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Orman G, Kralik SF, Battini R, Buchignani B, Desai NK, Goetti R, Meoded A, Mitter C, Wallacher-Scholz B, Boltshauser E, Huisman TAGM. Neuroimaging Features of Ectopic Cerebellar Tissue: A Case Series Study of a Rare Entity. AJNR Am J Neuroradiol 2021; 42:1167-1173. [PMID: 34255731 DOI: 10.3174/ajnr.a7105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/05/2021] [Indexed: 11/07/2022]
Abstract
Ectopic cerebellar tissue is a rare entity likely secondary to multiple, interacting, developmental errors during embryogenesis. Multiple sites of ectopic cerebellar tissue have been reported, including extracranial locations; however, an intracranial location is most common. We report on the MR imaging findings of a multi-institutional series of 7 ectopic cerebellar tissue cases (2 males, 4 females, 1 fetal) ranging from 22 weeks 5 days' gestational age to 18 years of age. All cases of ectopic cerebellar tissue were diagnosed incidentally, while imaging was performed for other causes. Ectopic cerebellar tissue was infratentorial in 6/7 patients and supratentorial in 1/7 patients. All infratentorial ectopic cerebellar tissue was connected with the brain stem or cerebellum. MR imaging signal intensity was identical to the cerebellar gray and white matter signal intensity on all MR imaging sequences in all cases. Ectopic cerebellar tissue should be considered in the differential diagnoses of extra-axial masses with signal characteristics similar to those of the cerebellum. Surgical biopsy or resection is rarely necessary, and in most cases, MR imaging is diagnostic.
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Affiliation(s)
- G Orman
- From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., A.M., T.A.G.M.H.), Texas Children's Hospital, Houston, Texas
| | - S F Kralik
- From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., A.M., T.A.G.M.H.), Texas Children's Hospital, Houston, Texas
| | - R Battini
- Department of Developmental Neuroscience (R.B.), Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine (R.B., B.B.), University of Pisa, Pisa, Italy
| | - B Buchignani
- Department of Clinical and Experimental Medicine (R.B., B.B.), University of Pisa, Pisa, Italy
| | - N K Desai
- From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., A.M., T.A.G.M.H.), Texas Children's Hospital, Houston, Texas
| | - R Goetti
- Department of Medical Imaging (R.G.), The Children's Hospital at Westmead, The University of Sydney, Sydney, Australia
| | - A Meoded
- From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., A.M., T.A.G.M.H.), Texas Children's Hospital, Houston, Texas
| | - C Mitter
- Department of Biomedical Imaging and Image-Guided Therapy (C.M.), Medical University of Vienna, Vienna, Austria
| | - B Wallacher-Scholz
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity (B.W.-S.), Dr. von Hauner Children's Hospital, LMU University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - E Boltshauser
- Department of Pediatric Neurology (E.B.), University Children's Hospital Zürich, Zurich, Switzerland
| | - T A G M Huisman
- From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., A.M., T.A.G.M.H.), Texas Children's Hospital, Houston, Texas
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Prat Matifoll JA, Wilson M, Goetti R, Birman C, Bennett B, Peadon E, Prats-Uribe A, Prelog K. A Case Series of X-Linked Deafness-2 with Sensorineural Hearing Loss, Stapes Fixation, and Perilymphatic Gusher: MR Imaging and Clinical Features of Hypothalamic Malformations. AJNR Am J Neuroradiol 2020; 41:1087-1093. [PMID: 32409310 DOI: 10.3174/ajnr.a6541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/20/2020] [Indexed: 11/07/2022]
Abstract
X-linked deafness-2 (DFNX2) is an X-linked recessive disorder characterized by profound sensorineural hearing loss and a pathognomonic temporal bone deformity. Because hypothalamic malformations associated with DFNX2 have been rarely described, we aimed to further describe these lesions and compare them with features of a nonaffected population. All patients diagnosed with DFNX2 between 2006 and 2019 were included and compared with age-matched patients with normal MR imaging findings and without hypothalamic dysfunction. MR imaging features differing between groups were selected to help identify DFNX2. Sensitivity and specificity were calculated for these features. Agreement among 3 radiologists was quantified using the index κ. Information on the presence or absence of gelastic seizures, precocious puberty, or delayed puberty was also gathered. We selected distinctive MR imaging features of hypothalamic malformations in DFNX2. The feature selected on axial T2 images was the folded appearance of the ventromedial hypothalamus (sensitivity, 100%; specificity, 95.8%) characterized by an abnormal internal/external cleft (sensitivity, 100%; specificity, 95.7%). On coronal T2, the first distinctive feature was a concave morphology of the medial eminence (sensitivity, 100%; specificity, 97.1%), the second feature was at least 1 hypothalamic-septum angle ≥90° (sensitivity, 90%; specificity, 72.5%), and the third feature was a forebrain-hypothalamic craniocaudal length of ≥6 mm (sensitivity, 70%; specificity, 79.7%). Clinical features were also distinctive because 9 patients with DFNX2 did not present with gelastic seizures or precocious puberty. One patient had delayed puberty. The κ index and intraclass correlation coefficient ranged between 0.78 and 0.95. Imaging and clinical features of the hypothalamus suggest that there is a hypothalamic malformation associated with DFNX2. Early assessment for pubertal delay is proposed.
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Affiliation(s)
| | | | - R Goetti
- Radiology Department (R.G.), University of Sydney, Children's Hospital at Westmead (Sydney), Westmead, New South Wales, Australia
| | | | | | - E Peadon
- Deafness Centre (E.P.); Children's Hospital at Westmead (Sydney), Westmead, New South Wales, Australia
| | - A Prats-Uribe
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (A.P.-U.), Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK
| | - K Prelog
- From the Departments of Radiology (J.-A.P.M., K.P.)
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Goetti R, Warnock G, Kuhn FP, Guggenberger R, O'Gorman R, Buck A, Khan N, Scheer I. Quantitative cerebral perfusion imaging in children and young adults with Moyamoya disease: comparison of arterial spin-labeling-MRI and H(2)[(15)O]-PET. AJNR Am J Neuroradiol 2013; 35:1022-8. [PMID: 24335546 DOI: 10.3174/ajnr.a3799] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral perfusion assessment is important in the preoperative evaluation and postoperative follow-up of patients with Moyamoya disease. The objective of this study was to evaluate the correlation of quantitative CBF measurements performed with arterial spin-labeling-MR imaging and H2[(15)O]-PET in children and young adults with Moyamoya disease. MATERIALS AND METHODS Thirteen children and young adults (8 female patients; age, 9.7 ± 7.1 years; range, 1-23 years) with Moyamoya disease underwent cerebral perfusion imaging with H2[(15)O]-PET (Discovery STE PET/CT, 3D Fourier rebinning filtered back-projection, 128 × 128 × 47 matrix, 2.34 × 2.34 × 3.27 mm(3) voxel spacing) and arterial spin-labeling (3T scanner, 3D pulsed continuous arterial spin-labeling sequence, 32 axial sections, TR = 5.5 seconds, TE = 25 ms, FOV = 24 cm, 128 × 128 matrix, 1.875 × 1.875 × 5 mm(3) voxel spacing) within less than 2 weeks of each other. Perfusion of left and right anterior cerebral artery, MCA, and posterior cerebral artery territories was qualitatively assessed for arterial spin-labeling-MR imaging and H2[(15)O]-PET by 2 independent readers by use of a 3-point-Likert scale. Quantitative correlation of relative CBF with cerebellar normalization between arterial spin-labeling-MR imaging and H2[(15)O]-PET was evaluated in a volume-based approach for each vascular territory after 3D image coregistration. RESULTS Interreader agreement was good (κ = 0.67-0.69), and strong and significant correlations were found between arterial spin-labeling-MR imaging and H2[(15)O]-PET for both qualitative perfusion scoring (ρ = 0.77; P < .001) and quantitative perfusion assessment of relative CBF with cerebellar normalization (r = 0.67, P < .001). CONCLUSIONS In children and young adults with Moyamoya disease, quantitative evaluation of CBF is possible with the use of arterial spin-labeling-MR imaging without ionizing radiation or contrast injection with a good correlation to H2[(15)O]-PET after cerebellar normalization.
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Affiliation(s)
- R Goetti
- From the Departments of Diagnostic Imaging (R. Goetti, R. Guggenberger, I.S.)Diagnostic and Interventional Radiology (R. Goetti, F.P.K., R. Guggenberger)
| | - G Warnock
- Nuclear Medicine (G.W., F.P.K., A.B.)
| | - F P Kuhn
- Diagnostic and Interventional Radiology (R. Goetti, F.P.K., R. Guggenberger)Nuclear Medicine (G.W., F.P.K., A.B.)
| | - R Guggenberger
- From the Departments of Diagnostic Imaging (R. Goetti, R. Guggenberger, I.S.)Diagnostic and Interventional Radiology (R. Goetti, F.P.K., R. Guggenberger)
| | | | - A Buck
- Nuclear Medicine (G.W., F.P.K., A.B.)
| | - N Khan
- the Moyamoya Center, Division of Neurosurgery, Department of Surgery (N.K.), University Children's Hospital Zurich, Zurich, Switzerland
| | - I Scheer
- From the Departments of Diagnostic Imaging (R. Goetti, R. Guggenberger, I.S.)
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Bertholdt S, Latal B, Liamlahi R, Pretre R, Scheer I, Goetti R, Dave H, Bernet V, Schmitz A, von Rhein M, Knirsch W. Cerebral lesions on magnetic resonance imaging correlate with preoperative neurological status in neonates undergoing cardiopulmonary bypass surgery. Eur J Cardiothorac Surg 2013; 45:625-32. [DOI: 10.1093/ejcts/ezt422] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schindera S, Winklehner A, Alkadhi H, Goetti R, Fischer M, Gnannt R, Szucs-Farkas Z. Effect of automatic tube voltage selection on image quality and radiation dose in abdominal CT angiography of various body sizes: A phantom study. Clin Radiol 2013; 68:e79-86. [DOI: 10.1016/j.crad.2012.10.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 10/03/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
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Gnannt R, Winklehner A, Goetti R, Schmidt B, Kollias S, Alkadhi H. Low kilovoltage CT of the neck with 70 kVp: comparison with a standard protocol. AJNR Am J Neuroradiol 2012; 33:1014-9. [PMID: 22300930 DOI: 10.3174/ajnr.a2910] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CT protocols should aim for radiation doses being as low as reasonably achievable. The purpose of our study was to assess the image quality and radiation dose of neck CT at a tube potential of 70 kVp. MATERIALS AND METHODS Twenty patients (7 female, mean age 51.4 years, age range 19-81 years) underwent contrast-enhanced 64-section CT of the neck at 70 kVp (ATCM, effective tube current-time product 614 eff.mAs, range 467-713 eff.mAs). All 20 patients had a previous neck CT at 120 kVp on the same scanner. Two radiologists assessed image quality and artifacts in the upper, middle, and lower neck. Image noise and attenuation were measured, and the CNR was calculated. Effective radiation dose was calculated. RESULTS Interobserver agreement regarding image quality of soft tissue for 70-kVp and 120-kVp scans was good to excellent. At 70 kVp, soft tissues were of diagnostic image quality in all scans, whereas the lower cervical spine was not of diagnostic quality in 3 and 4 scans per both readers. No difference was found among 70-kVp and 120-kVp scans for soft tissue image quality in the upper neck, while image quality was significantly better in the middle at 70 kVp (P < .05) and better in the lower third at 120 kVp (P < .05). CNR was significantly higher at 70 kVp in all levels for both readers (P < .001). Effective radiation dose at 70 kVp was significantly lower (0.88 ± 0.2 mSv) than at 120 kVp (1.33 ± 0.2 mSv, P < .001). CONCLUSIONS CT of the cervical soft tissues at 70 kVp is feasible, provides diagnostic image quality with improved CNR, and reduces radiation dose by approximately 34% compared with a standard protocol at 120 kVp. In contrast, low kVp CT of the lower cervical spine suffers from compromised image quality.
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Affiliation(s)
- R Gnannt
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Stähli BE, Bonassin F, Goetti R, Küest SM, Frank M, Altwegg LA, Gebhard C, Levis A, Wischnewsky MB, Lüscher TF, Alkadhi H, Kaufmann PA, Maier W. Coronary computed tomography angiography indicates complexity of percutaneous coronary interventions. J Invasive Cardiol 2012; 24:196-201. [PMID: 22562911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) provides information regarding lesion morphology and three-dimensional coronary anatomy incremental to coronary angiography. We addressed the question whether preprocedural CCTA bears potential for guiding percutaneous coronary interventions (PCI). METHODS AND RESULTS Sixty-six coronary lesions attempted with PCI within 6 months of preprocedural CCTA were retrospectively assessed. Lesion parameters from unenhanced computed tomography (CT) for calcium scoring and CCTA were analyzed and compared with PCI complexity. Complex PCI was defined as use of buddy wire, kissing balloon, necessity of high pressure balloons, or rotablator. Complex PCIs were observed in 32 interventions (48%). Median Agatston score and Hounsfield units were higher in lesions with complex as compared to those with non-complex interventions with 130 (interquartile range, 23-276) vs 29 (0-158; P=.01), and 493 (245-631) vs 341 (68-520 Hounsfield Units; P=.04), respectively. Median local plaque volume and plaque mass were higher in complex PCI with 17 (2-39) vs 5 (0-19.5 mm³; P=.007), and 48 (15-99) vs. 16 (1.5-63 mg hydroxyapatite/mm³; P=.03), respectively. Lesions leading to complex PCI were longer [1.8 (1.2-2.8) vs 1.3 (0.8-1.7) cm; P=.03], and had a higher rate of calcified plaques (23% vs 3%; P=.03). There was a significant correlation between CCTA- and angiography-derived local SYNTAX Scores (P<.001); the CCTA-derived score seems to be predictive for failed and complex PCI (area under curve = 0.75 ± 0.13 and 0.66 ± 0.08, respectively). CONCLUSIONS Preprocedural lesion assessment by CCTA indicates complexity of PCI. In patients with suspected complex coronary anatomy, prior CCTA adds important information for planning PCI.
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Affiliation(s)
- B E Stähli
- Department of Cardiology, Cardiovascular Center, University Hospital Zürich, Switzerland
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