1
|
Koesbandono, Muljadi R, Sutanto R, Fransiska SR, Takaliuang D, Erico A. Intracranial tuberculomas: review of MRI findings and clinical features. Clin Radiol 2024; 79:354-362. [PMID: 38286718 DOI: 10.1016/j.crad.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/14/2023] [Accepted: 12/24/2023] [Indexed: 01/31/2024]
Abstract
AIM To present a comprehensive analysis of the clinical features and magnetic resonance imaging (MRI) findings of intracranial tuberculomas in Indonesia. MATERIALS AND METHODS This was a retrospective analysis of brain MRI from 58 patients (29 women), mean age ± SD = 39 ± 2 years, diagnosed with intracranial tuberculomas. Clinical data, including symptoms, cerebrospinal fluid examination results, and MRI were also analysed. The diagnosis of intracranial tuberculoma was confirmed based on observed MRI changes following anti-tuberculosis therapy. RESULTS A total of 603 tuberculomas were fully detected via MRI in all patients. Among these lesions, 507 (84%) were located in the cerebrum, 61 (10%) in the cerebellum, 19 (3%) in the basal ganglia, 12 (2%) in the brain stem, and four (1%) in the thalamus. The MRI signals were classified into two groups: tuberculomas with caseating granulomas and tuberculomas with non-caseating granulomas. Among the patients, 29 had concomitant meningitis, seven had hydrocephalus, and four had cerebral infarction. Evidence of pulmonary tuberculosis was found in 16 patients, with one patient having coexisting thoracic vertebral tuberculosis. CONCLUSION The present study confirmed the significance of MRI as a valuable tool in the diagnosis of intracranial tuberculomas and the detection of associated abnormalities. The combination of MRI findings with clinical features can enhance the overall diagnostic accuracy for intracranial tuberculomas.
Collapse
Affiliation(s)
- Koesbandono
- Pelita Harapan University, Faculty of Medicine, Tangerang, Indonesia; Department of Radiology, Siloam Hospital Lippo Village, Tangerang, Indonesia
| | - R Muljadi
- Pelita Harapan University, Faculty of Medicine, Tangerang, Indonesia; Department of Radiology, Siloam Hospital Lippo Village, Tangerang, Indonesia
| | - R Sutanto
- Pelita Harapan University, Faculty of Medicine, Tangerang, Indonesia; Department of Radiology, Siloam Hospital Lippo Village, Tangerang, Indonesia
| | - S R Fransiska
- Pelita Harapan University, Faculty of Medicine, Tangerang, Indonesia; Department of Neurology, Siloam Hospital Lippo Village, Tangerang, Indonesia
| | - D Takaliuang
- Pelita Harapan University, Faculty of Medicine, Tangerang, Indonesia; Department of Radiology, Siloam Hospital Lippo Village, Tangerang, Indonesia.
| | - A Erico
- Pelita Harapan University, Faculty of Medicine, Tangerang, Indonesia; Department of Radiology, Siloam Hospital Lippo Village, Tangerang, Indonesia
| |
Collapse
|
2
|
Dahal P, Parajuli S. Magnetic resonance imaging findings in central nervous system tuberculosis: A pictorial review. Heliyon 2024; 10:e29779. [PMID: 38699716 PMCID: PMC11063446 DOI: 10.1016/j.heliyon.2024.e29779] [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: 10/27/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024] Open
Abstract
Central nervous system (CNS) tuberculosis is a post-primary form of tuberculosis. It has high mortality and morbidity rates despite early diagnosis and treatment. CNS tuberculosis can manifest as subacute/chronic meningitis, parenchymal tuberculous lesions, and spinal tuberculosis. Hematogenous spread of tuberculous bacilli to the brain results in the development of so called "rich foci" on the pial surface, ependyma, and grey-white matter junction. Rupture of these "rich foci" into the subarachnoid space triggers an intense granulomatous inflammatory reaction. Tuberculous meningitis can manifest as leptomeningitis or pachymeningitis. Intracranial parenchymal tuberculous lesions may present as tuberculoma, tuberculous abscess, cerebritis, rhombencephalitis, and encephalopathy, with atypical presentations not uncommon. Complications of CNS tuberculosis encompass hydrocephalus, syrinx formation, vasculitis, infarcts, neuritis, and enduring neurological deficits. Post-contrast 3D fluid-attenuated inversion recovery (FLAIR) and post-contrast T1 spin-echo sequences excel in detecting tuberculous meningitis compared to other conventional magnetic resonance imaging (MRI) sequences. In proton magnetic resonance spectroscopy (PMRS), the presence of a lipid peak at 1.3 ppm is indicative of tuberculous lesions. Magnetization transfer (MT) imaging enhances the detection of tuberculous lesions, as the magnetization transfer ratio (MTR) of tuberculous pathologies, owing to their high lipid content, is lower than that in bacterial or fungal pathologies and higher than that in viral pathologies. This review article delves into the various typical and atypical imaging presentations of CNS tuberculosis in MRI, along with recent advances in imaging techniques.
Collapse
Affiliation(s)
- Prajwal Dahal
- Department of Radiology and Imaging, Grande International Hospital, Kathmandu, Nepal
| | - Sabina Parajuli
- Resident PGY-1 Pathology, Department of Pathology, Bir Hospital, Kathmandu, Nepal
| |
Collapse
|
3
|
Gupta A, Paliwal VK, Bharatveer S, Mishra P, Jain N. Clinical and Radiological End Points to Stop Anti-Tubercular Treatment in Central Nervous System Tuberculoma and Predictors of Poor Outcome: A Retrospective Study. Am J Trop Med Hyg 2023; 109:1141-1147. [PMID: 37918003 PMCID: PMC10622483 DOI: 10.4269/ajtmh.23-0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/20/2023] [Indexed: 11/04/2023] Open
Abstract
The clinical and radiological end points to stop anti-tubercular treatment in central nervous system (CNS) tuberculoma are not known. This retrospective study was done to determine end points to stop anti-tubercular treatment and find the predictors of poor outcome in patients with CNS tuberculoma. Patients who were admitted with a diagnosis of brain/spine tuberculoma between January 2015 and December 2019 and who completed a minimum of 1-year follow-up were enrolled. Clinical and radiological end points to stop anti-tubercular treatment and predictors of death and poor outcome (modified Rankin scale > 2) were analyzed. One hundred and eight patients (male-to-female ratio, 47 [43.5%]:61 [56.5%]; brain tuberculoma, 102; spinal cord tuberculoma, 14; brain and spinal cord tuberculoma, 8) were included in the study. Median duration of anti-tubercular treatment was 24 months. Radiological resolution of tuberculoma (resolution of gadolinium-enhancing lesion, gliosis, calcification, cord atrophy, or syrinx formation) and radiological halt (no increase in size/number of tuberculoma on magnetic resonance imaging scans done 6 months apart) were used as end points to stop anti-tubercular treatment in 69 and 7 patients, respectively. Seven patients stopped their treatment by themselves, and 25 patients died. Altered sensorium, motor weakness, infarcts, hydrocephalus, and constitutional symptoms of tuberculous meningitis were predictors of poor outcome or death in CNS tuberculoma patients. Radiological resolution or radiological halt of brain/spinal cord tuberculoma was a reasonable end point to stop anti-tubercular treatment. However, this may require 24 months or more of anti-tubercular treatment. Associated tuberculous meningitis and its complications portend a poor prognosis.
Collapse
Affiliation(s)
- Ankit Gupta
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Swati Bharatveer
- Department of Emergency Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Prabhakar Mishra
- Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Neeraj Jain
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
4
|
Yeat CM, Achmad Sankala H, Mohd Zaki F, Mohamed Mukari SA. Tumour-like presentation of brainstem tuberculoma: a lesson learnt. BMJ Case Rep 2022; 15:e251672. [PMID: 36109096 PMCID: PMC9478784 DOI: 10.1136/bcr-2022-251672] [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] [Indexed: 11/04/2022] Open
Abstract
Brainstem tuberculoma is diagnostically challenging as it lacks clinical clues and imaging mimics a high-grade glioma (HGG). We report the case of an adolescent girl diagnosed with brainstem HGG, who was referred to our centre for Gamma Knife. Initial MRI showed a pontomedullary junction, ring-enhancing lobulated lesion demonstrating distinct central hypointensity on T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) images with extensive vasogenic oedema. An alternative diagnosis of infection was entertained, and biopsy was suggested; however, the parents opted for a trial of alternative treatment. Suboccipital craniotomy and debulking were only performed 3 months later when her symptoms worsened, and MRI revealed enlargement of the lesion. A cheesy 'tumour' was noted intraoperatively; histopathological findings later confirmed chronic granulomatous inflammation. In an endemic area, a high index of suspicion of a tuberculoma is vital specifically in the presence of central T2W/FLAIR hypointensity of a ring-enhancing lesion.
Collapse
Affiliation(s)
- Chia Ming Yeat
- Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | | | - Faizah Mohd Zaki
- Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | | |
Collapse
|
5
|
Merchant SA, Shaikh MJS, Nadkarni P. Tuberculosis conundrum - current and future scenarios: A proposed comprehensive approach combining laboratory, imaging, and computing advances. World J Radiol 2022; 14:114-136. [PMID: 35978978 PMCID: PMC9258306 DOI: 10.4329/wjr.v14.i6.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/17/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
Tuberculosis (TB) remains a global threat, with the rise of multiple and extensively drug resistant TB posing additional challenges. The International health community has set various 5-yearly targets for TB elimination: mathematical modelling suggests that a 2050 target is feasible with a strategy combining better diagnostics, drugs, and vaccines to detect and treat both latent and active infection. The availability of rapid and highly sensitive diagnostic tools (Gene-Xpert, TB-Quick) will vastly facilitate population-level identification of TB (including rifampicin resistance and through it, multi-drug-resistant TB). Basic-research advances have illuminated molecular mechanisms in TB, including the protective role of Vitamin D. Also, Mycobacterium tuberculosis impairs the host immune response through epigenetic mechanisms (histone-binding modulation). Imaging will continue to be key, both for initial diagnosis and follow-up. We discuss advances in multiple imaging modalities to evaluate TB tissue changes, such as molecular imaging techniques (including pathogen-specific positron emission tomography imaging agents), non-invasive temporal monitoring, and computing enhancements to improve data acquisition and reduce scan times. Big data analysis and Artificial Intelligence (AI) algorithms, notably in the AI sub-field called “Deep Learning”, can potentially increase the speed and accuracy of diagnosis. Additionally, Federated learning makes multi-institutional/multi-city AI-based collaborations possible without sharing identifiable patient data. More powerful hardware designs - e.g., Edge and Quantum Computing- will facilitate the role of computing applications in TB. However, “Artificial Intelligence needs real Intelligence to guide it!” To have maximal impact, AI must use a holistic approach that incorporates time tested human wisdom gained over decades from the full gamut of TB, i.e., key imaging and clinical parameters, including prognostic indicators, plus bacterial and epidemiologic data. We propose a similar holistic approach at the level of national/international policy formulation and implementation, to enable effective culmination of TB’s endgame, summarizing it with the acronym “TB - REVISITED”.
Collapse
Affiliation(s)
- Suleman Adam Merchant
- Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai 400022, Maharashtra, India
| | - Mohd Javed Saifullah Shaikh
- Department of Radiology, North Bengal Neuro Centre, Jupiter magnetic resonance imaging, Diagnostic Centre, Siliguri 734003, West Bengal, India
| | - Prakash Nadkarni
- College of Nursing, University of Iowa, Iowa 52242, IA, United States
| |
Collapse
|
6
|
Dhiman R, Lakra S, Panda PK, Hemachandran N, Sharma S, Saxena R. Neuro-ophthalmic manifestations of tuberculosis. Eye (Lond) 2022; 36:15-28. [PMID: 34127839 PMCID: PMC8727585 DOI: 10.1038/s41433-021-01619-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 05/04/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
Neuro-ophthalmic features are a known association in tuberculosis, especially common in central nervous system tuberculosis (CNS-TB). They are mostly the result of the visual pathway and/or ocular motor and other cranial nerve involvement. Furthermore, toxic optic neuropathy and paradoxical response to anti-tubercular drugs (ATT) are also not uncommon. The etiopathogenesis is by the complex interplay of various factors like exudates, vasculitis, arachnoiditis, presence of tuberculomas, hydrocephalus, brain infarcts and/or immune-mediated reaction. The entity often poses a diagnostic dilemma for the ophthalmologists/neuro-ophthalmologists and may lead to irreversible vision loss. The presence of neuro-ophthalmic features not only affect the visual outcome but are also predictors of systemic morbidity of the disease. Therefore, understanding and knowledge about this entity are necessary for the comprehensive management of the disease. While various forms of TB including CNS-TB have been well-dealt with in literature, little is discussed specifically about the neuro-ophthalmic manifestations of tuberculosis. Therefore, the purpose of this review is to highlight current understanding of the types of neuro-ophthalmic involvement in tuberculosis, its etiopathogenesis, diagnosis and management.
Collapse
Affiliation(s)
- Rebika Dhiman
- Neuro-Ophthalmology Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Subodh Lakra
- Neuro-Ophthalmology Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prateek Kumar Panda
- Pediatric Neurology Services, Department of Paediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Naren Hemachandran
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Sharma
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Saxena
- Neuro-Ophthalmology Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
7
|
Gudla S, Joyce JR. Tuberculosis presenting with seizure and abdominal pain in a young female: A case report. Radiol Case Rep 2021; 17:350-354. [PMID: 34887974 PMCID: PMC8637002 DOI: 10.1016/j.radcr.2021.10.041] [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: 09/06/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022] Open
Abstract
In this case report, a 23-year-old female presented to the Emergency Department with complaints of abdominal pain, weight loss, progressive headaches, and an episode of seizure-like activity. Computerized tomography abdomen/pelvis revealed multilobulated ovarian masses and scattered peritoneal thickening. A brain Magnetic resonance imaging was ordered and demonstrated a peripherally enhancing intracranial mass. The brain lesion was resected and pathology revealed necrotizing granulomatous inflammation. Cultures were positive for acid fast bacilli. The patient was diagnosed with tuberculosis and treated with multidrug therapy. Upon further questioning, the patient had recently traveled to a tuberculosis endemic region. This case highlights the importance of an in-depth history and physical exam as a means to a more complete differential diagnosis considering the age of the patient and the findings on imaging.
Collapse
Affiliation(s)
- Sai Gudla
- Radiology, University of Cincinnati Medical Center, 234 Goodman St, PO Box 670761, Cincinnati, Ohio 45267, USA
| | - Jennifer R Joyce
- Radiology, University of Cincinnati Medical Center, 234 Goodman St, PO Box 670761, Cincinnati, Ohio 45267, USA
| |
Collapse
|
8
|
Matsusue E, Inoue C, Tabuchi S, Yoshioka H, Nagao Y, Matsumoto K, Nakamura K, Fujii S. Utility of 3T single-voxel proton MR spectroscopy for differentiating intracranial meningiomas from intracranial enhanced mass lesions. Acta Radiol Open 2021; 10:20584601211009472. [PMID: 34211737 PMCID: PMC8215334 DOI: 10.1177/20584601211009472] [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: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 02/03/2023] Open
Abstract
Background Proton magnetic resonance spectroscopy (MRS) provides structural and
metabolic information that is useful for the diagnosis of meningiomas with
atypical radiological appearance. However, the metabolite that should be
prioritized for the diagnosis of meningiomas has not been established. Purpose To evaluate the differences between the metabolic peaks of meningiomas and
other intracranial enhanced mass lesions (non-meningiomas) using MR
spectroscopy in short echo time (TE) spectra and the most useful metabolic
peak for discriminating between the groups. Material and Methods The study involved 9 meningiomas, 22 non-meningiomas, intracranial enhancing
tumors and abscesses, and 15 normal controls. The ranking of the peak at
3.8 ppm, peak at 3.8 ppm/Creatine (Cr), β-γ Glutamine-Glutamate (bgGlx)/Cr,
N-acetyl compounds (NACs)/Cr, choline (Cho)/Cr, lipid and/or lactate
(Lip-Lac) at 1.3 ppm/Cr, and the presence of alanine (Ala) were derived. The
metabolic peaks were compared using the Mann-Whitney U test. ROC analysis
was used to determine the cut-off values for differentiating meningiomas
from non-meningiomas using statistically significant metabolic peaks. Results The ranking of the peak at 3.8 ppm among all the peaks, peak at 3.8 ppm/Cr,
bgGlx/Cr, Lip-Lac/Cr, and the presence of Ala discriminated meningiomas from
non-meningiomas with moderate to high accuracy. The highest accuracy was
96.9% at a threshold value of 3 for the rank of the peak at 3.8 ppm. Conclusion A distinct elevated peak at 3.8 ppm, ranked among the top three highest
peaks, allowed the detection of meningiomas.
Collapse
Affiliation(s)
- Eiji Matsusue
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Chie Inoue
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Sadaharu Tabuchi
- Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Hiroki Yoshioka
- Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Yuichiro Nagao
- Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kensuke Matsumoto
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kazuhiko Nakamura
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Tottori University, Tottori, Japan
| |
Collapse
|
9
|
Kulanthaivelu K, Jabeen S, Saini J, Raju S, Nalini A, Sadashiva N, Hegde S, Rolla NK, Saha I, M N, Vengalil S, Swaroop S, Rao S. Amide proton transfer imaging for differentiation of tuberculomas from high-grade gliomas: Preliminary experience. Neuroradiol J 2021; 34:440-448. [PMID: 33823712 DOI: 10.1177/19714009211002766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Tuberculomas can occasionally masquerade as high-grade gliomas (HGG). Evidence from magnetisation transfer (MT) imaging suggests that there is lower protein content in the tuberculoma microenvironment. Building on the principles of chemical exchange saturation transfer and MT, amide proton transfer (APT) imaging generates tissue contrast as a function of the mobile amide protons in tissue's native peptides and intracellular proteins. This study aimed to further the understanding of tuberculomas using APT and to compare it with HGG. METHOD Twenty-two patients (n = 8 tuberculoma; n = 14 HGG) were included in the study. APT was a 3D turbo spin-echo Dixon sequence with inbuilt B0 correction. A two-second, 2 μT saturation pulse alternating over transmit channels was applied at ±3.5 ppm around water resonance. The APT-weighted image (APTw) was computed as the MT ratio asymmetry (MTRasym) at 3.5 ppm. Mean MTRasym values in regions of interest (areas = 9 mm2; positioned in component with homogeneous enhancement/least apparent diffusion coefficient) were used for the analysis. RESULTS MTRasym values of tuberculomas (n = 14; 8 cases) ranged from 1.34% to 3.11% (M = 2.32 ± 0.50). HGG (n = 17;14 cases) showed MTRasym ranging from 2.40% to 5.70% (M = 4.32 ± 0.84). The inter-group difference in MTRasym was statistically significant (p < 0.001). APTw images in tuberculomas were notable for high MTRasym values in the perilesional oedematous-appearing parenchyma (compared to contralateral white matter; p < 0.001). CONCLUSION Tuberculomas demonstrate lower MTRasym ratios compared to HGG, reflective of a relative paucity of mobile amide protons in the ambient microenvironment. Elevated MTRasym values in perilesional parenchyma in tuberculomas are a unique observation that may be a clue to the inflammatory milieu.
Collapse
Affiliation(s)
- Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, India
| | - Shumyla Jabeen
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, India
| | - Sanita Raju
- Department of Neurology, National Institute of Mental Health and Neurosciences, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, India
| | | | | | | | - Netravathi M
- Department of Neurology, National Institute of Mental Health and Neurosciences, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, India
| | - Saikrishna Swaroop
- Department of Neurology, National Institute of Mental Health and Neurosciences, India
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, India
| |
Collapse
|
10
|
Teh YG, Azizan N, Mohd Naim NA, Ng CY, Wong KJ, Mohd Zaki F. Case Report: Unusual High-Grade Diffuse Leptomeningeal Glioneuronal Tumor Mimicking Tuberculous Meningitis in a Child From an Endemic Region. Front Pediatr 2021; 9:767614. [PMID: 34956980 PMCID: PMC8696155 DOI: 10.3389/fped.2021.767614] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Diffuse leptomeningeal glioneuronal tumor (DL-GNT) is a new entity described in the 2016 World Health Organization (WHO) classification of brain tumors. While DL-GNT is predominantly an indolent tumor that affects young boys, high-grade DL-GNT is unusual and seldom reported in children. Case Presentation: In this report, we describe the challenges and pitfalls associated with diagnosing this high-grade variant in a tuberculosis-endemic region. We highlight the importance of identifying non-typical imaging findings, i.e., non-enhancing cystic lesions with high T2 signal along the leptomeningeal surface, that may expedite the diagnosis of this condition. Histopathologic correlations with MR spectroscopy findings are also discussed. Conclusion: We provide the first clinical imaging report of utilizing MR spectroscopy to distinguish DL-GNT from tuberculosis with histopathologic correlation.
Collapse
Affiliation(s)
- Yong Guang Teh
- Department of Radiology, Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia.,Department of Radiology, Sabah Women & Children's Hospital, Kota Kinabalu, Malaysia
| | - Nornazirah Azizan
- Department of Pathology and Microbiology, Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Nur Atifah Mohd Naim
- Department of Radiology, Sabah Women & Children's Hospital, Kota Kinabalu, Malaysia
| | - Chiak Yot Ng
- Department of Radiology, Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Ke Juin Wong
- Department of Paediatrics, Sabah Women & Children's Hospital, Kota Kinabalu, Malaysia
| | - Faizah Mohd Zaki
- Department of Radiology, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| |
Collapse
|
11
|
Salvador GLO, Basso ACN, Barbieri PP, Leitao CA, Teixeira BCA, Neto AC. Central nervous system and spinal cord tuberculosis: Revisiting an important disease. Clin Imaging 2020; 69:158-168. [PMID: 32853843 DOI: 10.1016/j.clinimag.2020.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
Tuberculosis is a worldwide pandemic. Estimated that about 25% humans are colonized by Mycobacterium tuberculosis and about 1% are believed to develop the infection in the central nervous system (CNS-TB). Given the importance of this disease and its high levels of morbidity and mortality, it is imperative that every radiologist must be reminded of the most common findings of CNS-TB as there are several related differential diagnoses for this disease. The most common form CNS-TB is tuberculous meningitis (TBM), characterized mostly by basal meningitis, but infarction, hydrocephalus and tuberculomas could be present. Intracerebral tuberculosis is characterized by tuberculomas that can have different imaging features according to their stage. Vascular and spinal complications of tuberculosis are also reported. This review compiles the classic and unusual findings regarding CNS-TB together with new diagnostic scores in which neuroimaging have an important role.
Collapse
Affiliation(s)
- Gabriel L O Salvador
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil.
| | - Ana C N Basso
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Poliana P Barbieri
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Cleverson A Leitao
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Bernardo C A Teixeira
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| | - Arnolfo C Neto
- Department of Diagnostic Radiology, Hospital de Clinicas, Federal University of Parana, Curitiba, Parana, Brazil
| |
Collapse
|
12
|
Sawlani V, Patel MD, Davies N, Flintham R, Wesolowski R, Ughratdar I, Pohl U, Nagaraju S, Petrik V, Kay A, Jacob S, Sanghera P, Wykes V, Watts C, Poptani H. Multiparametric MRI: practical approach and pictorial review of a useful tool in the evaluation of brain tumours and tumour-like lesions. Insights Imaging 2020; 11:84. [PMID: 32681296 PMCID: PMC7367972 DOI: 10.1186/s13244-020-00888-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022] Open
Abstract
MRI has a vital role in the assessment of intracranial lesions. Conventional MRI has limited specificity and multiparametric MRI using diffusion-weighted imaging, perfusion-weighted imaging and magnetic resonance spectroscopy allows more accurate assessment of the tissue microenvironment. The purpose of this educational pictorial review is to demonstrate the role of multiparametric MRI for diagnosis, treatment planning and for assessing treatment response, as well as providing a practical approach for performing and interpreting multiparametric MRI in the clinical setting. A variety of cases are presented to demonstrate how multiparametric MRI can help differentiate neoplastic from non-neoplastic lesions compared to conventional MRI alone.
Collapse
Affiliation(s)
- Vijay Sawlani
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK.
- University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Markand Dipankumar Patel
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
- University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Nigel Davies
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Robert Flintham
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Roman Wesolowski
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Ismail Ughratdar
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Ute Pohl
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Santhosh Nagaraju
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Vladimir Petrik
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Andrew Kay
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Saiju Jacob
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
- University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Paul Sanghera
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Victoria Wykes
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
- University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Colin Watts
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
- University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Harish Poptani
- Centre for Pre-Clinical Imaging, Department of Cellular and Molecular Physiology, University of Liverpool, Crown Street, Liverpool, L69 3BX, UK
| |
Collapse
|
13
|
Role of Surgery in Intracranial Tuberculomas and Proposal of a Novel Diagnostic Criteria for Diagnosis (Sri Venkateswara Institute of Medical Sciences Criteria). World Neurosurg 2020; 138:e52-e65. [DOI: 10.1016/j.wneu.2020.01.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 11/19/2022]
|
14
|
Ranjan R, Namrata, Singh A, Mody S. MRS Showing a Singlet Peak at 3.8 ppm in Three Patients with CNS Tuberculomas. MAMC JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/mamcjms.mamcjms_47_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
15
|
Fayed N, Oliván B, Lopez Del Hoyo Y, Andrés E, Perez-Yus MC, Fayed A, Angel LF, Serrano-Blanco A, Roca M, Garcia Campayo J. Changes in metabolites in the brain of patients with fibromyalgia after treatment with an NMDA receptor antagonist. Neuroradiol J 2019; 32:408-419. [PMID: 31215319 DOI: 10.1177/1971400919857544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The aims of this work were to evaluate whether the treatment of patients with fibromyalgia with memantine is associated with significant changes in metabolite concentrations in the brain, and to explore any changes in clinical outcome measures. Magnetic resonance spectroscopy was performed of the right anterior and posterior insula, both hippocampi and the posterior cingulate cortex. Questionnaires on pain, anxiety, depression, global function, quality of life and cognitive impairment were used. Ten patients were studied at baseline and after three months of treatment with memantine. Significant increases were observed in the following areas: N-acetylaspartate (4.47 at baseline vs. 4.71 at three months, p = 0.02) and N-acetylaspartate+N-acetylaspartate glutamate in the left hippocampus (5.89 vs. 5.98; p = 0.007); N-acetylaspartate+N-acetylaspartate glutamate in the right hippocampus (5.31 vs 5.79; p = 0.01) and the anterior insula (7.56 vs. 7.70; p = 0.033); glutamate+glutamine/creatine ratio in the anterior insula (2.03 vs. 2.17; p = 0.022) and the posterior insula (1.77 vs. 2.00; p = 0.004); choline/creatine ratio in the posterior cingulate (0.18 vs. 0.19; p = 0.023); and creatine in the right hippocampus (3.60 vs. 3.85; p = 0.007). At the three-month follow-up, memantine improved cognitive function assessed by the Cognition Mini-Exam (31.50, SD = 2.95 vs. 34.40, SD = 0.6; p = 0.005), depression measured by the Hamilton Depression Scale (7.70, SD = 0.81 vs. 7.56, SD = 0.68; p = 0.042) and severity of illness measured by the Clinical Global Impression severity scale (5.79, SD = 0.96 vs. 5.31, SD = 1.12; p = 0.007). Depression, clinical global impression and cognitive function showed improvement with memantine. Magnetic resonance spectroscopy could be useful in monitoring response to the pharmacological treatment of fibromyalgia.
Collapse
Affiliation(s)
- Nicolas Fayed
- Department of Radiology, Quirónsalud Hospital, Spain
| | - Barbara Oliván
- Department of Psychology and Sociology, University of Zaragoza, Spain.,Preventative Activities and Health Promotion Network (REDIAPP) (G06/170)
| | - Yolanda Lopez Del Hoyo
- Department of Psychology and Sociology, University of Zaragoza, Spain.,Preventative Activities and Health Promotion Network (REDIAPP) (G06/170)
| | - Eva Andrés
- CIBER Epidemiology and Public Health, Clinical Epidemiology Unit, October 12 Hospital, Spain
| | | | - Alicia Fayed
- Department of Neurorehabilitation, San Juan de Dios Hospital, Spain
| | - Luisa F Angel
- Department of Radiology, Quirónsalud Hospital, Spain
| | - Antoni Serrano-Blanco
- Department of Psychiatry, Parc Sanitari St. Joan of God and the St. Joan of God Foundation, Spain.,Preventative Activities and Health Promotion Network (REDIAPP) (G06/170)
| | - Miquel Roca
- Health Sciences Research University Institute, Juan March Hospital, Illes Balears University, Spain.,Preventative Activities and Health Promotion Network (REDIAPP) (G06/170)
| | - Javier Garcia Campayo
- Department of Psychiatry, Miguel Servet Hospital and the University of Zaragoza. Aragon Institute for Health Research (IIS Aragon), Spain.,Preventative Activities and Health Promotion Network (REDIAPP) (G06/170)
| |
Collapse
|
16
|
Chawla S, Lee SC, Mohan S, Wang S, Nasrallah M, Vossough A, Krejza J, Melhem ER, Nabavizadeh SA. Lack of choline elevation on proton magnetic resonance spectroscopy in grade I-III gliomas. Neuroradiol J 2019; 32:250-258. [PMID: 31050313 DOI: 10.1177/1971400919846509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Elevated levels of choline are generally emphasized as marker of increased cellularity and cell membrane turnover in gliomas. In this study, we investigated the incidence rate of lack of choline/creatine and choline/water elevation in a population of grade I-III gliomas. A cohort of 41 patients with histopathologically confirmed gliomas underwent multi-voxel proton magnetic resonance spectroscopy on a 3 T magnetic resonance system prior to treatment. Peak areas for choline and myoinositol were measured from all voxels that exhibited hyperintensity on fluid-attenuated inversion recovery images and were normalized to creatine and unsuppressed water from each voxel. The average metabolite/creatine and metabolite/water ratios from these voxels were then computed. Similarly, average metabolite ratios were computed from normal brain parenchyma. Gliomas were considered for lack of choline elevation when choline/creatine and choline/water ratios from neoplastic regions were less than those from normal brain parenchyma regions. Six of 41 (14.6%) grade I-III gliomas showed lack of elevation for choline/creatine and choline/water ratios compared to normal brain parenchyma. Four of these six gliomas also demonstrated elevated levels of myoinositol/creatine ratio. All other gliomas (n = 35) had elevated choline levels from neoplastic regions relative to normal parenchyma. The sensitivity of choline/creatine or choline/water in determining a grade I-III glioma was 85.4%. These findings suggest that a lack of choline/creatine or choline/water elevation may be seen in some gliomas and low choline levels should not prevent us from considering the possibility of a grade I-III glioma.
Collapse
Affiliation(s)
- Sanjeev Chawla
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA
| | - Seung-Cheol Lee
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA
| | - Suyash Mohan
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA
| | - Sumei Wang
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA
| | - MacLean Nasrallah
- 2 Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, USA
| | - Arastoo Vossough
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA.,3 Department of Radiology, Children's Hospital of Philadelphia, USA
| | - Jaroslaw Krejza
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA.,4 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, USA
| | - Elias R Melhem
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA.,4 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, USA
| | - S Ali Nabavizadeh
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA
| |
Collapse
|
17
|
Nair BR, Rajshekhar V. Factors Predicting the Need for Prolonged (>24 Months) Antituberculous Treatment in Patients with Brain Tuberculomas. World Neurosurg 2019; 125:e236-e247. [PMID: 30684718 DOI: 10.1016/j.wneu.2019.01.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/02/2019] [Accepted: 01/05/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with brain tuberculomas are generally managed with 12-18 months of antituberculous treatment (ATT) with or without surgery. However, a subset of these patients may require ATT for longer periods. We studied the factors that were associated with the need for prolonged ATT (>24 months) in patients with brain tuberculomas. METHODS This retrospective study included patients with intracranial tuberculomas managed from January 2000 to December 2015 if they were followed up until completion of therapy and resolution of the tuberculoma/s. The predictive factors analyzed were the number of lesions (solitary vs. multiple), location (infratentorial vs. supratentorial and infratentorial), previous ATT treatment (yes vs. no), surgery (yes vs. no), and size of the lesion (≤2.5 cm vs. >2.5 cm). RESULTS Of the 86 patients, 19 (22%) received ATT for >2 years. On multivariate analysis, multiple lesions were significantly associated with the need for prolonged ATT (P = 0.02). Size of the tuberculoma showed a trend toward significance (P = 0.06), with tuberculomas >2.5cm having a 3.68 times increased risk of requiring prolonged ATT. CONCLUSIONS Although 78% of brain tuberculomas resolve with 12-24 months of ATT, 22% required >24 months of ATT. Multiple tuberculomas had significant association with prolonged ATT, with a median duration of resolution of 36 months. Because tuberculomas >2.5 cm were likely to need longer duration of ATT, brain tuberculomas that require surgery should be excised totally or reduced in size to <2.5 cm to enable early resolution.
Collapse
Affiliation(s)
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| |
Collapse
|
18
|
Magnetic resonance imaging spectrum of intracranial tubercular lesions: one disease, many faces. Pol J Radiol 2018; 83:e524-e535. [PMID: 30800191 PMCID: PMC6384409 DOI: 10.5114/pjr.2018.81408] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/19/2018] [Indexed: 12/13/2022] Open
Abstract
Tuberculosis is a devastating disease and has shown resurgence in recent years with the advent of acquired immunodeficiency syndrome. Central nervous system involvement is the most devastating form of the disease, comprising 10% of all tuberculosis cases. The causative organism, Mycobacterium tuberculosis, incites a granulomatous inflammatory response in the brain, the effects of which can be appreciated on magnetic resonance imaging (MRI), which can thus be used for diagnosis of the same. Neurotuberculosis can present in various patterns, which can be identified on MRI. The meningeal forms include leptomeningitis and pachymeningitis. Parenchymal forms of neurotuberculosis include tuberculoma in its various stages, tubercular cerebritis and abscess, tubercular rhombencephalitis, and tubercular encephalopathy. Each pattern has characteristic MRI appearances and differential diagnoses on imaging. Complications of neurotuberculosis, usually of tubercular meningitis, include hydrocephalus, vasculitis, and infarcts as well as cranial nerve palsies. Various MRI sequences besides the conventional ones can provide additional insight into the disease, help in quantifying the disease load, and help in differentiation of neurotuberculosis from conditions with similar imaging appearances and presentations. These can enable accurate and timely diagnosis by the radiologist and early institution of treatment in order to reduce the likelihood of permanent neurological sequelae.
Collapse
|
19
|
Ramachandran R, Muniyandi M, Iyer V, Sripriya T, Priya B, Govindarajan T. Dilemmas in the diagnosis and treatment of intracranial tuberculomas. J Neurol Sci 2017; 381:256-264. [DOI: 10.1016/j.jns.2017.08.3258] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/09/2017] [Accepted: 08/24/2017] [Indexed: 11/30/2022]
|
20
|
Buré L, Boucher LM, Blumenkrantz M, Schob S, Lafaye de Micheaux P, Reinhold C, Gallix B. Can magnetic resonance spectroscopy differentiate malignant and benign causes of lymphadenopathy? An in-vitro approach. PLoS One 2017; 12:e0182169. [PMID: 28792506 PMCID: PMC5549694 DOI: 10.1371/journal.pone.0182169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/13/2017] [Indexed: 11/23/2022] Open
Abstract
Lymphadenopathy continues to be a common problem to radiologists and treating physicians because of the difficulty in confidently categorizing a node as being benign or malignant using standard diagnostic techniques. The goal of our research was to assess whether magnetic resonance (MR) spectroscopy contains the necessary information to allow differentiation of benign from malignant lymph nodes in an in-vitro approach using a modern pattern recognition method. Tissue samples from a tissue bank were analyzed on a nuclear magnetic resonance (NMR) spectrometer. A total of 69 samples were studied. The samples included a wide variety of malignant and benign etiologies. Using 45 samples, we initially created a model which was able to predict if a certain spectrum originates from benign or malignant lymph nodes using a pattern-recognition technique which takes into account the entire magnetic spectrum rather than single peaks alone. The remaining 24 samples were blindly loaded in the model to assess its performance. We obtained an excellent accuracy in differentiating benign and malignant lymphadenopathy using the model. It correctly differentiated as malignant or benign, in a blinded fashion, all of the malignant samples (13 of 13) and 10 out of the 11 benign samples. We thus showed that magnetic spectroscopy is able to differentiate benign from malignant causes of lymphadenopathy. Additional experiments were performed to verify that the differentiating abilities of our model were not due to differential tissue decay in between benign and malignant tissues. If future experiments demonstrate that a similar approach could be executed with standard MR imaging, this technique could be useful as a problem-solving tool when assessing lymphadenopathy in general. Alternatively, our in-vitro technique could also be useful to pathologists faced with indeterminate pathologies of the lymph nodes after validating our results with a larger sample size.
Collapse
Affiliation(s)
- Lionel Buré
- Department of Radiology, McGill University Health Center, Montreal General Hospital, Montreal, Qc, Canada
| | - Louis-Martin Boucher
- Department of Radiology, McGill University Health Center, Montreal General Hospital, Montreal, Qc, Canada
| | - Miriam Blumenkrantz
- Department of Adult and Pediatric Pathology, McGill University Health Center, Royal Victoria Hospital, Montreal, Qc, Canada
| | - Stefan Schob
- Department of Neuroradiology, Leipzig University Hospital, Leipzig, Germany
| | | | - Caroline Reinhold
- Department of Radiology, McGill University Health Center, Montreal General Hospital, Montreal, Qc, Canada
| | - Benoit Gallix
- Department of Radiology, McGill University Health Center, Montreal General Hospital, Montreal, Qc, Canada
- * E-mail:
| |
Collapse
|
21
|
Li H, Xu Y, Shi W, Li F, Zeng Q, Yi C. Assessment of alterations in X-ray irradiation-induced DNA damage of glioma cells by using proton nuclear magnetic resonance spectroscopy. Int J Biochem Cell Biol 2017; 84:109-118. [PMID: 28122253 DOI: 10.1016/j.biocel.2017.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/15/2017] [Accepted: 01/18/2017] [Indexed: 12/25/2022]
Abstract
Glioma is one of the most common types of brain tumors. DNA damage is closely associated with glioma cell apoptosis induced by X-ray irradiation. Alterations of metabolites in glioma can be detected noninvasively by proton nuclear magnetic resonance (1H NMR) spectroscopy. To noninvasively explore the micro mechanism in X-ray irradiation-induced apoptosis, the relationship between metabolites and DNA damage in glioma cells was investigated. Three glioma cell lines (C6, U87 and U251) were randomly designated as control (0Gy) and treatment groups (1, 5, 10, 15Gy). After X-ray exposure, each group was separated into four parts: (i) to detect metabolites by 1H NMR spectroscopy; (ii) to make cell colonies; (iii) to detect cell cycle distribution and apoptosis rate by flow cytometry; and (iv) to measure DNA damage by comet assay. The metabolite ratios of lactate/creatine and succinate/creatine decreased (lactate/creatine: C6, 22.17-66.27%; U87, 15.93-44.56%; U251, 26.27-74.48%. succinate/creatine: C6, 14.41-48.35%; U87, 22.03-70.62%; U251, 17.33-60.06%) and choline/creatine increased (C6, 52.22-389.68%; U87, 56.15-82.36%; U251, 31.87-278.62%) in the treatment groups compared with the control group (each P<0.05), which linearly depended on DNA damage. An increasing dose of X-ray irradiation increased numbers of apoptotic cells (P<0.01), and the DNA damage parameters were dose-dependent (P<0.05). The colony-forming rate declined (P<0.01) and the percentage of cells at G1 stage increased when exposed to 1Gy X-ray (three cell lines, P<0.05). Metabolite alterations detected by 1H NMR spectroscopy can be used to determine DNA damage induced by X-ray irradiation. 1H NMR spectroscopy is a noninvasive method to predict DNA damage of glioma cell at the micro level.
Collapse
Affiliation(s)
- Hongxia Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yanjie Xu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Wenqi Shi
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Fuyan Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Qingshi Zeng
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China.
| | - Cui Yi
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| |
Collapse
|
22
|
Rapalino O, Ratai EM. Multiparametric Imaging Analysis: Magnetic Resonance Spectroscopy. Magn Reson Imaging Clin N Am 2016; 24:671-686. [PMID: 27742109 DOI: 10.1016/j.mric.2016.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Magnetic resonance spectroscopy (MRS) is a magnetic resonance-based imaging modality that allows noninvasive sampling of metabolic changes in normal and abnormal brain parenchyma. MRS is particularly useful in the differentiation of developmental or non-neoplastic disorders from neoplastic processes. MRS is also useful during routine imaging follow-up after radiation treatment or during antiangiogenic treatment and for predicting outcomes and treatment response. The objective of this article is to provide a concise but thorough review of the basic physical principles, important applications of MRS in brain tumor imaging, and future directions.
Collapse
Affiliation(s)
- O Rapalino
- Neuroradiology Division, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - E M Ratai
- Neuroradiology Division, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA; MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Building 149, 13th Street, Room 2301, Charlestown, MA 02129, USA.
| |
Collapse
|
23
|
Meyer HJ, Schramm D, Kunze C, Holzhausen HJ, Kornhuber M, Surov A. Headache as the leading symptom in a case of cerebral tuberculosis. Neuroradiol J 2016; 29:236-9. [PMID: 27000208 DOI: 10.1177/1971400916639965] [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: 11/15/2022] Open
Abstract
The advent of new and acute headaches poses a diagnostic challenge. The differential diagnosis comprises numerous diseases and syndromes, the prevalence of which varies depending on the geographical region. Due to increased magnitudes in international migration, the usual differential diagnostic spectrum has to be enlarged in individual cases. The presented case illustrates this dilemma and shows that, for example, tuberculosis deserves to be taken into consideration.
Collapse
Affiliation(s)
- Hans-Jonas Meyer
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Dominik Schramm
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Christian Kunze
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | | | - Malte Kornhuber
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Alexey Surov
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| |
Collapse
|