3-dimensional evaluation of lateral ventricle volumes of schizophrenia patients and investigation of the subgroups

Introduction

The thought of greater loss of brain tissue in Deficit Syndrome (DS) i.e. subgroup of schizophrenia with enduring primary negative symptoms defined by Carpenter et al.; this has not been verified by recent studies.

Objective

Accumulated researches suggest that enlargement in Lateral Ventricles (LV) is related with current negative symptoms and poor prognosis. However, this has not been validated in DS.

Aims

Our aim is to study the association between the enduring negative symptoms and LV changes schizophrenia. We included both deficit and non-deficit patients for comparison with controls.

Methods

Forty-five patients (18 DS, 27 non-DS) and 37 healthy controls were recruited, evaluated for positive and negative symptoms, depression and extrapyramidal symptoms. Structural magnetic resonance imaging was performed. LV was assessed by MANCOVA (gender, age total brain volume as confounding factors) in 3-dimensional (3D) shape analyses. Correlations between clinical and imaging data were analyzed by Pearson correlation coefficient; P > 0.05 being significant.

Results

LV of patients was found to be greater than controls, especially in regions adjacent to parietal and temporal regions but no significant difference between subgroups was detected. Enlargement in right LV by corpus callosum adjacency was found in DS. There was no correlation between negative symptoms and LV volume.

Conclusions

The idea of greater amount of LV enlargement in patients with predominant negative symptoms could not be observed in 3D analyses. New pathophysiological theories are needed for the explanation of negative symptoms, loss of functioning and poor prognosis rather than only commenting about tissue decrease/loss.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Brucellar spondylodiscitis: magnetic resonance imaging features with conventional sequences and diffusion-weighted imaging

PURPOSE

In this retrospective study, we evaluated the contribution and role of diffusion-weighted imaging (DWI) in differentiating acute and chronic forms of brucellar spondylodiscitis. We also describe the characteristics and some indistinguishable features of brucellar spondylodiscitis on magnetic resonance imaging (MRI) to emphasise the importance and limitations of MRI.

MATERIALS AND METHODS

MRI examinations of 25 patients with brucellar spondylodiscitis were retrospectively reviewed and analysed by two experienced radiologists. Signal and morphological changes were assessed. The imaging characteristics of acute and chronic forms of spondylodiscitis were compared. Both discriminative imaging findings of brucellar spondylodiscitis and some uncommon findings were interpreted.

RESULTS

Of 25 patients with spinal brucellosis, eight had thoracic, ten had lumbar, five had both thoracic and lumbar and two had both lumbar and sacral vertebral involvement. We detected posterior longitudinal ligament elevation in 11 patients, epidural abscess formation in 11 and paravertebral abscess formation in nine. Ten patients had cord compression and eight had root compression. Three patients had facet-joint involvement, and one had erector spinae muscle involvement. Eight patients (32%) were in the acute stage, six (24%) in the subacute stage and 11 (44%) in the chronic stage. Vertebral bodies, vertebral end plates and intervertebral disc spaces were hypointense and hyperintense in the acute stage, whereas they were hypointense and heterogeneous in the subacute and chronic stages on T1- and T2-weighted images, respectively. In the acute stage on the DWI series, vertebral bodies, end plates and discs were all hyperintense but hypointense in the chronic stage.

CONCLUSIONS

Although conventional MRI has several advantages over other imaging modalities and is very useful in the differential diagnosis between brucellar spondylodiscitis and other spinal pathologies, it has some difficulties in discriminating acute and chronic forms of spondylodiscitis. DWI is a sensitive, fast sequence that has the potential for differentiating acute and chronic forms of spondylodiscitis, which makes it crucial in spinal imaging.

Cerebral cortical and deep venous thrombosis without sinus thrombosis: clinical MRI correlates

BACKGROUND

Cortical and/or deep vein thrombosis (CDVT) without dural sinus involvement is uncommon and presents diagnostic difficulty for many reasons. Our aim is to determine the relationship between magnetic resonance imaging (MRI) findings and clinical findings in patients with CDVT.

METHODS

Forty-six patients with venous stroke proved on MRI included in our Registry, corresponding to 0.1% of 4650 patients with stroke, were studied. Magnetic resonance angiography (MRA) was performed in all patients, and 18 of them had follow-up MRA. Outcome was evaluated by using the Glasgow Outcome Scale at the time of discharge and during follow-up.

RESULTS

Thirty-two patients presented cortical venous stroke; 21 of them had involvement of the dorsomedial venous system, six had a defect in the posteroinferior venous group, and five had a defect in the anteroinferior venous group. Thirteen patients presented simultaneous involvement of the superficial and deep venous system; seven with a defect in the parietal and internal cerebral veins (three with involvement of vein of Gallen), four with a defect in the temporooccipital (vein of Labbé) and basal vein of Rosenthal, two with a deficit in the anterior frontotemporal and uncal-pterygoid venous system. One patient had deep venous thrombosis primarily localized to the thalami bilaterally and the basal ganglia on the right because of occlusion of the thalamostriate veins. The main presenting symptoms of CDVT were headache, focal neurologic signs, partial complex or secondary generalized seizures, and consciousness disturbances in those with deep venous thrombosis, presented alone or in combination at onset. CDVT was more than twofold more frequent in women than in men. Pregnancy, puerperium, oral contraceptive use, and infections were the most common predisposing factors.

CONCLUSION

Computerized tomography, conventional MRI and diffusion-weighted imaging showing ischemic and/or hemorrhagic lesion that does not follow the boundary of classical arterial boundaries without signs of sinus thrombosis, and partial or generalized seizures followed by focal neurologic signs may predict CDVT. The outcome of patients with cortical venous stroke was good, but not in those with cortical plus deep venous infarction.

Traumatic Nerve Root Avulsion and Pseudomeningocele Diagnosed by Three Dimensional MRI Technique (CISS Sequence)

This case report demonstrates the importance of the CISS sequence, a fast imaging technique in MRI, in case of suspected nerve root avulsion. We present a case of traumatic pseudomeningoceles at T1-T2 root levels with right T2 ventral root avulsion without associated skeletal fracture diagnosed by MRI using the three dimensional CISS technique. A 28-year-old man presented to the Emergency Department following a motorcycle accident. Clinical examination revealed paresis in intrinsic muscles of the right hand. Traumatic pseudomeningoceles at T1-T2 root levels bilaterally with right T2 ventral root avulsion without associated skeletal fracture were diagnosed by three dimensional cervicothoracic MRI with CISS technique.

Identification of axonal involvement in Hallervorden-Spatz disease with magnetic resonance spectroscopy

Hallervorden-Spatz disease is a neurodegenerative disorder associated with cysteine-iron complex accumulation typically seen as bilateral symmetrical hypointense signal changes in the medial globus pallidus on magnetic resonance imaging. We used magnetic resonance spectroscopy to identify and quantify neuronal damage in two siblings with Hallervorden-Spatz disease. The first patient presenting with a rapidly progressive extrapyramidal syndrome had markedly decreased N-acetylaspartate (NAA) to creatinine (Cr) ratios in the globus pallidi and the periatrial white matter. He also had increased myoinositol (mI) to creatinine (Cr) ratios implying glial proliferation in the affected regions. However the second patient who had the initial presentation of disease had normal NAA/Cr and mI/Cr ratios. These findings indicate that the quantification of NAA:Cr and mI:Cr ratios might be used to predict the extent of neuronal axonal loss and glial proliferation in patients with Hallervorden-Spatz disease respectively.

Role of the constructive interference in steady-state sequence in the classification of sacral meningeal cysts

PURPOSE

To investigate the role of the CISS (constructive interference in steady state) sequence in sacral meningeal cysts.

MATERIAL AND METHODS

Fourteen patients with sacral meningeal cysts were included. Conventional T1W and T2W sequences and the CISS sequence (TR/TE = 12.25/5.90) were obtained at 1.5-T. The 1-mm-thick base images and multiplanar reformatted images of the CISS sequence were studied. The sacral meningeal cysts were classified by the CISS sequence in accordance with the previously described surgical and histopathological criteria.

RESULTS

A total of 25 sacral meningeal cysts were identified in the 14 patients. The cysts and their contents were visualized by the CISS sequence, and the CISS sequence was superior to the T1W and T2W images. Fifteen of the cysts were consistent with type I lesions (extradural meningeal cysts without nerve fibers inside) and 10 cysts with type II lesions (extradural meningeal cysts with nerve fibers inside). There were no type III lesions (intradural meningeal cysts) in the sacral region.

CONCLUSION

Previous studies have indicated that conventional MRI as well as magnetic resonance myelography are inconsistent for a classification of sacral meningeal cysts. The CISS sequence with its capability to obtain T2W thin slice acquisitions is superior in showing the nerve root fibers contained in the cysts, which is essential in the differentiation of type I and II cysts. Application of the CISS sequence is recommended in the diagnosis of sacral meningeal cysts.

Wallenberg's lateral medullary syndrome: diffusion-weighted imaging findings

PURPOSE

To investigate the efficacy of diffusion-weighted imaging in patients with Wallenberg's lateral medullary syndrome.

MATERIAL AND METHODS

Thirteen patients with Wallenberg's lateral medullary syndrome were examined with conventional and echoplanar diffusion-weighted magnetic resonance (MR) imaging in a 1.5 T magnetic resonance unit. MR examinations were obtained in the acute or subacute stage of clinical syndrome, and diffusion-weighted imaging (DWI) was considered to be positive for infarction when an increase in signal was seen on b = 1000 s/mm2 images in the posterolateral medullary localization.

RESULTS

DWIs were positive in 12 patients in the acute or subacute stages of this clinical syndrome. A false-negative result was obtained in only one patient examined within the first day, 10 h after onset of the symptoms. In the visual evaluation of the DWI, the contrast between normal and infarcted brainstem area was better in the high b-value images than in the apparent diffusion coefficient map images.

CONCLUSION

DWI is a valuable technique for examining patients presenting with the signs and symptoms of Wallenberg's syndrome and high b-value images can provide complementary data to T2-weighted images. However, because most of our case group were in either the acute or subacute stage, true sensitivity of the method in the hyperacute stage of the syndrome remains unclear.

Report of diffusion-weighted MRI in two cases with different cerebral hydatid disease

PURPOSE

To present MRI findings in two cases of cerebral hydatid disease with an emphasis on diffusion-weighted imaging (DWI) findings of Echinococcus granulosus (EG) versus Echinococcus alveolaris (EA).

RESULTS

EG lesions were isointense with cerebrospinal fluid in all sequences including DWI. On DWI, EA lesions remained hypointense on b = 1000 s/mm2 diffusion-weighted images. Apparent diffusion coefficient (ADC) values of EG and EA lesions were completely different from each other, 2.88 +/- 0.24 x 10(-3) s/mm2 and 1.33 +/- 0.15 x 10(-3) s/mm2, respectively.

CONCLUSION

The ADC values could not be used to discriminate from other differential diagnoses.

Multiple, primary spinal-paraspinal hydatid cysts

A patient is presented with widespread primary hydatid cysts in spinal-paraspinal locations, secondary to Echinococcus granulosus. An alternative mechanism to explain how the embryos gained access to the body is proposed: The embryos penetrated the intestinal muscle and may have directly entered into the inferior vena cava system through small venous connections between this system and portal circulation. Various conditions in daily life associated with Valsalva maneuver might have caused such an atypical passage of the embryos to the inferior caval system toward the retroperitoneum and spinal-paraspinal structures via lumber epidural venous plexuses.

Proton MR spectroscopy in Rett syndrome

Seven patients (mean age 7.7yr) with Rett syndrome, a condition with progressive regression of psychomotor development are included in this study. Proton MR spectroscopy images were obtained with the multivoxel chemical-shift imaging mode (TR=1500ms, TE=40ms). Spectra from 224 voxels in the brain parenchyma were studied. N-acetyl aspartate (NAA), creatine (Cr), choline (Cho), and myoinositol (mI) peaks were quantitatively evaluated, and NAA/Cr, NAA/Cho, and Cho/Cr, mI/Cr ratios were calculated. Five age-matched normal cases were available as controls. In three patients with Rett syndrome spectroscopy findings were normal, and the metabolite ratios were similar to control cases. In the remaining four patients with the syndrome prominent decrease of the NAA peak was the main finding resulting in decreases in NAA/Cr (1.14+/-17), and NAA/Cho (1.08+/-27) ratios (p<0.0001). Cho/Cr ratios (0.93+/-26), and mI/Cr ratios (0.88+/-36) were normal compared to controls. There was no correlation between spectroscopic changes and clinical status of the patients. The findings suggested that not only reduced neuronal-dendritic arborizations but also decreased neuronal function could contribute to spectroscopy changes in Rett syndrome.

Proton MR spectroscopy in the diagnosis and differentiation of encephalitis from other mimicking lesions

In this study, proton magnetic resonance spectroscopy (1H MRS) findings of encephalitis were reported. For comparison, other lesions mimicking encephalitis on conventional magnetic resonance (MR) imaging were included in the study. These lesions consisted of acute infarctions and low grade infiltrative gliomas. The 1H MRS findings of encephalitis and gliomas were almost the same whereas infarctions revealed high lactate levels differentiating the disorder from other two pathologies. The differentiation of encephalitis and gliomas based on MR findings could reliably made with short time follow up MR examinations where gliomas tend to grow in contrast to encephalitis which showed regression.

Mesenteric Castleman's disease: case report

An asymptomatic case of hyaline vascular-type Castleman's disease localized to the mesentery and detected incidentally by ultrasound is presented. Computed tomographic, angiographic, and histologic findings are reported. This type of Castleman's disease predominates in the thorax and is very rare in the mesentery.