaging/Neuroradiology, King Saud University Medical City/College of Medicine, King Saud University, Riyadh, SAU
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Freiburg Neuropathology Case Conference : A 58-year-old Patient with an Asymptomatic Cerebellopontine Angle Mass Lesion. Clin Neuroradiol 2022; 32:587-592. [PMID: 35545685 PMCID: PMC9187539 DOI: 10.1007/s00062-022-01175-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/03/2022]
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6
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Städt M, Holtmannspötter M, Nania A, Ritter L, Voit-Höhne H. Case report: Scattered intraventricular lesions on MRI following epidermoid cyst resection. Radiol Case Rep 2021; 17:190-193. [PMID: 34815825 PMCID: PMC8593265 DOI: 10.1016/j.radcr.2021.09.067] [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] [Received: 08/13/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022] Open
Abstract
Local recurrence after epidermoid cyst surgery is a frequently reported complication, but intraventricular spread after surgery has not yet been described in literature. We present the case of a 61-year-old male patient with steadily progressive headaches after surgical excision of an epidermoid cyst in the right cerebellopontine angle about two months ago. The MRI showed multiple intraventricular FLAIR-hyperintensities with diffusion restriction, suggestive of scattered remnants of the epidermoid cyst. We recommend early postoperative MRI-scans after cranial epidermoid surgery, which should be carefully inspected not only for local remnants but also rare complications like intraventricular spread.
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Affiliation(s)
- Michael Städt
- Institute of Neuroradiology, Paracelsus Medical University, 90471 Nuremberg, Germany
| | | | - Alberto Nania
- Department of clinical neurosciences, NHS Lothian, EH16 4SA Edinburgh, UK
| | - Leonard Ritter
- Department of Neurosurgery, Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Heinz Voit-Höhne
- Institute of Neuroradiology, Paracelsus Medical University, 90471 Nuremberg, Germany
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The role of apparent diffusion coefficient as a predictive factor for tumor recurrence in patients with cerebellopontine angle epidermoid tumor. Neurosurg Rev 2021; 45:1383-1392. [PMID: 34581893 DOI: 10.1007/s10143-021-01654-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/04/2021] [Accepted: 09/24/2021] [Indexed: 01/03/2023]
Abstract
Intracranial epidermoid tumors are slowly growing benign tumors, but due to adjacent critical neurovascular structures, surgical resection is challenging, with the risk of recurrence. The apparent diffusion coefficient (ADC) has been used to evaluate the characteristics of brain tumors, but its utility for intracranial epidermoid tumors has not been specifically explored. This study analyzed the utility of preoperative ADC values in predicting tumor recurrence for patients with intracranial epidermoid tumors. Between 2008 and 2019, 21 patients underwent surgery for cerebellopontine angle (CPA) epidermoid tumor, and their preoperative ADC data were analyzed. The patients were divided into two groups: the recurrence group, defined by regrowth of the remnant tumor or newly developed mass after gross total resection on magnetic resonance imaging (MRI); and the stable group, defined by the absence of growth or evidence of tumor on MRI. Receiver operating characteristic (ROC) analysis was used to obtain the ADC cutoff values for predicting tumor recurrence. The prognostic value of the ADC was assessed using Kaplan-Meier curves. The minimum ADC values were significantly lower in the recurrence group than in the stable tumor group (P = 0.020). ROC analysis showed that a minimum ADC value lower than 804.5 × 10-6 mm2/s could be used to predict higher recurrence risk of CPA epidermoid tumors. Non-total resection and mean and minimum ADC values lower than the respective cutoffs were negative predictors of recurrence-free survival. Minimum ADC values could be useful in predicting the recurrence of CPA epidermoid tumors.
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8
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Nussbaum LA, Schwarzrock CA, Burke EM, Torok CM, Nussbaum ES. CT cisternography to visualize epidermoid tumors for stereotactic radiosurgery treatment planning. J Clin Neurosci 2021; 89:91-96. [PMID: 34119301 DOI: 10.1016/j.jocn.2021.04.025] [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: 02/18/2021] [Revised: 03/30/2021] [Accepted: 04/26/2021] [Indexed: 11/26/2022]
Abstract
The visualization of intracranial epidermoid tumors is often limited by difficulties associated with distinguishing the tumor from the surrounding cerebrospinal fluid using traditional computed tomography (CT) or magnetic resonance imaging (MRI) modalities. This report describes our experience using CT cisternography to visualize intracranial epidermoid tumors in three illustrative cases. CT cisternography of the epidermoid tumor provides more clarity and precision compared to traditional neuroimaging modalities. We demonstrate the feasibility of using CT cisternography to produce high-resolution images with well-defined tumor margins that can be used effectively for precise SRS treatment planning.
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Affiliation(s)
- Leslie A Nussbaum
- Department of Neurosurgery, National Brain Aneurysm & Tumor Center, United Hospital, 3033 Excelsior Blvd., Suite 495, Minneapolis, MN 55416, USA; John Naseff Cyberknife Center at United Hospital, Allina Health, 310 Smith Ave N #440, St. Paul, MN 55102, USA.
| | - Camille A Schwarzrock
- John Naseff Cyberknife Center at United Hospital, Allina Health, 310 Smith Ave N #440, St. Paul, MN 55102, USA
| | | | - Collin M Torok
- Midwest Radiology, 2355 Highway 36 West, Roseville, MN 55113, USA
| | - Eric S Nussbaum
- Department of Neurosurgery, National Brain Aneurysm & Tumor Center, United Hospital, 3033 Excelsior Blvd., Suite 495, Minneapolis, MN 55416, USA
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Choo Y, Seo Y, Choi J. Giant Intradiploic Epidermoid Cyst in the Occipital Bone: A Case Report. Brain Tumor Res Treat 2021; 9:21-25. [PMID: 33913268 PMCID: PMC8082287 DOI: 10.14791/btrt.2021.9.e3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/20/2022] Open
Abstract
Epidermoid cysts are uncommon intracranial tumors. As one of the extradural types of epidermoid cysts, intradiploic epidermoid cysts are even rarer tumors and occur in any part of the skull. We herein report a rare case of a giant intradiploic epidermoid cyst of the occipital bone. A 57-year-old woman presented with a 1-year history of localized headache in the occipital area. CT and MRI showed an extradural mass measuring 50×70 mm in the occipital bone with bony destruction. The patient underwent surgical resection. The tumor was completely removed with its capsule. There was no extension to the intradural space. The pathological report confirmed that the tumor was an epidermoid cyst. Follow-up MRI 24 months after the operation showed no recurrence. The headache was well controlled without any medications. We report a rare case of intradiploic epidermoid cyst with clinical and radiologic features and surgical treatment. It is important to consider this diagnosis for a patient with persistent regional headache with or without a growing scalp mass.
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Affiliation(s)
- Yoonhee Choo
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Youngbeom Seo
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea.
| | - Joonhyuk Choi
- Department of Pathology, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
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Mustafa WF, Abbas M, Elsorougy L. Role of diffusion-weighted imaging in differentiation between posterior fossa brain tumors. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-019-0145-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Diffusion-weighted imaging (DWI) is an imaging modality using multi-section single-shot spin echo planar imaging (EPI) sequence which is extremely sensitive for detection of water motion within intra, extra, and transcellular regions. This character is important to differentiate between brain tumors either low (benign) or highly (malignant) cellular tumors.
Objective
To evaluate the role of DWI and apparent diffusion coefficient (ADC) in evaluation and differentiation between different brain posterior fossa tumors in children and adults.
Patients and methods
The study included 34 patients with different brain posterior fossa tumors for evaluation by conventional MRI (using 1.5 T MRI PHILIPS Achieva 2.1 Best Netherland) and DWI.
Results
Our study showed that mean ADC values were significantly different between the four groups of posterior fossa tumors in children: juvenile pilocytic astrocytoma (JPA), medulloblastoma, ependymoma, and brain stem glioma while mean ADC values were not significantly different between posterior fossa tumors in the adult group. Regions of interest were manually positioned, and all values were automatically calculated and expressed in 10−3 mm2/s.
Conclusion
DWI is an ideal additional imaging technique, which is a rapid, easy, non-invasive imaging modality, with no contrast injection needed. It has been widely applied in the differentiation between posterior fossa brain tumors and in the diagnosis of various intracranial diseases.
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Kim CS, Yoon SH, Oh JW, Lee KC. Epidermoid cyst in temple area with skull perforation. Arch Craniofac Surg 2020; 21:137-140. [PMID: 32380817 PMCID: PMC7206461 DOI: 10.7181/acfs.2019.00703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/27/2020] [Indexed: 11/11/2022] Open
Abstract
Epidermoid cysts are benign tumors that account for approximately 1% of intracranial tumors. In very rare cases, temporally located extradural intradiploic epidermoid cysts can cause neurological symptoms and skull perforation. Herein, we report the case of a 34-year-old woman who underwent successful treatment of an epidermoid cyst in the temporal region accompanied by neurological symptoms. Accurate radiological evaluation and complete removal of the tumor and capsule play a vital role in ensuring favorable long-term outcomes. Computed tomography and magnetic resonance imaging scans can provide an accurate assessment of the extent of intracranial expansion and invasion of the cerebral parenchyma, as well as enabling the precise localization and characterization of the bone defect and mass. In addition, collaborative surgery with a neurosurgeon is required for cases involving intracranial expansion and dural invasion.
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Affiliation(s)
- Cha Soo Kim
- Department of Plastic and Reconstructive Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Ho Yoon
- Department of Plastic and Reconstructive Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Wook Oh
- Department of Plastic and Reconstructive Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Keun Cheol Lee
- Department of Plastic and Reconstructive Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Case report: Pediatric giant suprasellar epidermoid cyst. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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13
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Application of diffusion-weighted MR imaging with ADC measurement for distinguishing between the histopathological types of sinonasal neoplasms. Clin Imaging 2019; 55:76-82. [PMID: 30769222 DOI: 10.1016/j.clinimag.2019.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/20/2019] [Accepted: 02/06/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate the potential contribution of quantitative DWI parameters including ADCmean and ADCratio values to help in distinguishing the histopathological types of sinonasal neoplasms. METHODS This retrospective study included 83 patients (50 males, 33 females; mean age 61 years) with pathologically proven untreated sinonasal neoplasms who have undergone diffusion-weighted MRI imaging from February 2010 to August 2017. Diffusion-weighted MRI was performed on a 3 T unit with b factors of 0 and 1000 s/mm2, and ADC maps were generated. Mean ADC values of sinonasal tumors and ADC ratios (ADCmean of the tumor to ADCmean of pterygoid muscles) were compared with the histopathological diagnosis by utilizing the Kruskal-Wallis non-parametric test. RESULTS Mean ADCmean and ADCratio were 0.8 (SD, ±0.4) × (10-3 mm2/s) and 1.2 (SD, ±0.5), respectively, and each parameter was significantly different between histopathological types (p < 0.05). Mean ADCmean and ADCratio were higher in adenoid cystic carcinoma (ACC) than in SCC, lymphoma, neuroendocrine carcinoma and sinonasal undifferentiated carcinoma (SNUC) (p < 0.05). Optimized ADCmean thresholds of 0.79, 0.81, 0.74 and 0.78 (10-3 mm2/s) achieved maximal discriminatory accuracies of 100%, 79%, 100% and 89% for ACC/SNUC, ACC/SCC, ACC/neuroendocrine carcinoma, and ACC/lymphoma, respectively. CONCLUSIONS The optimized ADCmean threshold of 0.80 (10-3 mm2/s) could be used to differentiate ACC from non-ACC sinonasal neoplasms with maximal discriminatory accuracy (82%) and sensitivity of 100%. However, there is considerable overlapping of the ADCmean and ADCratio values among non-ACC sinonasal neoplasms hence surgical biopsy is still needed.
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Carney O, Falzon A, MacKinnon A. Diffusion-weighted MRI in paediatric neuroimaging. Clin Radiol 2018; 73:999-1013. [DOI: 10.1016/j.crad.2018.07.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
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15
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Huo CW, Caputo C, Wang YY. Suprasellar keratinous cyst: A case report and review on its radiological features and treatment outcome. Surg Neurol Int 2018; 9:15. [PMID: 29497568 PMCID: PMC5806421 DOI: 10.4103/sni.sni_269_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/21/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Keratinous or epidermoid cysts (ECs) are encapsulated lesions lined by squamous cell epithelium. They comprise approximately 1% of intracranial lesions. Contrary to dermoid cysts, they lack dermal elements such as sebaceous or apocrine glands and hair follicles. The sellar region is the second most common intracranial site following the cerebellopontine angle. Here, we report a case of EC in a patient who complained of endocrine disturbances. We also performed a systematic review on previously published cases to analyze clinical and radiological characteristics and report the treatment outcomes of suprasellar ECs. CASE DESCRIPTION A 42-year-old woman presented with a one-year history of amenorrhea, weight gain, severe headache, and visual disturbances for 6 months. Work-up identified an elevated prolactin level and a temporal field defect of the right eye. Magnetic resonance imaging (MRI) showed a cystic suprasellar lesion pushing on the optic chiasm. She underwent endoscopic trans-sphenoidal surgery, which confirmed a keratinous cyst on histology. Postoperatively, complete resection was confirmed on imaging. She did well although her hospital stay was prolonged due to diabetes insipidus and hypocortisolism. CONCLUSION Chronic endocrine disturbances can be the presenting complaints of a suprasellar EC, whose T1-weighted MRI appearance can be non-specific, mimicking other differential diagnoses, such as a Rathke's cleft cyst. However, the T2-weighted MRI appearances of ECs are generally hyper-intense and lesions show diffusion restriction. Treatment is surgical and yields good outcomes in most cases reported.
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Affiliation(s)
- C. W. Huo
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Victoria, Australia
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - C. Caputo
- Department of Endocrinology, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Y. Y. Wang
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Victoria, Australia
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Keyhole Neurosurgery, Suite B, Level 2 Healy Wing, 41 Victoria parade, Fitzroy, VIC, Australia
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Zhou F, Yang Z, Zhu W, Chen L, Song J, Quan K, Li S, Li P, Pan Z, Liu P, Mao Y. Epidermoid cysts of the cavernous sinus: clinical features, surgical outcomes, and literature review. J Neurosurg 2017; 129:973-983. [PMID: 29271707 DOI: 10.3171/2017.6.jns163254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Epidermoid cysts of the cavernous sinus (CS) are rare, and no large case series of these lesions has been reported. In this study, the authors retrospectively reviewed the outcomes of the surgical management of CS epidermoid cysts undertaken at their center and performed a review of any such cysts reported in the literature over the past 40 years. METHODS Clinical data were obtained on 31 patients with CS epidermoid cysts that had been surgically treated at the authors' hospital between 2001 and 2016. The patients' medical records, imaging data, and follow-up outcomes were retrospectively analyzed. The related literature from the past 40 years (18 articles, 20 patients) was also evaluated. RESULTS The most common chief complaints were facial numbness or hypesthesia (64.5%), absent corneal reflex (45.2%), and abducens or oculomotor nerve deficit (35.5%). On MRI, 51.6% of the epidermoid cysts showed low T1 signals and equal or high T2 signals. In the other lesions, the radiological findings varied considerably given differences in the composition of the cysts. Surgery was performed via the extradural approach (58.1%), intradural approach (32.3%), or a combined approach (9.7%). After the operation, symptoms remained similar or improved in 90.3% of patients and new oculomotor paralysis developed after the operation in 9.7% of patients. Seven patients (22.6%) developed meningitis postoperatively (5 aseptic and 2 septic), and all of them recovered. All patients achieved good recovery before discharge (Karnofsky Performance Status score ≥ 70). Over an average follow-up of 4.6 ± 3.0 years in 25 patients (80.6%), no recurrence or reoperation occurred, regardless of whether total or subtotal resection of the capsule had been achieved. CONCLUSIONS Both the extradural and intradural approaches can enable satisfactory lesion resection. A favorable prognosis and symptomatic improvement can be expected after both total and subtotal capsule resections. Total capsule resection is encouraged to minimize the possibility of recurrence provided that the resection can be safely performed.
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Affiliation(s)
- Feng Zhou
- 1Department of Neurosurgery, Huashan Hospital; and
| | - Zixiao Yang
- 1Department of Neurosurgery, Huashan Hospital; and
| | - Wei Zhu
- 1Department of Neurosurgery, Huashan Hospital; and
| | - Liang Chen
- 1Department of Neurosurgery, Huashan Hospital; and
| | | | - Kai Quan
- 1Department of Neurosurgery, Huashan Hospital; and
| | - Sichen Li
- 1Department of Neurosurgery, Huashan Hospital; and
| | - Peiliang Li
- 1Department of Neurosurgery, Huashan Hospital; and
| | - Zhiguang Pan
- 1Department of Neurosurgery, Huashan Hospital; and
| | - Peixi Liu
- 1Department of Neurosurgery, Huashan Hospital; and
| | - Ying Mao
- 1Department of Neurosurgery, Huashan Hospital; and.,2State Key Laboratory of Medical Neurobiology, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, People's Republic of China
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17
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[Extra-axial tumors of the central nervous system]. Radiologe 2017; 57:715-727. [PMID: 28812110 DOI: 10.1007/s00117-017-0291-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Extra-axial tumors are intracranial neoplasms but are not located within the brain parenchyma. The localization of intracranial neoplasms helps to narrow down the possible differential diagnoses and also plays a deciding role in the treatment strategy and the prognosis. For this reason exact localization of these lesions is extremely important. Extra-axial tumors are the most common neoplasms among adults. They can be divided in a broad spectrum of histopathological subgroups. The most common extra-axial tumors are meningiomas, which arise from the dura mater. In the vast majority of cases they are benign and slowly growing. Only a few rare subgroups show aggressive behavior.
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Soni N, Gupta N, Kumar Y, Mangla M, Mangla R. Role of diffusion-weighted imaging in skull base lesions: A pictorial review. Neuroradiol J 2017. [PMID: 28631996 DOI: 10.1177/1971400917709624] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Skull base lesions can be related to wide number of pathologies including infections, benign and malignant tumors. Accurate diagnosis and differentiation between these entities is important for prompt and appropriate treatment. However, computed tomography and routine magnetic resonance imaging techniques only provide information on the extent of the lesions, with limited ability to differentiate between benign and malignant lesions. Diffusion-weighted imaging can help in many such situations by providing additional information, including help in differentiating benign from malignant lesions, so that appropriate treatment can be initiated. In this review article, we illustrate the imaging findings of the spectrum of skull base lesions, emphasizing the role of diffusion-weighted imaging in this domain.
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Affiliation(s)
- Neetu Soni
- 1 Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Nishant Gupta
- 2 Department of Radiology, St Vincent's Medical Center, Bridgeport, USA
| | - Yogesh Kumar
- 3 Department of Radiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, USA
| | | | - Rajiv Mangla
- 5 Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, USA
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Suprasellar Epidermoid Cyst with Atypical Imaging Findings. World Neurosurg 2017; 98:870.e1-870.e3. [DOI: 10.1016/j.wneu.2016.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/06/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023]
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20
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Dmytriw AA, Sawlani V, Shankar J. Diffusion-Weighted Imaging of the Brain: Beyond Stroke. Can Assoc Radiol J 2017; 68:131-146. [PMID: 28131336 DOI: 10.1016/j.carj.2016.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022] Open
Abstract
Diffusion-weighted imaging provides image contrast that is different from that provided by conventional magnetic resonance imaging techniques. It is highly sensitive for detection of cytotoxic oedema, and as such has gained favor in the detection of acute infarcts. However, diffusion-weighted imaging is underrepresented in the characterisation of many other disease processes. Our objective is to differentiate diseases that manifest with various neurological disorders, based on diffusion contrast and apparent diffusion coefficient values and review of hyper- and hypointense lesions on diffusion-weighted imaging.
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Affiliation(s)
- Adam A Dmytriw
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Vijay Sawlani
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham, United Kingdom
| | - Jai Shankar
- Department of Diagnostic Imaging, QE II Health Sciences Centre, Halifax, Nova Scotia, Canada.
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21
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Zamora C, Castillo M. Sellar and Parasellar Imaging. Neurosurgery 2016; 80:17-38. [DOI: 10.1093/neuros/nyw013] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 10/18/2016] [Indexed: 11/13/2022] Open
Abstract
Abstract
The skull base is a complex anatomical region that harbors many important neurovascular structures in a relatively confined space. The pathology that can develop at this site is varied, and many disease processes may present with similar clinical and neuroimaging findings. While computed tomography maintains a role in the evaluation of many entities and can, for instance, delineate osseous erosion with great detail and characterize calcified tumor matrices, magnetic resonance imaging (MRI) is the mainstay in the neuroimaging assessment of most pathology occurring at the skull base. Various MRI sequences have proven to be robust tools for tissue characterization and can provide information on the presence of lipids, paramagnetic and diamagnetic elements, and tumor cellularity, among others. In addition, currently available MRI techniques are able to generate high spatial resolution images that allow visualization of cranial nerves and their involvement by adjacent pathology. The information obtained from such examinations may aid in the distinction of these disease processes and in the accurate delineation of their extent prior to biopsy or treatment planning.
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22
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Kankane VK, Jaiswal G, Gupta TK. Epidermoid cyst in Anterior, Middle & Extension of Posterior cranial fossa: rare Imaging with review of literature. ROMANIAN NEUROSURGERY 2016. [DOI: 10.1515/romneu-2016-0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Epidermoid cysts are benign slow growing more often extra-axial tumors that insinuate between brain structures, we present the clinical, imaging, and pathological findings in 35 years old female patients with atypical epidermoid cysts which was situated anterior, middle & posterior cranial fossa. NCCT head revealed hypodense lesion over right temporal and perisylvian region with extension in prepontine cistern with mass effect & midline shift and MRI findings revealed a non-enhancing heterogeneous signal intensity cystic lesion in right frontal & temporal region extending into prepontine cistern with restricted diffusion. Patient was detoriated in night of same day of admission, emergency Fronto-temporal craniotomy with anterior peterousectomy and subtotal resection was done. The histological examination confirms the epidermoid cyst. The timing of ectodermal tissue sequestration during fetal development may account for the occurrence of atypical epidermoid cysts.
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Srinivasan K, Thomas B, Shah D, Kannath SK, Menon G, Sandhyamani S, Kesavadas C, Kapilamoorthy TR. Quantification of diffusion and anisotropy in intracranial epidermoids using diffusion tensor metrics and p: q tensor decomposition. J Neuroradiol 2016; 43:363-370. [PMID: 27318387 DOI: 10.1016/j.neurad.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To quantitatively evaluate the diffusion tensor metrics p, q, L and fractional anisotropy in intracranial epidermoids in comparison with normal white matter in the splenium of the corpus callosum. METHODS This retrospective study included 20 consecutive patients referred to our institute. All patients had a magnetic resonance imaging (MRI) study on a 1.5-Tesla MR system. A spin-echo echo-planar DTI sequence with diffusion gradients along 30 non-collinear directions was performed. The eigen values (λ1, λ2, λ3) were computed for each voxel and, using p: q tensor decomposition, the DTI metrics p, q and L-values and fractional anositropy (FA) were calculated. The region of interest (ROI) (6 pixels each) was placed within the lesion in all the cases and in the splenium of the corpus callosum. RESULTS The mean FA in the lesion and splenium were 0.50 and 0.88 respectively, with a statistically significant difference between them (P<0.01). On p: q tensor decomposition, the mean p-value in the epidermoid was 1.55±0.24 and 1.35±0.20 in the splenium; the mean q-values in the epidermoid was 0.67±0.13 and 1.27±0.17 in the splenium; the differences were statistically significant (P=0.01 and <0.01 respectively). The significant difference between p- and q-values in epidermoids compared with the splenium of callosum was probably due to structural and orientation differences in the keratin flakes in epidermoids and white matter bundles in the callosum. However, no significant statistical difference in L-values was noted (P=0.44). CONCLUSION DTI metrics p and q have the potential to quantify the diffusion and anisotropy in various tissues thereby gaining information about their internal architecture. The results also suggest that significant differences of DTI metrics p and q between epidermoid and the splenium of the corpus callosum are due to the difference in structural organization within them.
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Affiliation(s)
- K Srinivasan
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum, India
| | - B Thomas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum, India.
| | - D Shah
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum, India
| | - S K Kannath
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum, India
| | - G Menon
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - S Sandhyamani
- Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - C Kesavadas
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum, India
| | - T R Kapilamoorthy
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum, India
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Abstract
Extra-axial brain tumors are the most common adult intracranial neoplasms and encompass a broad spectrum of pathologic subtypes. Meningiomas are the most common extra-axial brain tumor (approximately one-third of all intracranial neoplasms) and typically present as slowly growing dural-based masses. Benign meningiomas are very common, and may occasionally be difficult to differentiate from more aggressive subtypes (i.e., atypical or malignant varieties) or other dural-based masses with more aggressive biologic behavior (e.g., hemangiopericytoma or dural-based metastases). Many neoplasms that typically affect the brain parenchyma (intra-axial), such as gliomas, may also present with primary or secondary extra-axial involvement. This chapter provides a general and concise overview of the common types of extra-axial tumors and their typical imaging features.
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Affiliation(s)
- Otto Rapalino
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
| | - James G Smirniotopoulos
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Çakır Ç, Gençhellaç H, Temizöz O, Polat A, Şengül E, Duygulu G. Diffusion Weighted Magnetic Resonance Imaging for the Characterization of Solitary Pulmonary Lesions. Balkan Med J 2015; 32:403-9. [PMID: 26740901 DOI: 10.5152/balkanmedj.2015.15663] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/28/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND We evaluated the differential diagnosis of solitary pulmonary lesions on magnetic resonance imaging. AIMS To investigate the value of diffusion weighted imaging on the differential diagnosis of solitary pulmonary lesions. STUDY DESIGN Randomized prospective study. METHODS This prospective study included 48 solitary pulmonary nodules and masses (18 benign, 30 malignant). Single shot echo planar spin echo diffusion weighted imaging (DWI) was performed with two b factors (0 and 1000 s/mm(2)). Apparent diffusion coefficients (ADCs) were calculated. On diffusion weighted (DW) trace images, the signal intensities (SI) of the lesions were visually compared to the SI of the thoracic spinal cord using a 5-point scale: 1: hypointense, 2: moderately hypointense, 3: isointense, 4: moderately hyperintense, 5: significantly hyperintense. For the quantitative evaluation, the lesion to thoracic spinal signal intensity ratios and the ADCs of the lesions were compared between groups. RESULTS On visual evaluation, taking the density of the spinal cord as a reference, most benign lesions were found to be hypointense, while most of the malignant lesions were evaluated as hyperintense on DWI with a b factor of 1000 s/mm(2). In contrast, on T2 weighted images, it was seen that the distinction of malignant lesions from benign lesions was not statistically significant. The ADCs of the malignant lesions were significantly lower than those of benign lesions (mean ADC was 2.02×10(-3) mm(2)/s for malignant lesions, and 1.195×10(-3)±0.3 mm(2)/s for benign lesions). Setting the cut-off value at 1.5×10(-3), ADC had a sensitivity of 86.7% and a specificity of 88.9% for the differentiation of benign lesions from malignant lesions. CONCLUSION DWI may aid in the differential diagnosis of solitary pulmonary lesions. (ClinicalTrials.gov Identifier: NCT02482181).
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Affiliation(s)
- Çağlayan Çakır
- Department of Radiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Hakan Gençhellaç
- Department of Radiology, Trakya University Hospital, Edirne, Turkey
| | - Osman Temizöz
- Department of Radiology, Selçuk University Hospital, İzmir, Turkey
| | - Ahmet Polat
- Department of Radiology, Edirne State Hospital, Edirne, Turkey
| | - Ersin Şengül
- Department of Radiology, Trakya University Hospital, Edirne, Turkey
| | - Gökhan Duygulu
- Department of Radiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
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Wang Y, Zhang X, Cao K, Li Y, Li X, Qi L, Tang L, Wang Z, Gao S. Diffusion-tensor imaging as an adjunct to dynamic contrast-enhanced MRI for improved accuracy of differential diagnosis between breast ductal carcinoma in situ and invasive breast carcinoma. Chin J Cancer Res 2015; 27:209-17. [PMID: 25937784 DOI: 10.3978/j.issn.1000-9604.2015.03.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 12/03/2014] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To determine the value of diffusion-tensor imaging (DTI) as an adjunct to dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for improved accuracy of differential diagnosis between breast ductal carcinoma in situ (DCIS) and invasive breast carcinoma (IBC). METHODS The MRI data of 63 patients pathologically confirmed as breast cancer were analyzed. The conventional MRI analysis metrics included enhancement style, initial enhancement characteristic, maximum slope of increase, time to peak, time signal intensity curve (TIC) pattern, and signal intensity on FS-T2WI. The values of apparent diffusion coefficient (ADC), directionally-averaged mean diffusivity (Davg), exponential attenuation (EA), fractional anisotropy (FA), volume ratio (VR) and relative anisotropy (RA) were calculated and compared between DCIS and IBC. Multivariate logistic regression was used to identify independent factors for distinguishing IBC and DCIS. The diagnostic performance of the diagnosis equation was evaluated using the receiver operating characteristic (ROC) curve. The diagnostic efficacies of DCE-MRI, DWI and DTI were compared independently or combined. RESULTS EA value, lesion enhancement style and TIC pattern were identified as independent factor for differential diagnosis of IBC and DCIS. The combination diagnosis showed higher diagnostic efficacy than a single use of DCE-MRI (P=0.02), and the area of the curve was improved from 0.84 (95% CI, 0.67-0.99) to 0.94 (95% CI, 0.85-1.00). CONCLUSIONS Quantitative DTI measurement as an adjunct to DCE-MRI could improve the diagnostic performance of differential diagnosis between DCIS and IBC compared to a single use of DCE-MRI.
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Affiliation(s)
- Yuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiaopeng Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Kun Cao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yanling Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiaoting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Liping Qi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Lei Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhilong Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Shunyu Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Atypical intracranial epidermoid cysts: rare anomalies with unique radiological features. Case Rep Radiol 2015; 2015:528632. [PMID: 25667778 PMCID: PMC4312626 DOI: 10.1155/2015/528632] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/26/2014] [Indexed: 12/17/2022] Open
Abstract
Epidermoid cysts are benign slow growing extra-axial tumours that insinuate between brain structures, while their occurrences in intra-axial or intradiploic locations are exceptionally rare. We present the clinical, imaging, and pathological findings in two patients with atypical epidermoid cysts. CT and MRI findings for the first case revealed an intraparenchymal epidermoid cyst that demonstrated no restricted diffusion. The second case demonstrated an aggressive epidermoid cyst that invaded into the intradiploic spaces, transverse sinus, and the calvarium. The timing of ectodermal tissue sequestration during fetal development may account for the occurrence of atypical epidermoid cysts.
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Shetty A, Nair R, Tripathi P, Kumar V, Upadhyaya S. Endoscopic excision of a lateral ventricular epidermoid-A case report of a novel technique. Int J Surg Case Rep 2014; 5:1135-8. [PMID: 25437656 PMCID: PMC4275816 DOI: 10.1016/j.ijscr.2014.11.039] [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] [Received: 04/17/2014] [Revised: 11/12/2014] [Accepted: 11/12/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Epidermoids of the lateral ventricle are relatively rare tumours. As these tumours are soft and relatively avascular, they appear to be ideally suited for endoscopic surgical excision. At present the instruments available are specifically designed for endoscopic intra ventricular surgeries, limitations being inability to rapidly debulk the tumour and achieve adequate haemostasis. We present a case of lateral ventricular epidermoid that was excised endoscopically using a system originally designed for endoscopic disc surgery. PRESENTATION OF CASE We describe a female patient who presented with recurrent headache and occasional episodes of vomiting since 6 years. Preoperative diagnosis of lateral intra ventricular epidermoid was made with the help of an Magnetic resonance imaging (MRI) of the brain. Intraoperatively, an incision was made over the right Kocher's point and a 2.5cm dural opening was made following a small craniotomy and the Destaudeau endoscope was introduced. A 30° scope and gentle manipulation were used to view the ventricular cavity and ensure near total excision of the tumour. Here we record this novel technique. DISCUSSION Lateral intra-ventricular tumours are usually approached through a trans-cortical or intra hemispheric approach, under microscope. The use of endoscopes have been largely restricted because of non-availability and relative difficulty in controlling troublesome bleeding, incase of vascular tumours. CONCLUSION A multi portal endoscope that allows use of routine pituitary instruments would enable the surgeon to achieve haemostasis effectively and, in our opinion, should be a viable alternative to microscope for excision of intra ventricular tumours.
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Affiliation(s)
- Arjun Shetty
- Department of Neurosurgery, Manipal University, Manipal, India
| | - Rajesh Nair
- Department of Neurosurgery, Manipal University, Manipal, India.
| | | | - Vinod Kumar
- Department of Neurosurgery, Manipal University, Manipal, India
| | - Sunil Upadhyaya
- Department of Neurosurgery, Manipal University, Manipal, India
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29
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Angioglioma misdiagnosed as encephalomalacia on magnetic resonance imaging for over a decade. J Comput Assist Tomogr 2014; 38:485-7. [PMID: 24651748 DOI: 10.1097/rct.0000000000000043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a case of intractable seizures secondary to an angioglioma that was misdiagnosed as post-traumatic encephalomalacia for over a decade, with a discussion of the radiological findings and a review of the literature.
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30
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Potential role of advanced MRI techniques for the peritumoural region in differentiating glioblastoma multiforme and solitary metastatic lesions. Clin Radiol 2013; 68:e689-97. [DOI: 10.1016/j.crad.2013.06.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 06/10/2013] [Accepted: 06/14/2013] [Indexed: 11/22/2022]
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31
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O'Connor KM, Barest G, Moritani T, Sakai O, Mian A. "Dazed and diffused": making sense of diffusion abnormalities in neurologic pathologies. Br J Radiol 2013; 86:20130599. [PMID: 24167185 DOI: 10.1259/bjr.20130599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
To review diffusion abnormalities seen in diffusion-weighted MRI in neurological pathologies. We examine the clinical significance of the abnormalities in a broad spectrum of neurological diseases and highlight our current understanding of their causes. Diffusion abnormalities seen on diffusion-weighted MRI can play an important role in the diagnosis and follow-up of a broad spectrum of neurological diseases. A thorough understanding of the appearance and significance of these abnormalities is critical in patient management.
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Affiliation(s)
- K M O'Connor
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJB, Culebras A, Elkind MSV, George MG, Hamdan AD, Higashida RT, Hoh BL, Janis LS, Kase CS, Kleindorfer DO, Lee JM, Moseley ME, Peterson ED, Turan TN, Valderrama AL, Vinters HV. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44:2064-89. [PMID: 23652265 PMCID: PMC11078537 DOI: 10.1161/str.0b013e318296aeca] [Citation(s) in RCA: 2002] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the global impact and advances in understanding the pathophysiology of cerebrovascular diseases, the term "stroke" is not consistently defined in clinical practice, in clinical research, or in assessments of the public health. The classic definition is mainly clinical and does not account for advances in science and technology. The Stroke Council of the American Heart Association/American Stroke Association convened a writing group to develop an expert consensus document for an updated definition of stroke for the 21st century. Central nervous system infarction is defined as brain, spinal cord, or retinal cell death attributable to ischemia, based on neuropathological, neuroimaging, and/or clinical evidence of permanent injury. Central nervous system infarction occurs over a clinical spectrum: Ischemic stroke specifically refers to central nervous system infarction accompanied by overt symptoms, while silent infarction by definition causes no known symptoms. Stroke also broadly includes intracerebral hemorrhage and subarachnoid hemorrhage. The updated definition of stroke incorporates clinical and tissue criteria and can be incorporated into practice, research, and assessments of the public health.
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Chowdhury FH, Haque MR, Sarker MH. Intracranial epidermoid tumor; microneurosurgical management: An experience of 23 cases. Asian J Neurosurg 2013; 8:21-8. [PMID: 23741259 PMCID: PMC3667457 DOI: 10.4103/1793-5482.110276] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES An intracranial epidermoid tumor is relatively a rare tumor, accounting for approximately 0.1% of all intracranial space occupying lesions. These are also known as pearly tumor due to their pearl like appearance. In this series, the localization of the tumor, presenting age and symptoms, imaging criteria for diagnosis, surgical management strategy with completeness of excision and overall outcome were studied prospectively. Here, we report our short experience of intracranial epidermoid as a whole. MATERIALS AND METHODS Between January 2006 to December 2010, 23 cases of intracranial epidermoid were diagnosed preoperatively with almost certainty by computed tomography (CT) and magnetic resonance imaging (MRI) of brain in plain, contrast and other relevant studies. All of them underwent operation in Dhaka Medical College Hospital and in some Private Hospital in Dhaka, Bangladesh. All patients were followed-up routinely by clinical examination and neuroimaging. Average follow-up was 39 (range-71-11months) months. Patients of the series were prospectively studied. RESULTS Supratentorial epidermoids were 04 cases and infratemporal epidermoids were 19 cases. Clinical features and surgical strategy varies according to the location and extension of the tumors. Age range was 19-71 years (37.46 years). Common clinical features were headache, cerebellar features, seizure, vertigo, hearing impairment and features of raised intracranial pressure (ICP). Investigation was CT scan or/+ MRI of brain in all cases. Pre-operative complete excision was 20 cases, but post-operative images showed complete excision in 17 cases. Content of tumor was pearly white/white material in all cases except one, where content was putty material. Re-operation for residual/recurrent tumor was nil. Complications included pre-operative mortality one case, persisted sixth nerve palsy in one case, transient memory disturbance one case, and extra dural hematoma one case. One senior patient expired three months after the operation from spontaneous intracerebral hemorrhage. Rest of the patients were stable and symptom/s free till last follow-up. CONCLUSION In the management of such tumors, one should keep in mind that an aggressive radical surgery carrying a high morbidity and mortality and a conservative subtotal tumor excision is associated with a higher rate of recurrence, but earlier diagnosis and complete excision or near total excision of this benign tumor can cure the patient with the expectation of normal life.
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Chowdhury FH, Haque MR. Endoscopic assisted microsurgical removal of cerebello-pontine angle and prepontine epidermoid. J Neurosci Rural Pract 2012. [PMID: 23189019 PMCID: PMC3505358 DOI: 10.4103/0976-3147.102647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Cerebello-pontine(CP) angle and prepontine epidermoid tumors are challenging lesions because they grow along the subarachnoid spaces around the very important neurovascular structures and often extend into the supratentorial compartment. They have typically been removed through a variety of anterolateral, lateral, and posterolateral cranial base microsurgical approaches. Sometime they were removed by the endoscope-assisted microneurosurgical (EAM) techniques. Here we report a CP angle and preontine epidermoid tumor extended to supratentorial compartment presented with trigeminal neuralgia that was removed by pure endoscopic visualization through retrosigmoid retromastoid lateral suboccipital approach. (The method of using endoscope along with surgical instruments passing along the sides of endoscope is termed as Endoscope-Controlled Microsurgery–ECM.) So far our knowledge, in the literature this type of report is probably very rare.
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Affiliation(s)
- Forhad H Chowdhury
- Department of Neurosurgery, Dhaka Medical College Hospital, Dhaka, Bangladesh
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Imaging appearance of petrous apex dermoid cysts containing little or no fat. Jpn J Radiol 2012; 31:133-7. [DOI: 10.1007/s11604-012-0150-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
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Santos GT, Leite CC, Machado LR, McKinney AM, Lucato LT. Reduced diffusion in neurocysticercosis: circumstances of appearance and possible natural history implications. AJNR Am J Neuroradiol 2012; 34:310-6. [PMID: 22821919 DOI: 10.3174/ajnr.a3198] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Few studies discuss DWI findings in patients with NCC, and their conclusions are variable and contradictory. The aim of our study was to describe DWI findings of a cohort of patients with NCC, emphasizing the frequency of reduced diffusion. MATERIALS AND METHODS This retrospective study included 48 patients with NCC. Two neuroradiologists analyzed MR images regarding location, number, and stage of NCC lesions. On the basis of visual analysis, they defined, by consensus, the presence of high signal within NCC lesions on DWI and measured their ADC values when feasible. RESULTS The total number of lesions was 342: parenchymal (263), subarachnoid (65), and intraventricular (14); 83 were DWI hyperintense. The first pattern was a small eccentric hyperintense dot/curvilinear structure on DWI (representing the scolex) noted in intraparenchymal lesions in vesicular (41 lesions, 29%) and colloidal vesicular (18 lesions, 19%) stages, in 14 (22%) subarachnoid lesions, and 2 (14%) intraventricular lesions; rADC calculations were hampered by the intrinsic small dimensions of this finding. The second pattern was the presence of total/subtotal DWI hyperintensity in intraparenchymal lesions, 5 in the colloidal vesicular stage (5%) and 1 in the granular nodular phase (3%). Two subarachnoid lesions also showed the same presentation; in this second pattern, reduced diffusion was present in different degrees, measured by rADC calculations. CONCLUSIONS DWI may identify the scolex, increasing diagnostic confidence for NCC. Total/subtotal DWI hyperintensity, related to the stage of the lesion, though uncommon, allows including NCC as a consideration in the differential diagnosis of lesions with reduced diffusion and ring enhancement.
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Affiliation(s)
- G T Santos
- Departments of Radiology, Clinics Hospital of the University of Sao Paulo, School of Medicine, Sao Paulo, Brazil
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Chin BM, Orlandi RR, Wiggins RH. Evaluation of the sellar and parasellar regions. Magn Reson Imaging Clin N Am 2012; 20:515-43. [PMID: 22877954 DOI: 10.1016/j.mric.2012.05.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The article reviews the anatomy and imaging evaluation of the sellar and parasellar regions. Both common and uncommon sellar and suprasellar masses are reviewed, focusing on a systematic approach to analysis and when appropriate, differential creation.
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Affiliation(s)
- Brian M Chin
- Department of Radiology, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140, USA.
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Singh P, Yadav MK, Singh SK, Lal A, Khandelwal N. Case series: Diffusion weighted MRI appearance in prostatic abscess. Indian J Radiol Imaging 2011; 21:46-8. [PMID: 21431033 PMCID: PMC3056370 DOI: 10.4103/0971-3026.76054] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
DIFFUSION: weighted MRI (DWI) is a novel technique that analyzes the diffusion of water molecules in vivo. DWI has been used extensively in the central nervous system. Its use in body imaging is on the rise. In the prostate, it has been used in the evaluation of prostatic carcinoma. We present DWI findings in two patients of prostatic abscess.
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Affiliation(s)
- Paramjeet Singh
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kim MS, Kim KA, Chang SH. Testicular Epidermoid Cyst on Diffusion-Weighted MR Imaging and ADC Map : A Case Report. ACTA ACUST UNITED AC 2011. [DOI: 10.13104/jksmrm.2011.15.2.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Mi Sun Kim
- Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Korea
| | - Kyung Ah Kim
- Department of Radiology, Yonsei University College of Medicine, Korea
| | - Sun Hee Chang
- Department of Pathology, Ilsan Paik Hospital, Inje University College of Medicine, Korea
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Sood S, Gupta A, Tsiouris AJ. Advanced magnetic resonance techniques in neuroimaging: diffusion, spectroscopy, and perfusion. Semin Roentgenol 2010; 45:137-46. [PMID: 20171345 DOI: 10.1053/j.ro.2009.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kocaoglu M, Bulakbasi N, Sanal HT, Kismet E, Caliskan B, Akgun V, Tayfun C. Pediatric abdominal masses: diagnostic accuracy of diffusion weighted MRI. Magn Reson Imaging 2010; 28:629-36. [DOI: 10.1016/j.mri.2010.02.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Revised: 12/14/2009] [Accepted: 02/08/2010] [Indexed: 01/18/2023]
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ARAI A, SASAYAMA T, KOYAMA J, FUJITA A, HOSODA K, KOHMURA E. Epidermoid Cyst in Meckel's Cave With Unusual Computed Tomography and Magnetic Resonance Imaging Findings -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:701-4. [DOI: 10.2176/nmc.50.701] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Atsushi ARAI
- Department of Neurosurgery, Kobe University Graduate School of Medicine
| | - Takashi SASAYAMA
- Department of Neurosurgery, Kobe University Graduate School of Medicine
| | - Junji KOYAMA
- Department of Neurosurgery, Kobe University Graduate School of Medicine
| | - Atsushi FUJITA
- Department of Neurosurgery, Kobe University Graduate School of Medicine
| | - Kohkichi HOSODA
- Department of Neurosurgery, Kobe University Graduate School of Medicine
| | - Eiji KOHMURA
- Department of Neurosurgery, Kobe University Graduate School of Medicine
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Duan ZX, Chu SH, Ma YB, Zhang H, Zhu JL. Giant intradiploic epidermoid cyst of the occipital bone. J Clin Neurosci 2009; 16:1478-80. [DOI: 10.1016/j.jocn.2008.09.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Revised: 09/17/2008] [Accepted: 09/18/2008] [Indexed: 02/07/2023]
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Santhosh K, Thomas B, Radhakrishnan VV, Saini J, Kesavadas C, Gupta AK, Kapilamoorthy TR, Nair SN. Diffusion tensor and tensor metrics imaging in intracranial epidermoid cysts. J Magn Reson Imaging 2009; 29:967-70. [PMID: 19306444 DOI: 10.1002/jmri.21686] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To explore the utility of diffusion tensor imaging (DTI) and diffusion tensor metrics (DTM) in characterizing the structural pathology of epidermoid cysts. DTI gives information about the tissue structure; a high fractional anisotropy (FA) indicates a highly structured orientation of the tissue, fibers, or white matter tracts. Based on the tensor rank, a set of three metrics has been described that can be used to measure the directional dependence of diffusion: linear anisotropy (CL), planar anisotropy (CP), and spherical anisotropy (CS). DTM takes into account the shape of diffusion anisotropy and hence may provide better insight into the orientation of structures than FA. MATERIALS AND METHODS DTI was performed in three patients with epidermoid cysts. FA, directionally-averaged mean diffusivity (Dav), exponential apparent diffusion coefficient (eADC), and DTM, such as CL, CP, and CS, were measured from the tumor core as well as from the normal-appearing white matter. Histopathological correlation was obtained. RESULTS Epidermoid cysts showed high FA with Dav values similar to that of normal white matter. eADC maps did not show any restriction of diffusion. FA values were high, but not as high as that for the white matter. CP values were higher and CL values were lower than those obtained for the white matter in various regions. CONCLUSION High CP values suggest preferential diffusion of water molecules along a two-dimensional geometry, which could be attributed to the well-structured orientation of keratin filaments and flakes within the tumor as demonstrated by histopathology. Advanced imaging modalities like DTI with DTM can provide information regarding the microstructural anatomy of the epidermoid cysts.
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Affiliation(s)
- Kannath Santhosh
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
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Thiriat S, Riehm S, Kremer S, Martin E, Veillon F. Apparent diffusion coefficient values of middle ear cholesteatoma differ from abscess and cholesteatoma admixed infection. AJNR Am J Neuroradiol 2009; 30:1123-6. [PMID: 19246529 DOI: 10.3174/ajnr.a1473] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A retrospective study was conducted on a cohort of 15 patients who underwent surgery because cholesteatoma or abscess was suspected. All patients had MR imaging prior to surgery with diffusion-weighted images (DWI) from which the apparent diffusion coefficient (ADC) value was calculated. Using this technique, we were able to determine 3 distinct ADC value ranges corresponding to the 3 groups of lesions found at surgery (pure cholesteatoma, cholesteatoma with infection, and abscess or infection). This needs to be confirmed by further studies with a wider range of patients.
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Affiliation(s)
- S Thiriat
- Department of Radiology, Hautepierre Strasbourg, Strasbourg, France.
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Jolapara M, Kesavadas C, Radhakrishnan VV, Saini J, Patro SN, Gupta AK, Kapilamoorthy TR, Bodhey N. Diffusion tensor mode in imaging of intracranial epidermoid cysts: one step ahead of fractional anisotropy. Neuroradiology 2008; 51:123-9. [PMID: 18839162 DOI: 10.1007/s00234-008-0464-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 09/15/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The signal characteristics of an epidermoid on T2-weighted imaging have been attributed to the presence of increased water content within the tumor. In this study, we explore the utility of diffusion tensor imaging (DTI) and diffusion tensor metrics (DTM) in knowing the microstructural anatomy of epidermoid cysts. MATERIALS AND METHODS DTI was performed in ten patients with epidermoid cysts. Directionally averaged mean diffusivity (D(av)), exponential diffusion, and DTM-like fractional anisotropy (FA), diffusion tensor mode (mode), linear (CL), planar (CP), and spherical (CS) anisotropy were measured from the tumor as well as from the normal-looking white matter. RESULTS Epidermoid cysts showed high FA. However, D(av) and exponential diffusion values did not show any restriction of diffusion. Diffusion tensor mode values were near -1, and CP values were high within the tumor. This suggested preferential diffusion of water molecules along a two-dimensional geometry (plane) in epidermoid cysts, which could be attributed to the parallel-layered arrangement of keratin filaments and flakes within these tumors. CONCLUSION Thus, advanced imaging modalities like DTI with DTM can provide information regarding the microstructural anatomy of the epidermoid cysts.
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Affiliation(s)
- Milan Jolapara
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India
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Diffusion-Weighted Imaging in the Differential Diagnosis of Cystic Lesions of the Pancreas. AJR Am J Roentgenol 2008; 191:1115-21. [DOI: 10.2214/ajr.07.3754] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Spontaneous Resolution of a Meckel's Cave Arachnoid Cyst Causing Sixth Cranial Nerve Palsy. J Neuroophthalmol 2008; 28:186-91. [DOI: 10.1097/wno.0b013e318183be6c] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chung EM, Murphey MD, Specht CS, Cube R, Smirniotopoulos J. From the Archives of the AFIP Pediatric Orbit Tumors and Tumorlike Lesions: Osseous Lesions of the Orbit. Radiographics 2008; 28:1193-214. [DOI: 10.1148/rg.284085013] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Maier SE, Mulkern RV. Biexponential analysis of diffusion-related signal decay in normal human cortical and deep gray matter. Magn Reson Imaging 2008; 26:897-904. [PMID: 18467062 DOI: 10.1016/j.mri.2008.01.042] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 01/14/2008] [Indexed: 10/22/2022]
Abstract
Diffusion imaging with high-b factors, high spatial resolution and cerebrospinal fluid signal suppression was performed in order to characterize the biexponential nature of the diffusion-related signal decay with b-factor in normal cortical gray and deep gray matter (GM). Integration of inversion pulses with a line scan diffusion imaging sequence resulted in 91% cerebrospinal fluid signal suppression, permitting accurate measurement of the fast diffusion coefficient in cortical GM (1.142+/-0.106 microm2/ms) and revealing a marked similarity with that found in frontal white matter (WM) (1.155+/-0.046 microm2/ms). The reversal of contrast between GM and WM at low vs high b-factors is shown to be due to a significantly faster slow diffusion coefficient in cortical GM (0.338+/-0.027 microm2/ms) than in frontal WM (0.125+/-0.014 microm2/ms). The same characteristic diffusion differences between GM and WM are observed in other brain tissue structures. The relative component size showed nonsignificant differences among all tissues investigated. Cellular architecture in GM and WM are fundamentally different and may explain the two- to threefold higher slow diffusion coefficient in GM.
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Affiliation(s)
- Stephan E Maier
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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