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Gaeta M, Galletta K, Cavallaro M, Mormina E, Cannizzaro MT, Lanzafame LRM, D'Angelo T, Blandino A, Vinci SL, Granata F. T1 relaxation: Chemo-physical fundamentals of magnetic resonance imaging and clinical applications. Insights Imaging 2024; 15:200. [PMID: 39120775 PMCID: PMC11315875 DOI: 10.1186/s13244-024-01744-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/07/2024] [Indexed: 08/10/2024] Open
Abstract
A knowledge of the complex phenomena that regulate T1 signal on Magnetic Resonance Imaging is essential in clinical practice for a more effective characterization of pathological processes. The authors review the physical basis of T1 Relaxation Time and the fundamental aspects of physics and chemistry that can influence this parameter. The main substances (water, fat, macromolecules, methemoglobin, melanin, Gadolinium, calcium) that influence T1 and the different MRI acquisition techniques that can be applied to enhance their presence in diagnostic images are then evaluated. An extensive case illustration of the different phenomena and techniques in the areas of CNS, abdomino-pelvic, and osteoarticular pathology is also proposed. CRITICAL RELEVANCE STATEMENT: T1 relaxation time is strongly influenced by numerous factors related to tissue characteristics and the presence in the context of the lesions of some specific substances. An examination of these phenomena with extensive MRI exemplification is reported. KEY POINTS: The purpose of the paper is to illustrate the chemical-physical basis of T1 Relaxation Time. MRI methods in accordance with the various clinical indications are listed. Several examples of clinical application in abdominopelvic and CNS pathology are reported.
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Affiliation(s)
- Michele Gaeta
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Karol Galletta
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Marco Cavallaro
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Enricomaria Mormina
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | | | | | - Tommaso D'Angelo
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy.
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD, Rotterdam, The Netherlands.
| | - Alfredo Blandino
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Francesca Granata
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
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McEntire CRS, Glenn T, Unizony S, Cho T, Reda H, Chwalisz BK. Symmetric leukoencephalopathy associated with systemic lupus erythematosus: A systematic review of a distinctive neurorheumatologic syndrome. Mult Scler Relat Disord 2024; 88:105717. [PMID: 38943754 DOI: 10.1016/j.msard.2024.105717] [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: 01/12/2024] [Revised: 06/04/2024] [Accepted: 06/08/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND A symmetric leukoencephalopathy can occur in the context of systemic lupus erythematosus (SLE), often as a first manifestation of underlying rheumatologic disease. Recognition of this distinctive syndrome can prompt investigation for SLE when undiagnosed, or prompt treatment initiation when the diagnosis is already known. Earlier recognition of this syndrome could lead to more effective treatment of the disease. METHODS Clinical, laboratory, and radiographic features of three patients were described from an academic medical center in the United States with treatment dates between 2015 and 2022. A systematic review of literature from 1991 to 2023 yielded data for an additional 23 patients. RESULTS Twenty-six total patients with symmetric leukoencephalopathy were included in this study. The median age of the patients was 37 years (range 10-69), 22 patients (85 %) were female, and 4 (15 %) were male. Fourteen of 26 patients (54 %) had this as the first clinical manifestation of SLE. Contrast enhancement was present on MRI brain in 3/26 (88 %) patients. Twenty patients (77 %) were treated with pulse-dose steroids, and all but one patient received some immunomodulatory therapy. Seven patients (27 %) progressed to death. No meaningful predictive differences were found between patients who survived and those who did not. CONCLUSIONS In this case series and literature review patients developed symmetric leukoencephalopathy in systemic lupus erythematosus most often as the first clinical manifestation of SLE. Clinicians should consider this syndrome in any patient with acute onset of symmetric leukoencephalopathy on brain magnetic resonance imaging.
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Affiliation(s)
- Caleb R S McEntire
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States.
| | - Trevor Glenn
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | - Sebastian Unizony
- Rheumatology, Allergy and Immunology Division, Massachusetts General Hospital, Boston, MA, United States
| | - Tracey Cho
- Neuro-Immunology Division, University of Iowa Hospitals and Clinics, United States
| | - Haatem Reda
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Bart K Chwalisz
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
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Chen Y, Yan J, Jiang M, Zhang T, Zhao Z, Zhao W, Zheng J, Yao D, Zhang R, Kendrick KM, Jiang X. Adversarial Learning Based Node-Edge Graph Attention Networks for Autism Spectrum Disorder Identification. IEEE TRANSACTIONS ON NEURAL NETWORKS AND LEARNING SYSTEMS 2024; 35:7275-7286. [PMID: 35286265 DOI: 10.1109/tnnls.2022.3154755] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Graph neural networks (GNNs) have received increasing interest in the medical imaging field given their powerful graph embedding ability to characterize the non-Euclidean structure of brain networks based on magnetic resonance imaging (MRI) data. However, previous studies are largely node-centralized and ignore edge features for graph classification tasks, resulting in moderate performance of graph classification accuracy. Moreover, the generalizability of GNN model is still far from satisfactory in brain disorder [e.g., autism spectrum disorder (ASD)] identification due to considerable individual differences in symptoms among patients as well as data heterogeneity among different sites. In order to address the above limitations, this study proposes a novel adversarial learning-based node-edge graph attention network (AL-NEGAT) for ASD identification based on multimodal MRI data. First, both node and edge features are modeled based on structural and functional MRI data to leverage complementary brain information and preserved in the constructed weighted adjacent matrix for individuals through the attention mechanism in the proposed NEGAT. Second, two AL methods are employed to improve the generalizability of NEGAT. Finally, a gradient-based saliency map strategy is utilized for model interpretation to identify important brain regions and connections contributing to the classification. Experimental results based on the public Autism Brain Imaging Data Exchange I (ABIDE I) data demonstrate that the proposed framework achieves a classification accuracy of 74.7% between ASD and typical developing (TD) groups based on 1007 subjects across 17 different sites and outperforms the state-of-the-art methods, indicating satisfying classification ability and generalizability of the proposed AL-NEGAT model. Our work provides a powerful tool for brain disorder identification.
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Michaelidou EE, Kaczmarska A, Gutierrez-Quintana R, Morris J, Hammond G, Cloquell A. Case report: MRI and CT imaging features of a melanocytic tumour affecting a cervical vertebra in an adult dog, and review of differential diagnosis for T1W-hyperintense lesions. Front Vet Sci 2024; 11:1334813. [PMID: 38655532 PMCID: PMC11035764 DOI: 10.3389/fvets.2024.1334813] [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] [Received: 11/07/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
A 7-year-old Lhasa Apso presented with a history of left thoracic limb lameness and neck pain. Magnetic resonance imaging revealed a well-defined, extradural lesion that was hyperintense on T1-weighted (T1W) images and isointense on T2-weighted (T2W) images and T2* images located at the left lamina of the C4 vertebra. Computed tomography showed an isoattenuating and contrast-enhancing mass centered on the left C4 vertebral lamina with associated osteolysis. The mass was surgically debulked, and histopathology revealed a malignant melanocytic tumour. The patient recovered completely and received radiotherapy and three doses of the melanoma vaccine as adjunctive treatment. Eighteen months following treatment, the patient presented with neck pain again, but further investigations were declined at this stage, and the patient was euthanised. To the author's knowledge, this is the first case report describing the imaging characteristics of a cervical extradural melanocytic tumour in a dog. This case illustrates the MRI and CT imaging features and treatment of a canine melanocytic tumour of the cervical vertebrae.
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Affiliation(s)
- Elli Elizabeth Michaelidou
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
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Ruaux E, Nougaret S, Gavrel M, Charlot M, Devouassoux-Shisheboran M, Golfier F, Thomassin-Naggara I, Rousset P. Endometriosis MR mimickers: T1-hyperintense lesions. Insights Imaging 2024; 15:19. [PMID: 38267748 PMCID: PMC10808095 DOI: 10.1186/s13244-023-01587-3] [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: 06/27/2023] [Accepted: 11/25/2023] [Indexed: 01/26/2024] Open
Abstract
Endometriosis is a chronic and disabling gynecological disease that affects women of reproductive age. Magnetic resonance imaging (MRI) is considered the cornerstone radiological technique for both the diagnosis and management of endometriosis. While MRI offers higher sensitivity compared to ultrasonography, it is prone to false-positive results, leading to decreased specificity. False-positive findings can arise from various T1-hyperintense conditions on fat-suppressed T1-weighted images, resembling endometriotic cystic lesions in different anatomical compartments. These conditions include hemorrhage, hyperproteic content, MRI artifacts, feces, or melanin. Such false positives can have significant implications for patient care, ranging from incorrect diagnoses to unnecessary medical or surgical interventions and subsequent follow-up. To address these challenges, this educational review aims to provide radiologists with comprehensive knowledge about MRI criteria, potential pitfalls, and differential diagnoses, ultimately reducing false-positive results related to T1-hyperintense abnormalities.Critical relevance statementMRI has a 10% false-positive rate, leading to misdiagnosis. T1-hyperintense lesions, observed in the three phenotypes of pelvic endometriosis, can also be seen in various other causes, mainly caused by hemorrhages, high protein concentrations, and artifacts.Key points• MRI in endometriosis has a 10% false-positive rate, leading to potential misdiagnosis.• Pelvic endometriosis lesions can exhibit T1-hyperintensity across their three phenotypes.• A definitive diagnosis of a T1-hyperintense endometriotic lesion is crucial for patient management.• Hemorrhages, high protein concentrations, lipids, and artifacts are the main sources of T1-hyperintense mimickers.
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Affiliation(s)
- Edouard Ruaux
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, 165 Chemin du Grand Revoyet, EMR 3738, 69495, Pierre Bénite, France
| | - Stéphanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, U1194, Montpellier University, 34295, Montpellier, France
| | - Marie Gavrel
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Mathilde Charlot
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Mojgan Devouassoux-Shisheboran
- Department of Pathology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, 69495, Pierre Bénite, France
| | - François Golfier
- Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, 69495, Pierre Bénite, France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Service Imageries Radiologiques et Interventionnelles Spécialisées, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 75020, Paris, France
| | - Pascal Rousset
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, 165 Chemin du Grand Revoyet, EMR 3738, 69495, Pierre Bénite, France.
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Zahr N, Sullivan E, Pfefferbaum A. [WITHDRAWN] Serum biomarkers of liver fibrosis identify changes in striatal metabolite levels. RESEARCH SQUARE 2024:rs.3.rs-2729490. [PMID: 37034697 PMCID: PMC10081358 DOI: 10.21203/rs.3.rs-2729490/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The full text of this preprint has been withdrawn by the authors due to author disagreement with the posting of the preprint. Therefore, the authors do not wish this work to be cited as a reference. Questions should be directed to the corresponding author.
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Alturki IA, Alluhidan TA, Alturki AA, Alzahrani FS, Alluwaymi NA. Hyperintense Perilesional Edema on T1-Weighted Imaging in Cavernoma: A Case Report. Cureus 2024; 16:e51454. [PMID: 38169697 PMCID: PMC10758170 DOI: 10.7759/cureus.51454] [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: 12/31/2023] [Indexed: 01/05/2024] Open
Abstract
Cavernoma, also called a cavernous malformation, is a vascular malformation that happens during development. It tends to look like a berry-shaped lesion. In cerebral hemorrhagic cavernous malformations (cavernoma), T1-weighted imaging that shows hyperintense perilesional edema in brain masses is an unusual radiological finding. This sign's association with cavernoma is gaining prominence. We present the case of a 35-year-old female patient without significant medical history who reported a seven-day history of left-side weakness that began in the upper limb, progressed to the lower limb, and was associated with nausea. The non-contrast T1- T1-weighted images displayed a gradient of hyperintense content of the lesion with surrounding relatively hyperintense perilesional edema. The patient consequently underwent surgery to evacuate the hematoma and excise the lesion, which went uneventfully.
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Malczuk J, Costachescu B, Schmitt E, Klein O. Spontaneous regression of white epidermoid cyst of the pre-bulbar cistern in a 3-year-old child: a case report and literature review. Childs Nerv Syst 2023; 39:3065-3070. [PMID: 37668670 DOI: 10.1007/s00381-023-06140-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
We describe the first case of regression of a white epidermoid cyst in a child. White epidermoid cysts are rare benign lesions, particularly in pediatric cases. Typically, these cysts need surgical resection. However, we report the case of a 3-year-old child with recurrent aseptic meningitis, in whom CT scan and MRI revealed a white epidermoid cyst in the pre-bulbar cistern. Surprisingly, over a 5-year follow-up period, the cyst showed dramatic regression without any symptoms. This case sheds light on the potential for spontaneous regression of white epidermoid cysts in children, challenging the need for risky surgical interventions. This report opens up new perspectives on the pathophysiology and management options for this type of lesion in children.
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Affiliation(s)
- Josephine Malczuk
- Department of Pediatric Neurosurgery and Facial Surgery Children's Hospital, 54500, Vandoeuvre les Nancy, France.
| | - Bogdan Costachescu
- Gr. T. Popa, University of Medicine and Pharmacy, 700115, Iasi, Romania
- Prof. Dr. N. Oblu" Emergency Clinical Hospital, 700309, Iasi, Romania
| | - Emmanuelle Schmitt
- Department of Diagnostic and Therapeutic Neuroradiology, Hopital Central, 54035, Nancy, France
| | - Olivier Klein
- Department of Pediatric Neurosurgery and Facial Surgery Children's Hospital, 54500, Vandoeuvre les Nancy, France
- CHRU Nancy, Nancy, France
- CME of CHRU Nancy, Nancy, France
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Yamano A, Yanaka K, Onuma K, Nakamura K, Takahashi N, Kohzuki H, Sakamoto N, Matsuda M, Ishikawa E. Significance of perilesional T1 hyperintense areas in the differential diagnosis of primary adult-type diffuse glioma: A case report. Radiol Case Rep 2023; 18:3448-3452. [PMID: 37502482 PMCID: PMC10369393 DOI: 10.1016/j.radcr.2023.07.023] [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: 05/02/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023] Open
Abstract
Perilesional T1 hyperintensity on magnetic resonance imaging (MRI) of intra-axial brain masses is an unusual feature of the perilesional area, characteristic of cavernous malformations (CMs) and metastatic brain tumors (METs). Here, we report a case of primary diffuse glioma with a perilesional T1 hyperintense area (HIA) on MRI. A 61-year-old woman with transient aphasia visited our hospital. Radiological examination revealed an intra-axial mass with acute/subacute hemorrhaging and calcification in the left frontal lobe. It was presumed to be a CM because of the perilesional T1 HIA. Gross total resection of the tumor was performed, and the pathological diagnosis was anaplastic oligodendroglioma, not otherwise specified by World Health Organization 2016 classification. Histopathological findings in the perilesional T1 HIA indicated hemorrhage involvement in the surrounding white matter. No recurrence appeared after radio-chemotherapy. Perilesional T1 HIAs, characteristic of CMs and METs, are also seen in primary diffuse gliomas. Therefore, caution should be taken when using this sign for the differential diagnosis of intracranial masses.
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Affiliation(s)
- Akinari Yamano
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Kiyoyuki Yanaka
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Kuniyuki Onuma
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Kazuhiro Nakamura
- Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Nobuyuki Takahashi
- Department of Radiology, Tsukuba Memorial Hospital, Tsukuba City, Ibaraki, Japan
| | - Hidehiro Kohzuki
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Noriaki Sakamoto
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
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Lara-Olivas JA, Sangrador-Deitos MV, Villalobos-Díaz R, Marian-Magaña R, Gomez-Amador JL. A rare case of a right infratentorial meningioma and a left giant posterior communicating thrombosed aneurysm. Surg Neurol Int 2023; 14:317. [PMID: 37810320 PMCID: PMC10559378 DOI: 10.25259/sni_473_2023] [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: 06/04/2023] [Accepted: 08/19/2023] [Indexed: 10/10/2023] Open
Abstract
Background Giant intracranial aneurysms cause symptoms due to mass effect and can mimic other lesions in imaging studies. The coexistence of tumors and aneurysms is relatively rare, with meningiomas being the predominant tumors found in such cases. The relationship between these two entities is complex and represent a neurosurgical challenge. Case Description A 61-year-old woman presented with intermittent headache, vertigo, right peripheral facial palsy, hearing loss, and left hemiparesis. Magnetic resonance imaging revealed two lesions: a supratentorial paraclinoid lesion in the left frontotemporal region and a right infratentorial extra-axial mass, suggestive of a meningioma. The patient underwent a two-staged surgical intervention to address both lesions. Conclusion In this particular case, the lesions were located on different sides and in different cranial compartments, making it even rarer.
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Lasocki A, Stuckey SL, Caspersz L, Xie J, McArthur GA. Prospective Comparison of T1-SPACE and MPRAGE for the Identification of Intrinsic T1 Hyperintensity in Patients with Intracranial Melanoma Metastases. AJNR Am J Neuroradiol 2023; 44:1039-1044. [PMID: 37620155 PMCID: PMC10494940 DOI: 10.3174/ajnr.a7975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 07/17/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND AND PURPOSE Volumetric TSE (3D-TSE) techniques are increasingly replacing volumetric magnetization-prepared gradient recalled-echo (3D-GRE) sequences due to improved metastasis detection. In addition to providing a baseline for assessing postcontrast enhancement, precontrast T1WI also identifies intrinsic T1 hyperintensity, for example, reflecting melanin or blood products. The ability of precontrast 3D-TSE to demonstrate intrinsic T1 hyperintensity is not clear from the literature; thus, this study compares precontrast 3D-TSE and 3D-GRE sequences for identifying intrinsic T1 hyperintensity in patients with metastatic melanoma. MATERIALS AND METHODS Patients with metastatic melanoma and previously reported intrinsic T1 hyperintensity were identified. MRIs were performed at 3T including both 3D-GRE (MPRAGE) and 3D-TSE T1 sampling perfection with application-optimized contrasts by using different flip angle evolution (T1-SPACE) sequences precontrast. Axial 1-mm slices of both T1WI sequences were independently reviewed by 2 neuroradiologists, comparing the conspicuity of each lesion between the 2 sequences according to a 5-point scale and assessing whether the intrinsic T1 hyperintensity was attributable to melanin, blood products, or both. RESULTS Twenty examinations were performed, with a total of 214 lesions demonstrating intrinsic T1 hyperintensity. Both readers found that intrinsic T1 hyperintensity was less conspicuous with T1-SPACE compared with MPRAGE for most lesions assessed (81.8%, averaged across both readers), including for lesions with intrinsic T1 hyperintensity attributable to melanin and blood products. Intrinsic T1 hyperintensity was rarely more conspicuous on T1-SPACE (1.4%). CONCLUSIONS Precontrast intrinsic T1 hyperintensity is more conspicuous with MPRAGE than T1-SPACE. In patients with metastatic melanoma, 3D-GRE should be preferred as the precontrast T1WI sequence when both 3D-TSE and 3D-GRE are performed postcontrast and when not administering IV contrast.
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Affiliation(s)
- Arian Lasocki
- From the Department of Cancer Imaging (A.L., S.L.S., L.C.), Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology (A.L., S.L.S., G.A.M.), The University of Melbourne, Parkville, Victoria, Australia
- Department of Radiology (A.L.), The University of Melbourne, Parkville, Victoria, Australia
| | - Stephen L Stuckey
- From the Department of Cancer Imaging (A.L., S.L.S., L.C.), Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- School of Clinical Sciences at Monash Health (S.L.S.), Monash University, Clayton, Victoria, Australia
- Department of Medical Imaging and Radiation Sciences (S.L.S.), Monash University, Clayton, Victoria, Australia
| | - Lauren Caspersz
- From the Department of Cancer Imaging (A.L., S.L.S., L.C.), Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jing Xie
- Centre for Biostatistics and Clinical Trials (J.X.), Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Grant A McArthur
- Sir Peter MacCallum Department of Oncology (A.L., S.L.S., G.A.M.), The University of Melbourne, Parkville, Victoria, Australia
- Department of Medical Oncology (G.A.M.), Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Chithrapathra KE, Hewanayake WS, Egodage S, Silva S. Diabetic Striatopathy: A Case Report of a Patient With Poor Glycaemic Control and Abnormal Movements. Cureus 2023; 15:e45581. [PMID: 37868561 PMCID: PMC10587642 DOI: 10.7759/cureus.45581] [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: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Diabetic striatopathy (DS) is a condition occurring in individuals with type II diabetes mellitus (T2DM) where there are abnormal (usually single-sided) bodily movements (hemiballismus-hemichorea (HBHC)). DS involves the interaction between diabetes leading to damage to areas such as the striatum with the development of a noticeable hyperkinetic movement disorder. Here, we present a case of a 72-year-old man with T2DM, ischaemic heart disease, and dyslipidaemia, who presented with involuntary movements of the bilateral upper limbs (the left side more affected than the right) for three weeks along with progressively worsening subtle involuntary movements of the mouth and tongue, with intact speech, swallowing, and gait. The neurological examination revealed high-amplitude intermittent, sudden onset involuntary movements of the bilateral upper limbs, primarily affecting the left side. Based on clinical findings, which were supported by imaging studies, a diagnosis of diabetic striatopathy was made. His presentation was beyond the classical presentation of unilateral involvement seen in HBHC, but with early identification and strict glycemic control, satisfactory improvement of his clinical status was achieved.
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Affiliation(s)
| | | | | | - Shehan Silva
- Medicine, University of Sri Jayawardenapura, Gangodawila, LKA
- Internal Medicine, Colombo South Teaching Hospital, Kalubowila, LKA
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Khaled ML, Tarhini AA, Forsyth PA, Smalley I, Piña Y. Leptomeningeal Disease (LMD) in Patients with Melanoma Metastases. Cancers (Basel) 2023; 15:cancers15061884. [PMID: 36980770 PMCID: PMC10047692 DOI: 10.3390/cancers15061884] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Leptomeningeal disease (LMD) is a devastating complication caused by seeding malignant cells to the cerebrospinal fluid (CSF) and the leptomeningeal membrane. LMD is diagnosed in 5-15% of patients with systemic malignancy. Management of LMD is challenging due to the biological and metabolic tumor microenvironment of LMD being largely unknown. Patients with LMD can present with a wide variety of signs and/or symptoms that could be multifocal and include headache, nausea, vomiting, diplopia, and weakness, among others. The median survival time for patients with LMD is measured in weeks and up to 3-6 months with aggressive management, and death usually occurs due to progressive neurologic dysfunction. In melanoma, LMD is associated with a suppressive immune microenvironment characterized by a high number of apoptotic and exhausted CD4+ T-cells, myeloid-derived suppressor cells, and a low number of CD8+ T-cells. Proteomics analysis revealed enrichment of complement cascade, which may disrupt the blood-CSF barrier. Clinical management of melanoma LMD consists primarily of radiation therapy, BRAF/MEK inhibitors as targeted therapy, and immunotherapy with anti-PD-1, anti-CTLA-4, and anti-LAG-3 immune checkpoint inhibitors. This review summarizes the biology and anatomic features of melanoma LMD, as well as the current therapeutic approaches.
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Affiliation(s)
- Mariam Lotfy Khaled
- Metabolism and Physiology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Cairo 12613, Egypt
| | - Ahmad A Tarhini
- Departments of Cutaneous Oncology and Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Peter A Forsyth
- Neuro-Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Inna Smalley
- Metabolism and Physiology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Yolanda Piña
- Neuro-Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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Kuroedov D, Cunha B, Pamplona J, Castillo M, Ramalho J. Cerebral cavernous malformations: Typical and atypical imaging characteristics. J Neuroimaging 2023; 33:202-217. [PMID: 36456168 DOI: 10.1111/jon.13072] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/11/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022] Open
Abstract
Cavernous malformations (CMs) are benign vascular malformations that maybe seen anywhere in the central nervous system. They are dynamic lesions, growing or shrinking over time and only rarely remaining stable. Size varies from a few millimeters to a few centimeters. CMs can be sporadic or familial, and while most of them are congenital, de novo and acquired lesions may also be seen. Etiology is still unknown. A genetic molecular mechanism has been proposed since a cerebral cavernous malformation gene loss of function was found in both familial and sporadic lesions. Additionally, recent studies suggest that formation of CMs in humans may be associated with a distinctive bacterial gut composition (microbioma). Imaging is fairly typical but may vary according to age, location, and etiology. Follow-up is not well established because CMs patients have a highly unpredictable clinical course. Angiogenic and inflammatory mechanisms have been implicated in disease activity, as well as lesional hyperpermeability and iron deposition. Imaging and serum biomarkers of these mechanisms are under current investigation. Treatment options, including surgery or radiosurgery, are not well defined and are dependent upon multiple factors, including clinical presentation, lesion location, number of hemorrhagic events, and medical comorbidities. Our purpose is to review the imaging features of CMs based on their size, location, and etiology, as well as their differential diagnosis and best imaging approach. New insights in etiology will be briefly considered. Follow-up strategies, including serum and imaging biomarkers, and treatment options will also be discussed.
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Affiliation(s)
- Danila Kuroedov
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Bruno Cunha
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jaime Pamplona
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Mauricio Castillo
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Joana Ramalho
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
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Interactions of dopamine, iron, and alpha-synuclein linked to dopaminergic neuron vulnerability in Parkinson's disease and neurodegeneration with brain iron accumulation disorders. Neurobiol Dis 2022; 175:105920. [DOI: 10.1016/j.nbd.2022.105920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 11/08/2022] Open
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Diagnostic challenges of primary diffuse leptomeningeal melanomatosis in early adolescence: A case report. Brain Dev 2022; 44:421-425. [PMID: 35260265 DOI: 10.1016/j.braindev.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 01/20/2022] [Accepted: 02/13/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Primary diffuse leptomeningeal melanomatosis is an extremely rare variant of primary melanoma of the central nervous system. It is characterized by a variety of nonspecific clinical, radiological, and histopathological features requiring differential diagnosis from a variety of diseases. Here, we aimed to use our own clinical case as an example of the difficulties in the diagnosis of this disease. CASE PRESENTATION A 14-year-old boy presented with focal to bilateral tonic-clonic seizures. Brain MRI showed diffuse cortical surface and subcortical lesions, isointense on T1-weighted images and hypointense on T2-weighted images, respectively, with diffuse leptomeningeal gadolinium enhancement. Cytology of the cerebrospinal fluid revealed atypical mononuclear cells, but characteristic melanoma cells were not found. Although we suspected meningeal carcinomatosis, we did not perform abrainbiopsy under the tentative diagnosis of Sturge-Weber syndrome. A definitive diagnosis of primary diffuse leptomeningeal melanomatosis was made with abrainbiopsy after hedevelopednon-convulsive status epilepticus. Despite treatment, he died of hydrocephalus 1 year and 8 months after onset. CONCLUSION Primary diffuse leptomeningeal melanomatosis poses a clinical diagnostic and therapeutic challenge. Leptomeningeal enhancement extending into the cerebral sulci and signal changes in T1/T2 weighted images of cortical and subcortical lesions on MRI are key to an early decision regarding whether to perform a biopsy, even in the pediatric population.
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Park G, Kesserwani HN. A Case Report of Diabetic Striatopathy: An Approach to Diagnosis Based on Clinical and Radiological Findings. Cureus 2022; 14:e25089. [PMID: 35733455 PMCID: PMC9205274 DOI: 10.7759/cureus.25089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/21/2022] Open
Abstract
Diabetic striatopathy (DS) is an acute hyperkinetic movement disorder characterized by hemiballismus-hemichorea (HBHC) due to nonketotic hyperglycemia. DS manifests a fascinating interplay between endocrinopathy (diabetes), striatal (putamen, caudate nucleus, globus pallidus) pathology, and a dramatic neurological movement disorder, HBHC. The striking hyperintensity on imaging modalities such as computed axial tomography (CT) scan of the brain and T1-weighted magnetic resonance imaging (MRI) of the brain can mislead the clinician to an erroneous diagnosis of a cerebral hemorrhage and/or ischemic infarct, especially in an acute setting. We present an acute case of DS and outline the natural history, semiology, typical radiological findings, and therapeutic options. With careful and thoughtful analysis, an accurate diagnosis can be exacted, sparing the patient unnecessary anxiety and medical costs.
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18
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Masson’s Tumour of the Neck: a Rare Case Report. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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19
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Wu G, Liu L, Wang T, Pan C. T1 mapping is useful for staging deep venous thrombosis in the lower extremities. Acta Radiol 2022; 63:489-496. [PMID: 33910379 DOI: 10.1177/02841851211004425] [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: 11/16/2022]
Abstract
BACKGROUND The discrimination of acute and chronic deep venous thrombosis (DVT) is of great importance. Quantitative imaging is an urgent requirement in reflecting intrinsic characteristics of thrombosis. PURPOSE To investigate the feasibility of T1 mapping in staging DVT in the lower extremities. MATERIAL AND METHODS A total of 57 patients with DVT in the lower extremities (26 men, 31 women; mean age = 53.3 years) underwent T1-weighted imaging and T1 mapping for obtaining T1 signal intensity (SI) and T1 time of thrombus. The relative SI (rSI) of DVT was obtained by calculating the ratio of thrombus SI to muscle SI. The Mann-Whitney U test was used to compare rSI and T1 time of DVT between acute group (patients with limb edema ≤ 2 weeks) and chronic group (patients with limb edema > 2 weeks). A receiver operator characteristic (ROC) curve was constructed for further evaluation. RESULTS DVT rSI was significantly higher in the acute group versus the chronic group (2.8 ± 1.2 vs. 1.4 ± 0.6; P<0.05). DVT T1 time was significantly lower in the acute group versus the chronic group (819.4 ± 223.7 ms vs. 1264.8 ± 270.7 ms; P<0.05). The area under the curve (AUC) was 0.93 for T1 time and 0.75 for rSI. When using 1015 ms as the cut-off, the sensitivity and specificity of T1 time were 91% (32/35) and 86% (19/22), respectively. CONCLUSION T1 mapping is a potential technique in discriminating acute from chronic DVT in the lower extremities and warrants further investigation.
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Affiliation(s)
- Gang Wu
- Department of Radiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, PR China
| | - Liangjin Liu
- Department of Radiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, PR China
| | - Ting Wang
- Department of Ultrasound, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, PR China
| | - Chu Pan
- Department of Radiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, PR China
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20
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Fledderus AC, Widdershoven AL, Lapid O, Breugem CC, Pasmans SGMA, van der Horst CMAM, Engelen MM, Spuls PI. Neurological signs, symptoms and MRI abnormalities in patients with congenital melanocytic naevi and evaluation of routine MRI-screening: systematic review and meta-analysis. Orphanet J Rare Dis 2022; 17:95. [PMID: 35236387 PMCID: PMC8889704 DOI: 10.1186/s13023-022-02234-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A congenital melanocytic naevus (CMN) is a rare skin condition that can be associated with abnormalities of the central nervous system (CNS). These anomalies can sometimes cause severe complications, and rarely death. Adequate information about aetiology and management is therefore crucial. To identify how to monitor patients with CMN, we aimed to estimate the prevalence of neurological involvement in patients with CMN and to summarize what specific neurological signs and symptoms and MRI abnormalities are reported in the medical literature. In addition, we summarized and evaluated the recommendations regarding MRI-screening reported in the medical literature. METHODS This review was registered in PROSPERO and reported according to the MOOSE checklist. A search was conducted in EMBASE (Ovid), PubMed, and the Cochrane Library. We included studies with 10 or more patients with CMN, reporting on neurological signs and symptoms or CNS MRI. Study selection, data extraction and methodological quality assessment were performed by two independent reviewers. A meta-analysis was used to assess the prevalence of neurological signs and symptoms. RESULTS Out of 1287 studies, fourteen studies were eligible for inclusion of which eight were included in the meta-analysis. Neurological signs and symptoms prevalence was 7.04% (CI 95% 4.47-10.93%) in the meta-analysis group and 6.26% (95% CI 3.85-10%) in a subgroup of patients with a CMN > 6 cm, evaluated in seven studies. Neurodevelopmental delay and seizures were the most frequently reported signs and symptoms. CNS melanocytosis and hydrocephalus were the most frequently reported MRI abnormalities. It was not possible to estimate the increased risk of neurological involvement in patients with CMN due to low quality of evidence and clinical heterogeneity. CONCLUSION Standardization in CMN studies and a multi-centre prospective study are needed to evaluate neurological involvement. Based on current literature, it is not possible to make strong recommendations on routine MRI-screening. For now, every clinical centre should decide on its own policy and weigh the advantages and disadvantages of routine MRI.
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Affiliation(s)
- Anne C Fledderus
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, 1100 DD, Amsterdam, The Netherlands.
| | - Anna Linn Widdershoven
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Pediatric Neurology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Oren Lapid
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Corstiaan C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Doctor Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Chantal M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marc M Engelen
- Department of Pediatric Neurology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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21
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Ivan D, Ohlerth S, Richter H, Verdino D, Rampazzo A, Pot S. 3T high-resolution magnetic resonance imaging, conventional ultrasonography and ultrasound biomicroscopy of the normal canine eye. BMC Vet Res 2022; 18:67. [PMID: 35144606 PMCID: PMC8829979 DOI: 10.1186/s12917-021-03108-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/03/2021] [Indexed: 12/16/2022] Open
Abstract
Background Advances in MRI coil technology and increased availability of high-field MRI in veterinary medicine enable the acquisition of images of increasingly high spatial resolution while preserving signal-to-noise ratio.The purpose of the present study was to compare 3T high-resolution magnetic resonance imaging (HR-MRI) with ultrasound (US) and ultrasound biomicroscopy (UBM) in the normal canine eye, to assess its potential to depict normal ocular anatomy. Results HR-MRI was compared with US and UBM in 10 eyes from 10 healthy beagle dogs. Ocular structures (cornea, anterior chamber, iridocorneal angle, iris, lens, ciliary body, choroid, vitreous body, posterior wall of the eye, optic nerve and optic nerve sheath, extraocular muscles) were assessed subjectively and central corneal thickness (CCT), anterior chamber depth (ACD), aqueous depth (AQD), anteroposterior, mediolateral and dorsoventral lens diameter (APLD, MLLD, DVLD), anteroposterior diameter of the globe including and excluding the scleroretinal rim (APDSRR, APD), vitreous chamber depth (VCD) and optic nerve sheath diameter (ONSD) were measured in HR-MRI and in US. Optic nerve diameter (OND) was measured in HR-MRI. HR-MRI and UBM appearance of the anterior segment were subjectively compared. Detailed reference high-resolution MRI images of normal eyes of Beagle dogs are provided. Conclusions HR-MRI allowed assessment of all structures identified with US and UBM. The MRI examinations were performed under general anesthesia with the addition of a neuromuscular blocking agent, while US and UBM examinations were performed in conscious animals. Visibility of the entire ocular wall, the lens, the structures caudal to the ciliary body and the optic nerve and its sheath was superior with HR-MRI. HR-MRI allowed the distinction of retina, choroid and sclera, and the delineation of structures not previously identified in canine eyes with MRI, including Tenon’s capsule and the sub-Tenon’s space.Plane selection was more accurate with HR-MRI compared to US. In general, the range of measurements was narrower for MRI than for US. CCT, AQD, APLD, MLLD, APD, APDSRR and ONSD differed significantly between HR-MRI and US, respectively (p = 0.005-0.027).Micro-MRI may be useful for the assessment of ocular pathologies in the future.
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Affiliation(s)
- Daniel Ivan
- Clinic for Diagnostic Imaging, Department for Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
| | - Stefanie Ohlerth
- Clinic for Diagnostic Imaging, Department for Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Henning Richter
- Clinic for Diagnostic Imaging, Department for Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Dagmar Verdino
- Veterinary Anesthesia Services International GmbH, Winterthur, Switzerland
| | - Antonella Rampazzo
- Ophthalmology Section, Equine Department, Vetsuisse Faculty, Zurich, Switzerland
| | - Simon Pot
- Ophthalmology Section, Equine Department, Vetsuisse Faculty, Zurich, Switzerland
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22
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Correlation of radiological features of white epidermoid cysts with histopathological findings. Sci Rep 2022; 12:2314. [PMID: 35145173 PMCID: PMC8831518 DOI: 10.1038/s41598-022-06167-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
Epidermoid cysts are benign congenital extra-axial lesions commonly found in the posterior fossa. These lesions have a characteristic imaging appearance on computed tomography (CT) scan and magnetic resonance imaging (MRI), but occasionally they may exhibit atypical radiological features, showing unusual hyperintensity on T1-weighted images (T1WI). Currently, such atypical appearance is referred to as white epidermoid. We present the imaging features of 5 cases of white epidermoid cyst and discuss the possible underlying etiology of this unusual radiological appearance. We retrospectively searched our electronic radiology database from January 2005 to December 2015 for all intracranial epidermoid cysts, which were confirmed either by typical MRI appearance or histopathological examination. All white epidermoid cases were evaluated with non-enhanced CT scan and multisequential MRI. Histopathological correlation was carried out in four white epidermoid cases. A total of 61 patients with epidermoid cyst were found, of those 5 (8%) were considered white epidermoids. These consisted of 3 females and 2 males, ranging in age between 31–63 years (average age was 51.8 years). Three patients had lesions located in the posterior fossa. The 2 other patients had lesions in the suprasellar region, with extension to the right middle cranial fossa in one. All 5 lesions were hyperdense on CT scan and hyperintense on T1WI. One patient demonstrated evidence of transformation of a classic epidermoid to a white epidermoid after partial resection. Histopathologically, cholesterol clefts were seen in 3 epidermoid cysts, each which also showed microcalcifications, proteinaceous material or melanin. Hemorrhage was demonstrated in one additional lesion. White epidermoid cyst is an unusual intracranial lesion that should be considered when encountered with an extra-axial T1 hyperintense lesion. The cause of this hyperintensity is not clearly understood, but the presence of cholesterol, microcalcifications, proteinaceous content and rarely hemorrhage or melanin may be contributing factors.
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Interrelation between Spectral Online Monitoring and Postoperative T1-Weighted MRI in Interstitial Photodynamic Therapy of Malignant Gliomas. Cancers (Basel) 2021; 14:cancers14010120. [PMID: 35008284 PMCID: PMC8749816 DOI: 10.3390/cancers14010120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Treatment monitoring is highly important for the delivery and control of brain tumor therapy. For interstitial photodynamic therapy (iPDT), an intraoperative spectral online monitoring (SOM) setup was established in former studies to monitor photosensitizer fluorescence and treatment light transmission during therapy. In this work, data from patients treated with iPDT as the initial treatment for newly diagnosed glioblastoma (n = 11) were retrospectively analyzed. Observed changes in treatment light transmission were assessed, and changes in optical tissue absorption were calculated out of these. In addition, magnetic resonance imaging (MRI) data were recorded within 48 h after therapy and showed intrinsic T1 hyperintensity in the treated area in non-contrast-enhanced T1-weighted sequences. A 3D co-registration of intrinsic T1 hyperintensity lesions and the light transmission zones between cylindrical diffuser fiber pairs showed that reduction in treatment light transmission corresponding to increased light absorption had a spatial correlation with post-therapeutic intrinsic T1 hyperintensity (p ≤ 0.003). Abstract In a former study, interstitial photodynamic therapy (iPDT) was performed on patients suffering from newly diagnosed glioblastoma (n = 11; 8/3 male/female; median age: 68, range: 40–76). The procedure includes the application of 5-ALA to selectively metabolize protoporphyrin IX (PpIX) in tumor cells and illumination utilizing interstitially positioned optical cylindrical diffuser fibers (CDF) (2–10 CDFs, 2–3 cm diffusor length, 200 mW/cm, 635 nm, 60 min irradiation). Intraoperative spectral online monitoring (SOM) was employed to monitor treatment light transmission and PpIX fluorescence during iPDT. MRI was used for treatment planning and outcome assessment. Case-dependent observations included intraoperative reduction of treatment light transmission and local intrinsic T1 hyperintensity in non-contrast-enhanced T1-weighted MRI acquired within one day after iPDT. Intrinsic T1 hyperintensity was observed and found to be associated with the treatment volume, which indicates the presence of methemoglobin, possibly induced by iPDT. Based on SOM data, the optical absorption coefficient and its change during iPDT were estimated for the target tissue volumes interjacent between evaluable CDF-pairs at the treatment wavelength of 635 nm. By spatial comparison and statistical analysis, it was found that observed increases of the absorption coefficient during iPDT were larger in or near regions of intrinsic T1 hyperintensity (p = 0.003). In cases where PpIX-fluorescence was undetectable before iPDT, the increase in optical absorption and intrinsic T1 hyperintensity tended to be less. The observations are consistent with in vitro experiments and indicate PDT-induced deoxygenation of hemoglobin and methemoglobin formation. Further investigations are needed to provide more data on the time course of the observed changes, thus paving the way for optimized iPDT irradiation protocols.
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Abstract
Acute myelopathies are spinal cord disorders characterized by a rapidly progressive course reaching nadir within hours to a few weeks that may result in severe disability. The multitude of underlying etiologies, complexities in confirming the diagnosis, and often unforgiving nature of spinal cord damage have always represented a challenge. Moreover, certain slowly progressive myelopathies may present acutely or show abrupt worsening in specific settings and thus further complicate the diagnostic workup. Awareness of the clinical and magnetic resonance imaging characteristics of different myelopathies and the specific settings where they occur is fundamental for a correct diagnosis. Neuroimaging helps distinguish compressive etiologies that may require urgent surgery from intrinsic etiologies that generally require medical treatment. Differentiation between various myelopathies is essential to establish timely and appropriate treatment and avoid harm from unnecessary procedures. This article reviews the contemporary spectrum of acute myelopathy etiologies and provides guidance for diagnosis and management.
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Affiliation(s)
- Elia Sechi
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Nagesh CP, Rao R, Hiremath SB, Honavar SG. Magnetic resonance imaging of the orbit, Part 1: Basic principles and radiological approach. Indian J Ophthalmol 2021; 69:2574-2584. [PMID: 34571597 PMCID: PMC8597479 DOI: 10.4103/ijo.ijo_3141_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Magnetic resonance imaging (MRI) is an eloquent, noninvasive, cross-sectional imaging modality that offers superior tissue characterization of orbital pathologies. The ophthalmologist needs to be aware of the advantages of MRI and its step-wise interpretation in liaison with a radiologist to optimize patient outcomes. In this review, we discuss the basic principles of MRI, some of the commonly used sequences and protocols, the anatomy of the orbit on MRI, and an approach to radiological interpretation.
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Affiliation(s)
- Chinmay P Nagesh
- Consultant, Neurovascular and Interventional Radiology, Apollo Speciality Hospital, Bengaluru, Karnataka, India
| | - Raksha Rao
- Consultant, Orbit and Oculoplasty, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Shivaprakash B Hiremath
- Clinical Fellow, Division of Neuroradiology, Department of Medical Imaging, The Ottawa Hospital - Civic Campus, Ottawa, Canada
| | - Santosh G Honavar
- Consultant, Orbit & Oculoplasty, Centre for Sight, Banjara Hills, Hyderabad, Telangana, India
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26
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Mormina E, Granata F, Vinci SL, Coglitore A, Caragliano AA, Agostino T, Longo M, Visalli C. Imaging and clinical features of neurocutaneous melanosis in the pediatric population. Curr Med Imaging 2021; 17:1391-1402. [PMID: 34047260 DOI: 10.2174/1573405617666210527091109] [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: 10/12/2020] [Revised: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neurocutaneous melanosis (NCM) is a rare nonfamilial phakomatosis characterized by the presence of congenital melanocytic nevi and abnormal melanocytes infiltration of the leptomeninges. OBJECTIVE & METHODS This paper shows the importance of early diagnosis and the most important imaging features of the disease on CT and MR scans. PubMed database was searched from January 1972 to September 2020. Papers including imaging findings of NCM, clinical, follow-up, and treatment features were collected, selecting only 89 studies. DISCUSSION NCM is a term used for the first time by van Bogaert in 1948. It refers to a condition caused by an error during morphogenesis and migration leading to leptomeningeal melanocytic accumulation. Although histological findings are the gold standard for diagnosis confirmation, neuroimaging and clinical features strongly support the suspect of NCM. Localization and extension of the lesions are predictive of neurological manifestations related to increased intracranial pressure, mass lesions, or spinal cord compression. CT demonstrates sites of increased density in the anterior temporal lobe - mainly the amygdala - thalami, cerebellum, and frontal lobes base. However, MRI is the best imaging method to diagnose central nervous system lesions, often appearing as T1-short signal areas of the cerebral parenchyma, indicative of central nervous system melanosis. MRI can also reveal associated intracranial and intraspinal abnormalities. CONCLUSION Early imaging, when available, is helpful if NCM suspect is raised and may be of guidance in comparing later studies. NCM requires a multidisciplinary approach since it is a multisystem disease with a genetic component.
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Affiliation(s)
- Enricomaria Mormina
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Francesca Granata
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Sergio Lucio Vinci
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Alessandra Coglitore
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Antonio Armando Caragliano
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Tessitore Agostino
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Marcello Longo
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Carmela Visalli
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
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Human Hair as a Possible Surrogate Marker of Retained Tissue Gadolinium: A Pilot Autopsy Study Correlating Gadolinium Concentrations in Hair With Brain and Other Tissues Among Decedents Who Received Gadolinium-Based Contrast Agents. Invest Radiol 2021; 55:636-642. [PMID: 32433314 DOI: 10.1097/rli.0000000000000681] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We used laser ablation inductively coupled plasma mass spectrometry to quantify gadolinium in hair samples from autopsy cases with gadolinium-based contrast agent (GBCA) exposure. Hair gadolinium data were correlated with gadolinium concentrations in brain, skin, and bone tissues from the same case to investigate a potential noninvasive method for gadolinium quantification and monitoring. MATERIALS AND METHODS Medical records from autopsy cases at our institution were screened for history of GBCA exposure. Cases with exposure to a single type of GBCA with the most recent injection occurring within 1 year were identified and included in the study. The concentration of gadolinium in hair samples was analyzed by laser ablation inductively coupled plasma mass spectrometry, and brain (globus pallidus, dentate nucleus, white matter), bone, and skin tissues were analyzed by bulk inductively coupled plasma mass spectrometry. The mean of the maximum value in the hair samples was used to generate a representative measurement of the hair gadolinium concentration for each case. A linear regression analysis between each tissue type and hair was conducted to assess for possible correlation. RESULTS Tissue and hair samples from 18 autopsies (16 cases with exposure to GBCA, 2 controls) were included in the study. Comparing the different tissues revealed good correlation between some tissue types. The best model fit occurred between white matter and hair (R = 0.83; P < 0.0001) followed by the comparison between dentate nucleus and hair (R = 0.72; P < 0.0001) and dentate nucleus and skin (R = 0.70; P < 0.0001). CONCLUSIONS A significant correlation in this study between hair gadolinium concentrations and brain and skin gadolinium concentrations suggests that hair may serve as a safe and effective biomonitoring tissue for patients who receive GBCA injections.
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Ulivi L, Cosottini M, Migaleddu G, Orlandi G, Giannini N, Siciliano G, Mancuso M. Brain MRI in Monogenic Cerebral Small Vessel Diseases: A Practical Handbook. Curr Mol Med 2021; 22:300-311. [DOI: 10.2174/1566524021666210510164003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 11/22/2022]
Abstract
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Monogenic cerebral small vessel diseases are a topic of growing interest, as several genes responsible have been recently described and new sequencing techniques such as Next generation sequencing are available. Brain imaging is a key exam in these diseases. First, since it is often the first exam performed, an MRI is key in selecting patients for genetic testing and for interpreting Next generation sequencing reports. In addition, neuroimaging can be helpful in describing the underlying pathological mechanisms involved in cerebral small vessel disease. With this review, we aim to provide Neurologists and Stroke physicians with an up-to date overview of the current neuroimaging knowledge on monogenic small vessel diseases.
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Affiliation(s)
- Leonardo Ulivi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Pisa University, Via Roma 67, Pisa, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gianmichele Migaleddu
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giovanni Orlandi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Pisa University, Via Roma 67, Pisa, Italy
| | - Nicola Giannini
- Department of Experimental and Clinical Medicine, Neurological Clinic, Pisa University, Via Roma 67, Pisa, Italy
| | - Gabriele Siciliano
- Department of Experimental and Clinical Medicine, Neurological Clinic, Pisa University, Via Roma 67, Pisa, Italy
| | - Michelangelo Mancuso
- Department of Experimental and Clinical Medicine, Neurological Clinic, Pisa University, Via Roma 67, Pisa, Italy
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Ozturk K, Nascene D. Susceptibility-Weighted Imaging of the Pediatric Brain after Repeat Doses of Gadolinium-Based Contrast Agent. AJNR Am J Neuroradiol 2021; 42:1136-1143. [PMID: 33888459 DOI: 10.3174/ajnr.a7143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/17/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Gadolinium complexes have paramagnetic properties; thus, we aimed to determine the susceptibility changes in the globus pallidus and dentate nucleus following administration of linear or macrocyclic gadolinium-based contrast agents in children. MATERIALS AND METHODS Thirty-three patients with linear gadolinium-based contrast agent gadopentetate dimeglumine administration, 33 age- and sex-matched patients with macrocyclic gadolinium-based contrast agent gadobutrol administration, and 33 age- and sex-matched control subjects without gadolinium exposure were enrolled in this retrospective study. The signal intensity on SWI and T1WI was determined in the dentate nucleus, middle cerebellar peduncle, globus pallidus, and pulvinar of the thalamus in an ROI-based analysis to calculate dentate nucleus-to-middle cerebellar peduncle and globus pallidus-to-thalamus ratios. A repeated measures ANOVA was performed to compare SWIminimum, SWImean, and T1WI signal intensity ratios between gadolinium-based contrast agent groups and control subjects. Pearson correlation analysis was performed to determine any correlation between signal intensity ratios and variables. RESULTS Dentate nucleus-to-middle cerebellar peduncle and globus pallidus-to-thalamus ratios for both SWImean and SWIminimum were lower for the linear gadolinium-based contrast agent group compared with macrocyclic gadolinium-based contrast agent and control groups (P < .05). No significant difference of the SWImean and SWIminimum ratios were noted between the macrocyclic gadolinium-based contrast agent group and the control group (P > .05). Both dentate nucleus-to-middle cerebellar peduncle and globus pallidus-to-thalamus ratios on T1WI in the linear gadolinium-based contrast agent group were higher than in the control group and the macrocyclic gadolinium-based contrast agent group (P < .05). A negative correlation was identified between SWImean and SWIminimum ratios and the number of linear gadolinium-based contrast agent administrations (dentate nucleus-to-middle cerebellar peduncle ratio: SWImean, r = -0.43, P = .005; SWIminimum, r = -0.38, P = .011; globus pallidus-to-thalamus ratio: SWImean, r = -0.39, P = .009; SWIminimum, r = -0.33, P = .017). CONCLUSIONS SWI analysis of the pediatric brain demonstrated a statistically significant decrease in SWIminimum and SWImean values for the dentate nucleus and globus pallidus after administration of linear gadolinium-based contrast agents but not macrocyclic gadolinium-based contrast agents.
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Affiliation(s)
- K Ozturk
- From the Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - D Nascene
- From the Department of Radiology, University of Minnesota, Minneapolis, Minnesota
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Azuma M, Kadota Y, Matsuyama M, Moritake H, Hirai T. 3D fat-suppressed T1-weighted volume isotropic turbo spin-echo acquisition (VISTA) imaging for the evaluation of the ectopic posterior pituitary gland. Jpn J Radiol 2021; 39:564-570. [PMID: 33864182 DOI: 10.1007/s11604-020-01076-3] [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: 10/09/2020] [Accepted: 11/22/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We evaluated the usefulness of fat-suppressed three-dimensional T1-weighted volume isotropic turbo spin-echo acquisition (FS 3D T1W-VISTA) imaging for the evaluation of the ectopic posterior pituitary gland (EPPG). MATERIALS AND METHODS This retrospective study included 9 patients with EPPG due to causes other than tumor. All underwent sagittal two-dimensional (2D) T1W-, FS 3D T1W-VISTA- (VISTA), and 3D T2W-driven equilibrium radiofrequency reset pulse (DRIVE) imaging. Two radiologists independently reviewed the 2D T1W- and VISTA images for their image quality and for visualization of the EPPG and of pituitary stalk transection. DRIVE findings were used as the reference standard for pituitary stalk transection. Interobserver and intermodality agreements were evaluated with the kappa (κ) coefficient. The mean grade assigned to the 2D T1W- and the VISTA imaging technique for visualization of the EPPG was assessed by the Mann-Whitney U test. RESULTS Interobserver agreement for visualization of the EPPG on 2D T1W- and VISTA images was excellent (κ = 0.82 and κ = 1.00, respectively). The mean grade for EPPG visualization was significantly higher for VISTA- than 2D T1W images (p = 0.0039). CONCLUSION FS 3D T1W-VISTA imaging is useful for the evaluation of EPPG. Conventional MRI yields insufficient information for the evaluation of the ectopic posterior pituitary gland (EPPG). The visualization of the EPPG was significantly higher for fat-suppressed three-dimensional T1-weighted volume isotropic turbo spin-echo acquisition (FS 3D T1W-VISTA) than 2D T1W images. FS 3D T1W-VISTA imaging is useful for the evaluation of the EPPG.
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Affiliation(s)
- Minako Azuma
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
| | - Yoshihito Kadota
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Misayo Matsuyama
- Department of Pediatrics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroshi Moritake
- Department of Pediatrics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Duncan BR, Hasegawa M, Marshall DA, Gonzalez-Cuyar LF, Paulsen M, Kobayashi M, Maravilla KR, Simpson CD. Variability in hair gadolinium concentrations among decedents who received gadolinium-based contrast agents. Anal Bioanal Chem 2021; 413:1571-1582. [PMID: 33506336 PMCID: PMC10537202 DOI: 10.1007/s00216-020-03116-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/26/2020] [Accepted: 12/08/2020] [Indexed: 12/01/2022]
Abstract
This study utilized laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) to quantify gadolinium in the hair of autopsy cases that had received gadolinium-based contrast agents (GBCAs) before death. Consecutive autopsy cases were reviewed for GBCA injections and subjects who received a single type of GBCA in the year before death were included. Hair samples were analyzed using LA-ICP-MS as a line scan technique and parameters were optimized to maximize instrument sensitivity, accuracy, and precision. Linear regression analyses between hair measures and gadolinium dose were executed. LA-ICP-MS analysis produced a time-resolved record of GCBA exposure, with the position of the gadolinium peak maxima along the hair shaft providing a good estimate for the day that GBCA injection occurred (R2 = 0.46; p = 0.0022); however, substantial within and between subject variation in the position of the GBCA peak was observed. Average area under the curve for gadolinium peaks in the hair samples was a better predictor of gadolinium dose (R2 = 0.41; p = 0.0046), compared to the average of peak maxima concentration. Correlation between area under the curve and dose suggests that LA-ICP-MS analysis of hair may be an effective method to evaluate gadolinium levels in subjects in vivo after exposure to GBCAs. This study demonstrates that analysis of human hair using techniques with high spatial resolution such as LA-ICP-MS has excellent potential to reveal time-dependent signatures of past exposures.
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Affiliation(s)
- Brianne R Duncan
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, 98195, USA.
- Exponent, Inc., Bellevue, WA, 98007, USA.
| | - Makoto Hasegawa
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
- Department of Radiology, Toho University Ohashi Medical Center, Tokyo, 153-8515, Japan
| | - Desiree A Marshall
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Luis F Gonzalez-Cuyar
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Michael Paulsen
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Masahiro Kobayashi
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
| | - Kenneth R Maravilla
- Radiology & Neurological Surgery, University of Washington, Seattle, WA, 98195, USA
- Magnetic Resonance Research Laboratory, University of Washington, Seattle, WA, 98195, USA
| | - Christopher D Simpson
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, 98195, USA
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Pereira RG, Ribeiro BNDF, Hollanda RTDL, de Almeida LB, Simeão TB, Marchiori E. Non-neoplastic intracranial cystic lesions: not everything is an arachnoid cyst. Radiol Bras 2021; 54:49-55. [PMID: 33574631 PMCID: PMC7863714 DOI: 10.1590/0100-3984.2019.0144] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Intracranial cystic lesions are common findings on neuroimaging examinations, arachnoid cysts being the most common type of such lesions. However, various lesions of congenital, infectious, or vascular origin can present with cysts. In this pictorial essay, we illustrate the main causes of non-neoplastic intracranial cystic lesions, discussing their possible differential diagnoses as well as their most relevant imaging aspects.
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Affiliation(s)
| | - Bruno Niemeyer de Freitas Ribeiro
- Hospital Casa de Portugal / 3D Diagnóstico por Imagem, Rio de Janeiro, RJ, Brazil.,Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Zhang Y, Huang J, Ding J. Imaging manifestations and pathological analysis of intramuscular myxoma: A case report and literature review. Radiol Case Rep 2020; 16:300-304. [PMID: 33304439 PMCID: PMC7711187 DOI: 10.1016/j.radcr.2020.10.053] [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: 07/27/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022] Open
Abstract
Intramuscular Myxoma(IM) is a rare benign soft tissue tumor, and its etiology and histology source is still unclear. It is important to understand the pathological components of IM and its corresponding imaging features, as well as performing accurate and careful imaging assessments of IM before surgery. We present a case of a 43-year-old male who presented a lump in his left thigh and gradually enlarged during the past 8 years. The patient underwent CT, MRI, and CTA examined and was later pathologically confirmed as IM. This article will combine the literature,to explore the imaging manifestations and its pathological basis of intramuscular myxoma.
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Affiliation(s)
- Yi Zhang
- Departments of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - Jie Huang
- Departments of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - Jianping Ding
- Departments of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
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Otani S, Fushimi Y, Iwanaga K, Tomotaki S, Yokota Y, Oshima S, Sakurama A, Wicaksono KP, Hinoda T, Sakata A, Nakajima S, Okada T, Takita J, Kawai M, Togashi K. Signal Intensity and Volume of Pituitary and Thyroid Glands in Preterm and Term Infants. J Magn Reson Imaging 2020; 53:1151-1161. [PMID: 33067897 DOI: 10.1002/jmri.27395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Hypothalamic-pituitary-thyroid (HPT) maturation has not been extensively evaluated using neonatal MRI, even though both structures are visualized on MRI. HYPOTHESIS That signal intensity and volume of pituitary and thyroid (T) glands on MRI in neonates may be interrelated. STUDY TYPE Retrospective. SUBJECTS In all, 102 participants. FIELD STRENGTH/SEQUENCE 3.0T, T1 -weighted pointwise encoding time reduction with radial acquisition (PETRA). ASSESSMENT The volume of interest of the anterior pituitary (AP), posterior pituitary (PP), and T on MRI were defined on T1 -PETRA by two radiologists, and volumes of AP (AP_vol) and thyroid (T_vol) were calculated. Gestational age (GA), chronological age (CA), GA+CA, birth weight (BW), and thyroid function were recorded. Mean and maximum signal intensities of AP, PP, and T were normalized using signals from the pons and spinal cord as follows: signal ratio of anterior pituitary/pons (AP/pons), signal ratio of posterior pituitary/pons (PP/pons), and signal ratio of thyroid/cord (T/cord) T/cord, respectively. STATISTICAL TESTS Correlations between signal intensity and volume measures and GA, CA, GA+CA, and BW were assessed using Pearson's correlation coefficient or Spearman's rank correlation coefficient. Thyroid function analysis and Tmean /cord, Tmax /cord, and T_vol were evaluated using the Steel-Dwass test. RESULTS APmean /pons correlated positively with GA (ρ = 0.62, P < 0.001) and BW (ρ = 0.74, P < 0.001), and negatively with CA (ρ = -0.86, P < 0.001) and GA+CA (ρ = -0.46, P < 0.001). PPmean /pons correlated positively with GA (ρ = 0.49, P < 0.001) and BW (ρ = 0.63, P < 0.001), and negatively with CA (ρ = -0.70, P < 0.001) and GA+CA (r = -0.38, P < 0.001). Tmean /cord correlated positively with GA (ρ = 0.48, P < 0.001) and BW (ρ = 0.55, P < 0.001), and negatively with CA (ρ = -0.59, P < 0.001) and GA+CA (ρ = -0.22, P = 0.03). AP_vol correlated positively with GA (ρ = 0.68, P < 0.001) and BW (ρ = 0.73, P < 0.001), and negatively with CA (ρ = -0.72, P < 0.001). T_vol correlated positively with GA (ρ = 0.50, P < 0.001) and BW (ρ = 0.61, P < 0.001), and negatively with CA (ρ = -0.54, P < 0.001). APmean /pons correlated positively with Tmean /cord (ρ = 0.61, P < 0.001). DATA CONCLUSION Signal and volume of pituitary and thyroid glands correlated positively with GA and BW, and negatively with CA in neonates. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 5.
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Affiliation(s)
- Sayo Otani
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kogoro Iwanaga
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Seiichi Tomotaki
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Yokota
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sonoko Oshima
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Azusa Sakurama
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Krishna Pandu Wicaksono
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takuya Hinoda
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiko Sakata
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Nakajima
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohisa Okada
- Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junko Takita
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiko Kawai
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Katsevman GA, Razzaq B, Serrano CA. Hypothalamic Cavernomas: Pediatric Case Report with 8.5-Year Follow-up and Review of the Literature. World Neurosurg 2020; 146:6-13. [PMID: 33080404 DOI: 10.1016/j.wneu.2020.10.065] [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: 07/31/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cavernous malformations (cavernomas) are angiographically occult vascular lesions that can present symptomatically or be discovered incidentally. Rarely, they present in the hypothalamus or in children. CASE DESCRIPTION We describe the case of a 14-year-old male patient who presented with headaches and fever and was found to have a hypothalamic cavernoma that hemorrhaged. It was managed expectantly, with 1 rehemorrhage 21 months later, and the patient remains asymptomatic to this day aside from headaches. CONCLUSIONS This is to our knowledge the youngest case of a hypothalamic cavernoma to be reported and includes 8.5 years of follow-up and imaging. In addition, a literature review is performed that summarizes the 11 previously reported cases of hypothalamic cavernomas, including associated symptoms, management options, and outcomes.
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Affiliation(s)
- Gennadiy A Katsevman
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA.
| | - Bayan Razzaq
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Cesar A Serrano
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
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Increased T1 Signal Intensity of the Anterior Pituitary Gland on Unenhanced Magnetic Resonance Images After Chronic Exposure to Gadodiamide. Invest Radiol 2020; 55:25-29. [PMID: 31498162 DOI: 10.1097/rli.0000000000000604] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the signal intensity of the anterior pituitary (AP) gland on unenhanced T1-weighted images in patients with history of serial intravenous injections of gadodiamide and normal renal function. MATERIALS AND METHODS We included 53 patients who had undergone at least 5 injections of gadodiamide and a control group of 15 subjects who underwent at least 5 brain magnetic resonance imaging without gadolinium-based contrast agents. Using unenhanced sagittal T1-weighted images, values of mean signal intensity of the AP and of the central pons were obtained. Anterior pituitary-to-pons signal intensity ratios were calculated dividing the values of the AP by those of the pons. Then, the ratios were compared between the first and the last magnetic resonance imaging scans for all the subjects. To assess the difference between the first and the last ratios, nonparametric Wilcoxon signed-rank test with Monte Carlo resampling was applied. A P value less than 0.05 was considered as statistically significant. RESULTS The comparison between the first and the last scan revealed a statistically significant increase of AP-to-pons ratio in the last scan for the gadolinium-exposed group (P < 0.001), whereas nonsignificant results were found for the control group (P = nonsignificant). CONCLUSIONS We found an increased signal intensity of the AP on unenhanced T1-weighted images in patients with history of serial intravenous injections of gadodiamide and normal renal function, suggesting gadolinium deposition or long-term retention within the AP gland. Our findings need to be confirmed by further histochemical analysis of AP gland tissue samples.
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Neuromelanin accumulation in Substantia nigra in vascular parkinsonism. J Neural Transm (Vienna) 2020; 127:1089-1091. [DOI: 10.1007/s00702-020-02191-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/14/2020] [Indexed: 11/26/2022]
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Arnold SA, Platt SR, Gendron KP, West FD. Imaging Ischemic and Hemorrhagic Disease of the Brain in Dogs. Front Vet Sci 2020; 7:279. [PMID: 32528985 PMCID: PMC7266937 DOI: 10.3389/fvets.2020.00279] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/27/2020] [Indexed: 01/12/2023] Open
Abstract
Strokes, both ischemic and hemorrhagic, are the most common underlying cause of acute, non-progressive encephalopathy in dogs. In effect, substantial information detailing the underlying causes and predisposing factors, affected vessels, imaging features, and outcomes based on location and extent of injury is available. The features of canine strokes on both computed tomography (CT) and magnetic resonance imaging (MRI) have been described in numerous studies. This summary article serves as a compilation of these various descriptions. Drawing from the established and emerging stroke evaluation sequences used in the investigation of strokes in humans, this summary describes all theoretically available sequences. Particular detail is given to logistics of image acquisition, description of imaging findings, and each sequence's advantages and disadvantages. As the imaging features of both forms of strokes are highly representative of the underlying pathophysiologic stages in the hours to months following stroke onset, the descriptions of strokes at various stages are also discussed. It is unlikely that canine strokes can be diagnosed within the same rapid time frame as human strokes, and therefore the opportunity for thrombolytic intervention in ischemic strokes is unattainable. However, a thorough understanding of the appearance of strokes at various stages can aid the clinician when presented with a patient that has developed a stroke in the days or weeks prior to evaluation. Additionally, investigation into new imaging techniques may increase the sensitivity and specificity of stroke diagnosis, as well as provide new ways to monitor strokes over time.
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Affiliation(s)
- Susan A Arnold
- Department of Veterinary Clinical Sciences, University of Minnesota Twin Cities, St. Paul, MN, United States
| | - Simon R Platt
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, United States
| | - Karine P Gendron
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, United States
| | - Franklin D West
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, United States
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Kim SC, Ryoo I, Shin JM, Suh S, Jung HN, Shin SU. MR Findings of Fungus Ball: Significance of High Signal Intensity on T1-Weighted Images. J Korean Med Sci 2020; 35:e22. [PMID: 31950777 PMCID: PMC6970076 DOI: 10.3346/jkms.2020.35.e22] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Central dark-signal intensity with high-signal, hypertrophic mucosal wall of paranasal sinuses on T2-weighted images (T2WI) is a characteristic magnetic resonance imaging (MRI) feature of sinonasal fungus ball. However, this finding is usually interpreted as non-fungal chronic sinusitis with central normal sinus air. In addition, T1-weighted images (T1WI) and T2WI are basic sequences of all magnetic resonance (MR) examinations. Therefore, we evaluated the usefulness of T1WI for detecting fungus balls comparing with computed tomography (CT) findings and T2-weighted MRI findings. METHODS This retrospective study was approved by the Institutional Review Board of Korea University Guro Hospital. Two reviewers assessed preoperative CT and MR images of 55 patients with pathologically confirmed fungus balls. Reviewers evaluated the presence and patterns of calcifications on CT. Overall signals and the presence and extent of certain signals of fungus balls on MRI were also assessed. The relationship between calcifications and MRI signals was also evaluated. RESULTS Of the patients, 89.1% had calcifications on CT. All had dark signal portions with high signal, hypertrophic mucosal walls on T2WI. Most (92.7%) patients showed iso- to hyper-intense overall signals on T1WI and 89.1% had T1-weighted high signal portions on MRI. The presence, patterns, and location of calcifications had no significant correlation with T1-weighted high-signal intensity portion. CONCLUSION Fungus ball can be suggested by the presence of the hyper-signal intensity portions in the fungal mass on T1WI in conjunction with dark-signal lesions surrounded by high-signal, hypertrophic mucosal walls in paranasal sinuses on T2WI.
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Affiliation(s)
- Soo Chin Kim
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea
| | - Inseon Ryoo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Jae Min Shin
- Department of Otorhinolaryngology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sangil Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hye Na Jung
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Ui Shin
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea
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A new imaging entity consistent with partial ectopic posterior pituitary gland: report of six cases. Pediatr Radiol 2020; 50:107-115. [PMID: 31468085 DOI: 10.1007/s00247-019-04502-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/30/2019] [Accepted: 08/07/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Abnormal posterior pituitary development including ectopic location has been associated with endocrine manifestations of anterior pituitary dysfunction. OBJECTIVE We describe an unreported clinical and radiologic entity we call partial ectopic posterior pituitary for which associated endocrine consequences are not known. MATERIALS AND METHODS We selected pediatric head MRI examinations from 2005 to 2017 based on the finding of a double midline sellar and suprasellar bright spot on T1-weighted sequence. Medical history, physical examination, pituitary hormonal profile and bone age evaluation were extracted from the medical record of the selected patients. An experienced pediatric neuroradiologist reviewed head MRIs, which were performed on 3-tesla (T) magnet and included at least sagittal T1-weighted imaging centered on the sella turcica obtained with and without fat suppression. RESULTS In six cases, two midline bright spots were identified on T1-weighted sequences obtained both with and without fat suppression. While one spot was located at the expected site of the neurohypophysis in the posterior sella, the second one was in the region of the median eminence, suggesting partial ectopic posterior pituitary gland. Growth hormone deficiency, either isolated (n=1) or combined with thyroid stimulating hormone deficiency (n=1) was found. None of the children had clinical signs of posterior pituitary dysfunction. CONCLUSION We describe an unreported imaging entity suggesting partial ectopic posterior pituitary gland in six children. Anterior pituitary hormone deficiencies might be detected in those children and long-term follow-up could provide additional information on the development of other pituitary hormone deficiencies.
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El Mabood SA, Wahba Y, Yahia S, Sarhan MM, Mansour AK, Provenzano A, Elmahdi HS, Darwish A. Neurocutaneous melanosis is not always a benign disease. Indian J Dermatol Venereol Leprol 2019; 86:335. [PMID: 31512584 DOI: 10.4103/ijdvl.ijdvl_456_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Suzy Abd El Mabood
- Department of Pediatrics, Hematology, Oncology and Bone Marrow Transplantation Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yahya Wahba
- Department of Pediatrics, Genetic Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sohier Yahia
- Department of Pediatrics, Genetic Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed M Sarhan
- Department of Pediatrics, Hematology, Oncology and Bone Marrow Transplantation Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed K Mansour
- Department of Pediatrics, Hematology, Oncology and Bone Marrow Transplantation Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Aldesia Provenzano
- Department of Biomedical Experimental and Clinical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Hoda S Elmahdi
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmad Darwish
- Department of Pediatrics, Hematology, Oncology and Bone Marrow Transplantation Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Abd-Elghany AA, Naji AA, Alonazi B, Aldosary H, Alsufayan MA, Alnasser M, Mohammad EA, Mahmoud MZ. Radiological characteristics of glioblastoma multiforme using CT and MRI examination. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2019. [DOI: 10.1080/16878507.2019.1655864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Amr A. Abd-Elghany
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Biophysics Department, Faculty of Science, Cairo University, Giza, Egypt
| | - Abdu Ahmed Naji
- Radiology and Medical Imaging Department, King Fahad Medical City, Al-Riyadh, Saudi Arabia
| | - Batil Alonazi
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Hassan Aldosary
- Radiology and Medical Imaging Department, King Fahad Medical City, Al-Riyadh, Saudi Arabia
| | | | - Mohammed Alnasser
- Radiology and Medical Imaging Department, King Fahad Medical City, Al-Riyadh, Saudi Arabia
| | - Ebtsam A. Mohammad
- Biophysics Department, Faculty of Science, Cairo University, Giza, Egypt
| | - Mustafa Z. Mahmoud
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Donzuso G, Mostile G, Nicoletti A, Zappia M. Basal ganglia calcifications (Fahr's syndrome): related conditions and clinical features. Neurol Sci 2019; 40:2251-2263. [PMID: 31267306 PMCID: PMC6817747 DOI: 10.1007/s10072-019-03998-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/26/2019] [Indexed: 12/12/2022]
Abstract
Basal ganglia calcifications could be incidental findings up to 20% of asymptomatic patients undergoing CT or MRI scan. The presence of neuropsychiatric symptoms associated with bilateral basal ganglia calcifications (which could occur in other peculiar brain structures, such as dentate nuclei) identifies a clinical picture defined as Fahr's Disease. This denomination mainly refers to idiopathic forms in which no metabolic or other underlying causes are identified. Recently, mutations in four different genes (SLC20A2, PDGFRB, PDGFB, and XPR1) were identified, together with novel mutations in the Myogenic Regulating Glycosylase gene, causing the occurrence of movement disorders, cognitive decline, and psychiatric symptoms. On the other hand, secondary forms, also identified as Fahr's syndrome, have been associated with different conditions: endocrine abnormalities of PTH, such as hypoparathyroidism, other genetically determined conditions, brain infections, or toxic exposure. The underlying pathophysiology seems to be related to an abnormal calcium/phosphorus homeostasis and transportation and alteration of the blood-brain barrier.
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Affiliation(s)
- Giulia Donzuso
- Department "GF Ingrassia", Section Neuroscience, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giovanni Mostile
- Department "GF Ingrassia", Section Neuroscience, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Alessandra Nicoletti
- Department "GF Ingrassia", Section Neuroscience, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Mario Zappia
- Department "GF Ingrassia", Section Neuroscience, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
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Lee Y, Seo HS, Je BK, Kim SD, Oh HE. Benefit of dual-energy CT iodine overlay technique for T1-hyperintense brain lesion. Neurology 2019; 89:1426-1427. [PMID: 28947579 DOI: 10.1212/wnl.0000000000004424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Younghen Lee
- From the Departments of Radiology (Y.L., H.S.S., B.-K.J.), Neurosurgery (S.-D.K.), and Pathology (H.E.O.), Ansan Hospital, Korea University College of Medicine, South Korea.
| | - Hyung Suk Seo
- From the Departments of Radiology (Y.L., H.S.S., B.-K.J.), Neurosurgery (S.-D.K.), and Pathology (H.E.O.), Ansan Hospital, Korea University College of Medicine, South Korea
| | - Bo-Kyung Je
- From the Departments of Radiology (Y.L., H.S.S., B.-K.J.), Neurosurgery (S.-D.K.), and Pathology (H.E.O.), Ansan Hospital, Korea University College of Medicine, South Korea
| | - Sang-Dae Kim
- From the Departments of Radiology (Y.L., H.S.S., B.-K.J.), Neurosurgery (S.-D.K.), and Pathology (H.E.O.), Ansan Hospital, Korea University College of Medicine, South Korea
| | - Hwa Eun Oh
- From the Departments of Radiology (Y.L., H.S.S., B.-K.J.), Neurosurgery (S.-D.K.), and Pathology (H.E.O.), Ansan Hospital, Korea University College of Medicine, South Korea
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45
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Al-Smadi AS, Abdalla RN, Elmokadem AH, Shaibani A, Hurley MC, Potts MB, Jahromi BS, Carroll TJ, Ansari SA. Diagnostic Accuracy of High-Resolution Black-Blood MRI in the Evaluation of Intracranial Large-Vessel Arterial Occlusions. AJNR Am J Neuroradiol 2019; 40:954-959. [PMID: 31072969 PMCID: PMC6711667 DOI: 10.3174/ajnr.a6065] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/10/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE 3D high-resolution black-blood MRI or MR vessel wall imaging allows evaluation of the intracranial arterial wall and extraluminal pathology. We investigated the diagnostic accuracy and reliability of black-blood MRI for the intraluminal detection of large-vessel arterial occlusions. MATERIALS AND METHODS We retrospectively identified patients with intracranial arterial occlusions, confirmed by CTA or DSA, who also underwent 3D black-blood MRI with nonenhanced and contrast-enhanced T1 sampling perfection with application-optimized contrasts by using different flip angle evolution (T1 SPACE) sequences. Black-blood MRI findings were evaluated by 2 independent and blinded neuroradiologists. Large-vessel intracranial arterial segments were graded on a 3-point scale (grades 0-2) for intraluminal baseline T1 hyperintensity and contrast enhancement. Vessel segments were considered positive for arterial occlusion if focal weak (grade 1) or strong (grade 2) T1-hyperintense signal and/or enhancement replaced the normal intraluminal black-blood signal. RESULTS Thirty-one patients with 38 intracranial arterial occlusions were studied. The median time interval between black-blood MRI and CTA/DSA reference standard studies was 2 days (range, 0-20 days). Interobserver agreement was good for T1 hyperintensity (κ = 0.63) and excellent for contrast enhancement (κ = 0.89). High sensitivity (100%) and specificity (99.8%) for intracranial arterial occlusion diagnosis was observed with either intraluminal T1 hyperintensity or contrast-enhancement imaging criteria on black-blood MRI. Strong grade 2 intraluminal enhancement was maintained in >80% of occlusions irrespective of location or chronicity. Relatively increased strong grade 2 intraluminal T1 hyperintensity was noted in chronic/incidental versus acute/subacute occlusions (45.5% versus 12.5%, P = .04). CONCLUSIONS Black-blood MRI with or without contrast has high diagnostic accuracy and reliability in evaluating intracranial large-vessel arterial occlusions with near-equivalency to DSA and CTA.
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Affiliation(s)
- A S Al-Smadi
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
| | - R N Abdalla
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
- Department of Radiology (R.N.A.), Ain Shams University, Cairo, Egypt
| | - A H Elmokadem
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
- Department of Radiology (A.H.E.), Mansoura University, Mansoura, Egypt
| | - A Shaibani
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
- Neurological Surgery (A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - M C Hurley
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
- Neurological Surgery (A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - M B Potts
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
- Neurological Surgery (A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - B S Jahromi
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
- Neurological Surgery (A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - T J Carroll
- Department of Radiology (T.J.C.), University of Chicago, Chicago, Illinois
| | - S A Ansari
- From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.)
- Neurology (S.A.A.)
- Neurological Surgery (A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Cisneros O, Rehmani R, Garcia de de Jesus K. Cerebellar Cavernous Malformation (Cavernoma): A Case Report. Cureus 2019; 11:e4371. [PMID: 31218136 PMCID: PMC6553676 DOI: 10.7759/cureus.4371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cavernous malformations are congenital or acquired vascular abnormalities. They are uncommon entities with an incidence of 0.5% of the general population and usually are unnoticed until a hemorrhagic event occurs. Cavernomas can be concurrently seen with developmental venous anomalies (DVAs) in 20% (range 20%-40%) of cases, in which case they are known as mixed vascular malformations. We report a case of a healthy young adult, who presented with acute onset of headache, dizziness, and nausea with intermittent episodes of vomiting for four days. Brain tomography imaging at presentation revealed likely multiple foci of intracranial hemorrhage; however, magnetic resonance imaging (MRI) showed findings suggestive of an underlying cavernoma that had bled, in addition to a coexisting DVA. The patient was discharged home with no deficits. Outpatient follow-up five months later revealed no symptoms or neurologic deficits.
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Affiliation(s)
- Oscar Cisneros
- Internal Medicine, St. Barnabas Hospital Health System / Albert Einstein College of Medicine, Bronx, USA
| | - Razia Rehmani
- Neuroradiology, St. Barnabas Hospital Health System, Bronx, USA
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Collins M, McGauvran A, Elhassan B. High-pressure injection injury of the hand: peculiar MRI features and treatment implications. Skeletal Radiol 2019; 48:295-299. [PMID: 29909479 DOI: 10.1007/s00256-018-3005-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 02/02/2023]
Abstract
High-pressure injection injuries of the hand are rare, but potentially devastating injuries. The amount of tissue damage is dependent on the magnitude of the pressure generated by the device and the composition of the injected material. The standard of care is emergent surgical debridement of the injected material and devitalized tissue. Although, preoperative advanced imaging is not routinely pursued, MRI may be helpful in determining the anatomic distribution of the foreign material, and associated soft tissue or osseous injury. We present a case of a 28-year-old male with complications related to a high-pressure grease injection injury to his non-dominant hand. The MRI demonstrated peculiar imaging features of retained grease deposits and played an important role in surgical planning.
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Affiliation(s)
- Mark Collins
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Adam McGauvran
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Bassem Elhassan
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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Ajhoun Y, Ismail A, Nisrin L, Yasmine CR, Yassine M, Reda K, Oubaaz A. Unusual etiology of bilateral acute visual impairment: Optochiasmatic cavernoma haemorrhage. Am J Emerg Med 2019; 37:564.e1-564.e4. [PMID: 30616870 DOI: 10.1016/j.ajem.2018.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/28/2022] Open
Abstract
Optochiasmatic cavernoma haemorrhage is unusual etiology of bilateral acute visual impairment. This vascular hamartoma is extremely rare with a prevalence rate of 0.4-0.9% of the general population. They are frequently revealed by an optochiasmal apoplexy. We present the case of a 38 year old woman admitted to the emergency department for bilateral acute visual impairment, associated with frontal headaches. A brain MRI led to the diagnosis of an optochiasmatic cavernoma haemorrhage. Because of the rareness, and the lack of knowledge regarding the natural history of this lesion, surgical resection is the preferred management option in most reported cases. However after clear and detailed explanations of the surgical procedure as well as the risk of visual loss our patient refused to undergo any interventions. So our attitude was to carry out a close follow-up. After one year the visual evolution was satisfactory, no clinical worsening has been noticed and the MRIs examinations showed the same aspect with the same size. The aim of this observation is to evoke the diagnosis of an optochiasmatic cavernoma haemorrhage in case of acute chiasmal compression syndrome within patients in the third and fourth decades.
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Affiliation(s)
- Yousra Ajhoun
- Ophthalmology Department, Military Instruction Hospital Mohammed V, Rabat, Morocco.
| | - Aissa Ismail
- Anesthesiologie and Intensive Care Department, Military Instruction Hospital Mohammed V, Rabat, Morocco
| | - Laaribi Nisrin
- Ophthalmology Department, Military Instruction Hospital Mohammed V, Rabat, Morocco
| | - Chaoui Roqai Yasmine
- Ophthalmology Department, Military Instruction Hospital Mohammed V, Rabat, Morocco
| | - Mouzari Yassine
- Ophthalmology Department, Military Instruction Hospital Mohammed V, Rabat, Morocco
| | - Karim Reda
- Ophthalmology Department, Military Instruction Hospital Mohammed V, Rabat, Morocco
| | - Abdelbarre Oubaaz
- Ophthalmology Department, Military Instruction Hospital Mohammed V, Rabat, Morocco
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Neuroimaging in Fabry disease: current knowledge and future directions. Insights Imaging 2018; 9:1077-1088. [PMID: 30390274 PMCID: PMC6269338 DOI: 10.1007/s13244-018-0664-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/07/2018] [Accepted: 09/27/2018] [Indexed: 12/14/2022] Open
Abstract
Abstract Fabry disease (FD) is a rare X-linked disorder characterised by abnormal progressive lysosomal deposition of globotriaosylceramide in a large variety of cell types. The central nervous system (CNS) is often involved in FD, with a wide spectrum of manifestations ranging from mild symptoms to more severe courses related to acute cerebrovascular events. In this review we present the current knowledge on brain imaging for this condition, with a comprehensive and critical description of its most common neuroradiological imaging findings. Moreover, we report results from studies that investigated brain physiopathology underlying this disorder by using advanced imaging techniques, suggesting possible future directions to further explore CNS involvement in FD patients. Teaching Points • Conventional neuroradiological findings in FD are aspecific. • White matter hyperintensities represent the more consistent brain imaging feature of FD • Abnormalities of the vasculature wall of posterior circulation are also consistent features. • The pulvinar sign is not reliable as a finding pathognomonic for FD. • Advanced imaging techniques have increased our knowledge about brain involvement in FD.
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Guo BJ, Yang ZL, Zhang LJ. Gadolinium Deposition in Brain: Current Scientific Evidence and Future Perspectives. Front Mol Neurosci 2018; 11:335. [PMID: 30294259 PMCID: PMC6158336 DOI: 10.3389/fnmol.2018.00335] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/27/2018] [Indexed: 01/18/2023] Open
Abstract
In the past 4 years, many publications described a concentration-dependent deposition of gadolinium in the brain both in adults and children, seen as high signal intensities in the globus pallidus and dentate nucleus on unenhanced T1-weighted images. Postmortem human or animal studies have validated gadolinium deposition in these T1-hyperintensity areas, raising new concerns on the safety of gadolinium-based contrast agents (GBCAs). Residual gadolinium is deposited not only in brain, but also in extracranial tissues such as liver, skin, and bone. This review summarizes the current evidence on gadolinium deposition in the human and animal bodies, evaluates the effects of different types of GBCAs on the gadolinium deposition, introduces the possible entrance or clearance mechanism of the gadolinium and potential side effects that may be related to the gadolinium deposition on human or animals, and puts forward some suggestions for further research.
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Affiliation(s)
- Bang J. Guo
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, China
| | - Zhen L. Yang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Long J. Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, China
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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