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Hoppe J, Kalckreuth T, Metelmann M, Rumpf JJ, Klagges S, Dietzsch S, Scherlach C, Kuhnt T, Kortmann RD, Seidel C. [Skull base metastases with cranial nerve deficits : Clinical profile of a severe disease]. DER NERVENARZT 2022; 93:812-818. [PMID: 35024880 PMCID: PMC9363291 DOI: 10.1007/s00115-021-01229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund und Ziele Schädelbasismetastasen sind eine seltene Manifestation onkologischer Erkrankungen. Wenn Hirnnerven beteiligt sind, können schon kleine Läsionen erhebliche funktionelle Beeinträchtigungen hervorrufen. Spezifische klinische Charakteristika wie neurologische Symptome, assoziierte Primärtumoren, Prognose und optimale Therapie der Erkrankung sind schlecht definiert und sollen in dieser Arbeit systematisch dargestellt werden. Methoden Mit einem monozentrischen retrospektiven Ansatz wurden Schädelbasismetastasen bei Patienten, die im Zeitraum von 2006 bis 2018 behandelt wurden, detailliert hinsichtlich klinischer Charakteristika, der durchgeführten Therapie und des weiteren Erkrankungsverlaufs analysiert. Ergebnisse Insgesamt 45 Patienten mit Schädelbasismetastasen und Hirnnervenausfällen wurden erfasst. Die häufigsten Primärtumoren waren Prostatakarzinom (27 %), Mammakarzinom (22 %) und multiples Myelom (16 %). Die am häufigsten betroffenen Hirnnerven waren Nervus trigeminus (42 %), Nervus oculomotorius (33 %) und Nervus facialis (27 %). 84 % aller Patienten wiesen außerhalb der Schädelbasis liegende weitere Knochenmetastasen auf. Eine durale Infiltration oder eine Meningeosis neoplastica lagen bei je 13 % der Patienten vor. Nach Bestrahlung waren 61 % der Patienten hinsichtlich der auf die Schädelbasismetastase zurückzuführenden Symptome klinisch stabil, bei 22 % hatten sich die Symptome gebessert. Das mediane Gesamtüberleben betrug 8 Monate (Spanne: 0,4–51 Monate). Bei Patienten, die mit einer dosiseskalierten Bestrahlung behandelt wurden, bestand eine längere Überlebenszeit (16,4 Monate vs. 4,7 Monate). Dieser Effekt persistierte auch in der multivariaten Analyse unter Berücksichtigung der Faktoren Karnofsky-Index, Metastasenanzahl, Primärtumor und Bestrahlungsdosis (HR 0,37, p = 0,02). Diskussion Schädelbasismetastasen mit Hirnnervenausfällen haben ein vielgestaltiges Bild und oft eine schlechte Prognose. Um potenziell eine Überlebenszeitverbesserung zu erreichen, sind präzise Diagnostik und Therapie Voraussetzung. Prospektive kontrollierte Untersuchungen sind notwendig.
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Affiliation(s)
- J Hoppe
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland
| | - T Kalckreuth
- Department of Radiation-Oncology, University Hospital Freiburg, Freiburg, Deutschland
| | - M Metelmann
- Department of Neurology, University Hospital Leipzig, Leipzig, Deutschland
| | - J J Rumpf
- Department of Neurology, University Hospital Leipzig, Leipzig, Deutschland
| | - S Klagges
- Sächsisches Krebsregister Leipzig, Leipzig, Deutschland
| | - S Dietzsch
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland
| | - C Scherlach
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Deutschland
| | - T Kuhnt
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland
| | - R D Kortmann
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland
| | - C Seidel
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland. .,, Stephanstr. 9a, 04103, Leipzig, Deutschland.
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Abstract
Magnetic resonance (MR) imaging is a crucial tool for evaluation of the skull base, enabling characterization of complex anatomy by utilizing multiple image contrasts. Recent technical MR advances have greatly enhanced radiologists' capability to diagnose skull base pathology and help direct management. In this paper, we will summarize cutting-edge clinical and emerging research MR techniques for the skull base, including high-resolution, phase-contrast, diffusion, perfusion, vascular, zero echo-time, elastography, spectroscopy, chemical exchange saturation transfer, PET/MR, ultra-high-field, and 3D visualization. For each imaging technique, we provide a high-level summary of underlying technical principles accompanied by relevant literature review and clinical imaging examples.
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Affiliation(s)
- Claudia F Kirsch
- Division Chief, Neuroradiology, Professor of Neuroradiology and Otolaryngology, Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine at Northwell, North Shore University Hospital, Manhasset, NY
| | - Mai-Lan Ho
- Associate Professor of Radiology, Director of Research, Department of Radiology, Director, Advanced Neuroimaging Core, Chair, Asian Pacific American Network, Secretary, Association for Staff and Faculty Women, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; Division Chief, Neuroradiology, Professor of Neuroradiology and Otolaryngology, Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine at Northwell, North Shore University Hospital, Manhasset, NY.
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3
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Mehta RP, Cueva RA, Brown JD, Fliss DM, Gil Z, Kassam AB, Rassekh CH, Schlosser RJ, Snyderman CH, Har-El G. What's New in Skull Base Medicine and Surgery? Skull Base Committee Report. Otolaryngol Head Neck Surg 2016; 135:620-30. [PMID: 17011428 DOI: 10.1016/j.otohns.2006.04.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Accepted: 04/27/2006] [Indexed: 11/28/2022]
Affiliation(s)
- Ritvik P Mehta
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
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Hines JP, Howard BE, Hoxworth JM, Lal D. Positive and Negative Predictive Value of PET-CT in Skull Base Lesions: Case Series and Systematic Literature Review. J Neurol Surg Rep 2016; 77:e39-45. [PMID: 26937333 PMCID: PMC4773825 DOI: 10.1055/s-0035-1570387] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objectives To study positive (PPV) and negative predictive value (NPV) of positron emission tomography with computed tomography (PET-CT) scans in determining malignancy in skull base lesions and perform a systematic literature review for optimal PET-CT interpretation. Design Retrospective case series and systematic literature review of the current English literature. Setting Tertiary referral academic medical center. Participants All patients with skull base lesions that underwent PET-CT and tissue biopsy from 2010 to 2013. Main Outcome Measures PPV and NPV of radiologist's report and standardized uptake value (SUV) cutoff of 2.5 and 3, biopsy with pathologic interpretation, clinical follow-up. Results A total of 31 PET-CT scans of 16 patients were studied; 10 PET-CT were performed upfront for diagnostic purposes and 21 were post-treatment surveillance scans. The PPV of radiologist's interpretation, SUV cutoff of 2.5, and SUV cutoff of 3.0 was 80%, 60%, and 68.4%, with a NPV of 100%, 83.3%, and 75%, respectively. Literature search yielded 500 abstracts; 7 studies met inclusion criteria for detailed review. No consensus or guidelines for optimal SUV cutoff value was found. Conclusions PET-CT based on SUV cutoff criteria alone has high NPV but low PPV in determining malignancy in skull base lesions. Interpretation by a radiologist experienced in nuclear medicine and neuroradiology, synthesizing clinical, SUV, and radiologic data are of superior value.
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Affiliation(s)
- John Peyton Hines
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, United States
| | - Brittany E Howard
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, United States
| | - Joseph M Hoxworth
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, United States
| | - Devyani Lal
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, United States
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5
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Abstract
Skull base imaging requires a thorough knowledge of the complex anatomy of this region, including the numerous fissures and foramina and the major neurovascular structures that traverse them. Computed tomography (CT) and magnetic resonance imaging (MRI) play complementary roles in imaging of the skull base. MR is the preferred modality for evaluation of the soft tissues, the cranial nerves, and the medullary spaces of bone, while CT is preferred for demonstrating thin cortical bone structure. The anatomic location and origin of a lesion as well as the specific CT and MR findings can often narrow the differential diagnosis to a short list of possibilities. However, the primary role of the imaging specialist in evaluating the skull base is usually to define the extent of the lesion and determine its relationship to vital neurovascular structures. Technologic advances in imaging and radiation therapy, as well as surgical technique, have allowed for more aggressive approaches and improved outcomes, further emphasizing the importance of precise preoperative mapping of skull base lesions via imaging. Tumors arising from and affecting the cranial nerves at the skull base are considered here.
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Abstract
In the past three decades, there have been countless advances in imaging modalities that have revolutionized evaluation, management, and treatment of neuro-ophthalmic disorders. Non-invasive approaches for early detection and monitoring of treatments have decreased morbidity and mortality. Understanding of basic methods of imaging techniques and choice of imaging modalities in cases encountered in neuro-ophthalmology clinic is critical for proper evaluation of patients. Two main imaging modalities that are often used are computed tomography (CT) and magnetic resonance imaging (MRI). However, variations of these modalities and appropriate location of imaging must be considered in each clinical scenario. In this article, we review and summarize the best neuroimaging studies for specific neuro-ophthalmic indications and the diagnostic radiographic findings for important clinical entities.
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Affiliation(s)
- James D Kim
- Department of Ophthalmology (AGL: Clinical Professor), The University of Texas Medical Branch, Galveston, TX, USA
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Skull Base, Orbits, Temporal Bone, and Cranial Nerves: Anatomy on MR Imaging. Magn Reson Imaging Clin N Am 2011; 19:439-56. [DOI: 10.1016/j.mric.2011.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
This article briefly discusses the imaging approach to lesions of the anterior skull base. A brief review of normal anatomy and imaging techniques is followed by a discussion about common neoplastic and non-neoplastic pathologies involving this region.
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Affiliation(s)
- Hemant Parmar
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI 48109, USA.
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Lee AG, Johnson MC, Policeni BA, Smoker WRK. Imaging for neuro-ophthalmic and orbital disease - a review. Clin Exp Ophthalmol 2008; 37:30-53. [PMID: 19016810 DOI: 10.1111/j.1442-9071.2008.01822.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A literature review was performed by content experts in neuro-ophthalmology and neuroradiology using a systematic English-language Medline search (1994-2008) limited to articles with relevance to neuro-ophthalmic and orbital imaging. The information covered in this review includes: (i) the basic mechanics, indications and contraindications for cranial and orbital computed tomography and magnetic resonance (MR) imaging; (ii) the utility and indications for intravenous contrast, (iii) the use of specific MR sequences; (iv) the techniques and ophthalmic indications for computed tomography/MR angiography and venography; and (v) the techniques and indications for functional MR imaging, positron emission tomography scanning and single photon emission computed tomography. Throughout the review accurate and timely communication with the neuroradiologist regarding the clinical findings and suspected location of lesions is emphasized so as to optimize the ordering and interpretation of imaging studies for the ophthalmologist.
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Affiliation(s)
- Andrew G Lee
- Department of Ophthalmology, Universiyt of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
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Abstract
The utility of 18-F-fluorodeoxyglucose-positron emission tomography (PET) and PET/CT for the evaluation of skull base tumors is incompletely investigated, as a limited number of studies specifically focus on this region with regard to PET imaging. Several patterns can be ascertained, however, by synthesizing the data from various published reports and cases of primary skull base malignancies, as well as head and neck malignancies that extend secondarily to the skull base, including nasopharyngeal carcinoma, nasal cavity and paranasal sinus tumors, parotid cancers, and orbital tumors.
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Affiliation(s)
- Erik S Mittra
- Department of Radiology, Division of Nuclear Medicine, Stanford University Medical Center, 300 Pasteur Drive, Room H-0101, Stanford, CA 94305-5281, USA.
| | - Andrei Iagaru
- Department of Radiology, Division of Nuclear Medicine, Stanford University Medical Center, 300 Pasteur Drive, Room H-0101, Stanford, CA 94305-5281, USA
| | - Andrew Quon
- Department of Radiology, Division of Nuclear Medicine, Stanford University Medical Center, 300 Pasteur Drive, Room H-0101, Stanford, CA 94305-5281, USA
| | - Nancy Fischbein
- Department of Radiology, Division of Neuroradiology, Stanford University Medical Center, 300 Pasteur Drive, Room S-047, Stanford, CA 94305-5105, USA
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Borges A. Skull base tumours part I: imaging technique, anatomy and anterior skull base tumours. Eur J Radiol 2008; 66:338-47. [PMID: 18462901 DOI: 10.1016/j.ejrad.2008.01.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 01/11/2008] [Accepted: 01/14/2008] [Indexed: 10/22/2022]
Abstract
Advances in cross-sectional imaging, surgical technique and adjuvant treatment have largely contributed to ameliorate the prognosis, lessen the morbidity and mortality of patients with skull base tumours and to the growing medical investment in the management of these patients. Because clinical assessment of the skull base is limited, cross-sectional imaging became indispensable in the diagnosis, treatment planning and follow-up of patients with suspected skull base pathology and the radiologist is increasingly responsible for the fate of these patients. This review will focus on the advances in imaging technique; contribution to patient's management and on the imaging features of the most common tumours affecting the anterior skull base. Emphasis is given to a systematic approach to skull base pathology based upon an anatomic division taking into account the major tissue constituents in each skull base compartment. The most relevant information that should be conveyed to surgeons and radiation oncologists involved in patient's management will be discussed.
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Affiliation(s)
- Alexandra Borges
- Instituto Português de Oncologia Francisco Gentil, Centro de Lisboa, Serviço de Radiologia, Rua Professor Lima Basto, 1093 Lisboa Codex, Portugal.
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Abstract
Despite being introduced in the 1970s and 1980s, CT and MRI continue to be the primary imaging modalities for the temporal bone and skull base. Although the general concepts and physics remain the same, the images obtained currently are far superior. Augmenting these traditional modalities are nuclear medicine imaging techniques, functional imaging, and the fusion of different techniques. Advances in these areas are expanding our options and illuminating pathology in unique ways. As basic physiologic processes are better understood, new opportunities for novel imaging techniques should arise.
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Affiliation(s)
- Colin L W Driscoll
- Department of Otorhinolaryngology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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Bisdas S, Fetscher S, Feller AC, Baghi M, Knecht R, Gstoettner W, Vogl TJ, Balzer JO. Primary B cell lymphoma of the sphenoid sinus: CT and MRI characteristics with correlation to perfusion and spectroscopic imaging features. Eur Arch Otorhinolaryngol 2007; 264:1207-13. [PMID: 17479272 DOI: 10.1007/s00405-007-0322-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 04/12/2007] [Indexed: 10/23/2022]
Abstract
Primary non-Hodgkin lymphoma (NHL) of the paranasal sinuses is a rare neoplasm that cannot be easily diagnosed and differentiated as its clinical, histological, and imaging features are similar to those of other inflammatory and tumorous diseases in their early stages. We evaluated the morphological and functional imaging characteristics of primary NHL of the sphenoid sinus using CT and MR imaging. Morphological CT and MR imaging as well as perfusion CT imaging and proton MR spectroscopy (PRESS technique, TE = 135) was performed in three patients with the histological diagnosis of highly malignant primary B cell lymphoma of the sphenoid sinus. In all patients an inhomogeneous contrast agent enhancement as well as bony erosion of the sphenoid sinus was identified in CT and MR sections. In one patient an infiltration of the adjacent dura was present. The mean blood flow of the lymphomas was 135 ml/min per 100 g tissue, the mean blood volume was 8.06 ml/min, while the mean transit time and the mean permeability surface area product values were 5.11 s and 26.53 ml/min per 100 g, respectively. The mean choline to creatine ratio in the proton MR spectroscopy was 5.7. Cross-sectional imaging findings are not sufficient to establish the diagnosis of a primary NHL in the sphenoid sinus. Physiologic imaging offers valuable information that may be characteristic of the tumor. Future studies may lead to a safe differentiation of the lymphomas from other pathologic entities based on the combination of morphological and functional imaging.
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Affiliation(s)
- Sotirios Bisdas
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang-Goethe University Hospital Frankfurt, Theodor-Stern-Kai 9, 60590, Frankfurt, Germany.
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Affiliation(s)
- Arnaldo Neves Da Silva
- University of Virginia, Neurology Department, Division of Neuro-Oncology, Charlottesville, VA 22908-0432, USA
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