bluuebunny/crossref_metadata_2025 huggingface dataset:
Metabolite Profile in Pyramidal Tracts after Ischemic Brain Stroke Assessed by 1H MRS. A Multicenter Study
Authors: Kubas B. , Walecki J. , Kulak W. , Tarsow E. , Drozdowski W. , Pniewski J.
Published: April 2015

The magnitude of the motor deficit in patients with stroke depends not only on the size and location of the destroyed brain tissue, but also on axonal injury in the descending motor pathways which appears after stroke. After cerebral ischemia, there are no visible abnormalities in conventional MRI in the intact pyramidal tracts despite the process of neuronal destruction by Wallerian degeneration. Conventional MRI is not a sensitive test for Wallerian degeneration in the acute or subacute time period as it shows no changes within the first four weeks. Magnetic resonance spectroscopy (MRS) has been used for better quantification of the extent or severity of fibre damage by evaluating metabolite alterations in normal-appearing corticospinal and corticopontal tracts. This study assessed the role of 1H MRS in the detection of changes in cerebral metabolite levels in pyramidal tracts after cortical/ subcortical infarction and to compare metabolite alterations to clinical outcome (assessed by Barthel index, Scandinavian Stroke Scale). The study included 31 patients who had suffered an ischemic cortical/subcortical stroke involving the motor cortex or the descending fibers. Ratios of NAA/Cr, Cho/Cr, lip/Cr and Lac/Cr from internal capsules and cerebral peduncles were measured and compared with clinical status assessed by Barthel index and Scandinavian Stroke Scale (SSS). The ratio of NAA/Cr was significantly decreased (p<0.001) in the normal-appearing ipsilateral internal capsule in comparison with the control group. Cho/Cr and lac/Cr ratios were increased compared to the control group (p?0.019). Decrease of NAA/Cr ratio correlated with clinical status assessed by Barthel index and there was a correlation between clinical improvement (assessed by SSS) and lac/Cr ratio. Tissue metabolite concentrations distant from the infarcted region correlated with the clinical course and had predictive value. Proton MRS is very useful tool for evaluating major changes in metabolite levels in pyramidal tracts after brain stroke.
Posterior Fossa Arteriovenous Pial Fistula: Diagnostic and Endovascular Therapeutic Features
Authors: Izzo R. , Diano A. Alvaro , Lavanga A. , Vassallo P. , Muto M.
Published: April 2015

Intracranial arteriovenous fistulas (AVFs) are rare vascular cerebral lesions composed of one or more corticalpial arterial feeders directly connected with a single draining vein. They differ from the other AV malformations in that they lack a nidus and are located outside the dural leaflets. Because of high flow and pressure AVFs have a high risk of hemorrhage and if untreated cause death in up to 63% of cases. Treatment can be endovascular or microneurosurgical. We describe an infant with hydrocephalus and raised intracranial pressure and MRI findings of a single dilated venous vessel with a proximal varix in the perimedullary spaces confirmed by CT angiography and DSA that found a single artery-single vein fistula we successfully occluded with GDC coils.
Diffuse Cerebral Cortex, Cerebellar Cortex and Basal Ganglia Injury: A Rare MR Imaging Manifestation of Heat Stroke
Authors: Lo Ying-Chun , Yen David H.T. , Guo Wan-Yuo , Yang Chen-Chang
Published: April 2015

We present a case of heat stroke with rare magnetic resonance (MR) imaging manifestations. In addition to abnormal high signals in bilateral cerebellum and basal ganglia seen on T2-weighted MR images (T2WI), the case showed diffuse cerebral cortical high signals on T2WI and diffusion-weighted images (DWI). Heat stroke with diffuse hypoperfusion to the brain due to diversion of blood circulation was hypothesized as the cause of brain injury, including the cerebral cortex.
Emerging Patterns of Diffusion, Perfusion-Weighted MRI and Spectroscopy in Creutzfeldt-Jacob Disease
Authors: Romano A. , Bozzao A. , Tisei P. , Fantozzi L.M.
Published: April 2015

Sporadic Creutzfeldt-Jacob disease (CJD) is a transmissible, progressive, fatal spongiform encephalopathy. Routine MR imaging sequences may show abnormalities in the basal ganglia and cerebral cortex. Recently, several reports claimed that diffusion weighted MRI (DWI) could demonstrate early brain lesions in CJD patients when conventional MR images are normal on T2-weighted sequences. We evaluated the usefulness of DWI, perfusion-weighted MRI (PWI) and spectroscopy to confirm the clinical diagnosis and assess lesion progression in two patients with suspected CJD. We noted a diffuse hypoperfusion in the basal ganglia where ADC values were reduced but spectroscopy values were normal. A strong hypoperfusion was observed in the right head of the caudate nucleus in patient n° 2 where spectroscopy values were abnormal. A typical distribution of hypoperfusion followed the posterior progression of disease. We suggest the hypoperfusion in the areas presenting restricted diffusion probably reflects spongiform degeneration and moderate mass effects from cytotoxic edema.
Central Neurocytoma: Case Report of an 81-Year-Old and Histopathologic Findings
Authors: Brant-Zawadzki G. , Mathews M.S. , Duma C.M. , Kim B. , Chen P. , Heinemann S. , Brant-Zawadzki M.
Published: April 2015

Central Neurocytomas are rare and usually benign tumors found primarily in the lateral ventricles of the brain. Central Neurocytomas are composed of uniform round cells exhibiting neuronal differentiation and are found almost exclusively in young adults between 15 and 60 years of age. The authors report the case of an 81-year-old man with a history of severe psychosis and depression, who presented with progressive confusion and ataxia likely unrelated to a central neurocytoma of his right lateral ventricle. The patient underwent a stereotactic biopsy of the lesion, followed by Gamma Knife radiosurgery. Histopathology showed immunohistological staining for synaptophysin, neuron specific enolase (NSE) and neuronal nuclear antigen (NeuN). A review of published literature on central neurocytomas revealed that this tumor occurs most frequently in young adults with a median age between 25 and 30 years. This pathology has never been reported in patients over the age of 80. Gamma Knife radiosurgery was successful in decreasing the tumor volume by 20% at the four month follow-up, but the fact that the patient died of unrelated occurrences in the elderly cannot be ruled out. Patients with central neurocytomas commonly present with obstructive hydrocephalus and immediate treatment may be necessary to tide over urgent situations.
Characterization of Focal Brain Lesions by Gradient-Echo Arterial Spin-Tagging Perfusion Imaging
Authors: Chai Jyh-Wen , Yang Ming-Shiang , Chen Clayton Chi-Chang , Chiang Chih-Ming , Chu Woei-Chyn
Published: April 2015

A simple gradient-echo arterial spin tagging (GREAST) technique allows for quick assessment of regional tissue perfusion without the need for exogenous contrast agent. The purpose of this prospective study was to validate GREAST imaging in characterizing the regional perfusion status of focal brain lesions by comparing with relative cerebral blood volume (rCBV) maps obtained by using echo-planar imaging (EPI)–based dynamic susceptibility contrast MR imaging. Thirty-two patients whose nonenhanced brain MR images showed 34 focal brain lesions during routine examination were selected to immediately undergo GREAST and dynamic susceptibility contrast MR imaging to evaluate regional perfusion of the lesions. The Pearson correlation coefficient was used to test the relative quantification of local perfusion with the two imaging methods. Qualitative perfusion measurements agreed in 23 (79%) of 29 lesions for which GREAST and dynamic susceptibility contrast MR imaging were successful. On rCBV maps, six focal lesions with local hemorrhage were underestimated. In three patients with metal surgical implants, lesions could not be measured because of susceptibility artifacts and distortion on EPIs. After these lesions were excluded, the Pearson correlation coefficient between relative quantitative perfusion measurements on GREAST images versus rCBV maps was about 0.90 (p value = 0.000). The success rate of GREAST imaging was 94% (30 of 32 patients), higher than that of dynamic susceptibility contrast MR imaging (72%, or 23 of 32 patients). GREAST imaging was comparable to rCBV mapping for the relative quantification of regional perfusion of focal brain lesions. This technique may be useful in routine MR examination for characterizing the regional perfusion of brain focal lesions.
Multiple Intracranial Hemorrhages after Evacuation of Bilateral Subdural Effusions
Authors: Hsieh Cheng-Ta , Chiang Yung-Hsiao , Tsai Tung-Han , Chen Cheng-Yu , Su Yih-Huei
Published: April 2015

Postoperative intracerebral hemorrhages occurring after evacuation of subdural fluid collections have been infrequently reported and remain a devastating complication. The pathophysiological mechanism is still unclear. Disturbed autoregulation and restoration of normal cerebral flow seems to play an important role in this type of event because of rapid decompression. Herein, we present a case of multiple intracerebral hemorrhages in the putamen and cerebellar hemisphere following evacuation of bilateral subdural effusions, and review the relevant literature.
Middle Cerebral Artery Occlusion Causing Intracerebral Hemorrhage: Radiologic Findings
Authors: Ueno M. , Uchino A. , Egashira R. , Nomiyama K. , Takase Y. , Kudo S.
Published: April 2015

Middle cerebral artery (MCA) occlusion usually leads to cerebral infarction but rarely causes cerebral hemorrhage without infarction. We retrospectively investigated the unique radiographic manifestations in cases of cerebral hemorrhage without infarction. Computed tomography (CT) and angiographic images obtained in four patients (aged 26 to 70 years) with MCA occlusion associated with intracerebral hemorrhage were reviewed. Two patients also underwent magnetic resonance imaging (MRI), and one of these underwent magnetic resonance angiography as well; these images were also examined. Cranial CT revealed periventricular hemorrhage with ventricular penetration in one patient and with putaminal penetration in two. Solitary ventricular hemorrhage was found in the fourth patient. Angiography showed ipsilateral occlusion at the M1 portion of the MCA, accompanied by moyamoya-like vessels. No aneurysm or arteriovenous malformation was detected. MRI showed absence of the flow void in the affected MCA and an abnormal flow void in dilated collateral vessels in the basal ganglia. MCA occlusion can cause periventricular or ventricular hemorrhage, which appears to result from bleeding from fragile dilated collateral vessels and, thus, to have an etiology similar to that of adult moyamoya disease. MRI shows promise as a tool for evaluating the occlusion site.
MR Spectroscopy Findings in Lhermitte-Duclos Disease
Authors: Anik Y. , Anik I. , Koc K. , Inan N. , Akansel G. , Demirci A.
Published: April 2015

Lhermitte-Duclos disease (LDD) is a rare hamartomatous focal or diffuse enlargement of the cerebellum with unclear etiology. The characteristic magnetic resonance imaging (MRI) appearance consists of a non-enhancing mass in the cerebellar hemisphere with a striated pattern. The slow growing behavior of this benign lesion is characteristic. In a few reports on magnetic resonance spectroscopy (MRS) findings in LDD, a decreased level of N-acetyl aspartate, increased level of lactate and near normal level of choline were described. The information obtained from MRS is useful to confirm the relatively benign hamartomatous nature of the lesion. This paper reports a case of LDD and describes the MRI and MRS findings.
Lhermitte-Duclos Disease with Syringomyelia
Authors: Srinivasan K. , Gaikwad A. , Ushanandhini K.P. , Ritesh K.
Published: April 2015

Dysplastic gangliocytoma is defined as a rare cerebellar mass lesion with malformative, hamartomatous and neoplastic features, arising from cerebellar neurons and affecting the population in early adulthood. Common clinical presentation is in the form of headache, features of raised intracranial tension or hydrocephalus. It may also be found as an incidental lesion. Even though many cases of this disease entity have been reported in literature, its association with syrinx is less commonly highlighted and hence we are reporting these two cases which we encountered at our institute. Presence of an associated syrinx should not deter one to make a preoperative diagnosis of this condition once the striking imaging findings are visualized.
Stenting and Coil Embolization of a Surgically Treated Residual Aneurysm of the Middle Cerebral Artery Bifurcation Associated with Coil Embolization of a Communicating Artery Aneurysm
Authors: Leonardi M. , Dall'olio M. , Stafa A. , De Santis F.
Published: April 2015

We describe the case of a 76-year-old man admitted to our hospital for mild subarachnoid haemorrhage detected by CT scan in an aneurysm of the left middle cerebral artery bifurcation treated surgically 29 years earlier and not completely occluded. Angiography disclosed a further aneurysm in the anterior communicating artery. During the same procedure we treated the residual aneurysm in the left middle cerebral artery bifurcation positioning a Neuroform3 stent (Boston) and embolization deploying two biologically active Cerecyte coils (Balt) for a total of 10 cm and excluding the communicating artery aneurysm from the circulation releasing two active Cerecyte coils for a total length of 30.9 cm. The procedure was well tolerated by the patient and did not give rise to neurological deficits.
Transvenous Embolization of Cavernous Sinus Dural Arteriovenous Fistula with Onyx-18 and Platinum Coils
Authors: Chuhan Jiang , Xianli Lv , Youxiang Li , Aihua Liu , Zhongxue Wu
Published: April 2015

We describe a patient with dural arterial venous fistula of the cavernous sinus causing occulomotor palsy and chemosis. The fistula was successfully treated via transvenous approach with Onyx-18 and detachable platinum coils.
Transarterial Embolization of Dural Arteriovenous Fistulas of the Anterior Cranial Fossa Using Onyx-18
Authors: Xianli Lv , Youxiang Li , Aihua Liu , Ming Lv , Zhongxue Wu
Published: April 2015

We describe the first case of a dural arteriovenous fistula of the anterior cranial fossa successfully treated with transarterial embolization using Onyx-18.
Childhood Spinal Glioblastoma Multiforme with Intracranial Dissemination
Authors: Battaglia S. , Riccioli L. Albini , Bartiromo F. , Galassi E. , Marliani A.F. , Leonardi M.
Published: April 2015

Primary spinal cord tumors in children are uncommon and account for approximately 5% of all pediatric central nervous system tumors. Intracranial metastases from primary spinal cord tumors have rarely been reported. Spinal cord glioblastoma in children mainly involves the thoracic region, whereas involvement of the medullaris conus with intracranial dissemination has been described in six cases. This paper describes a pediatric case of thoracic glioblastoma multiforme with intracranial dissemination in the early stage of the clinical course and discuss the clinical and neuroradiological manifestations, the possible patterns of dissemination and finally to consider the therapeutic implications.
Perirolandic Sparing and Pituitary Apoplexy in Adult Brain with Global Hypoxia
Authors: Muttikkal T.J. Eluvathingal , Vattoth S. , Chavan V.N. Keluth , Nakhi A. Ben , Joseph V. Sajeev Pynadath
Published: April 2015

Global hypoxia in adult brain usually manifests as ischemic lesions in watershed territories. Acute profound hypoxia involves the cortex especially the perirolandic area, white matter and deep grey matter. Perirolandic sparing in adult global hypoxia is not described in literature. Few cases of perirolandic sparing are described in conditions like anoxia in term infants in the post-neonatal period and hepatic encephalopathy. We report a case of global hypoxia in adult brain with perirolandic sparing and unique association with pituitary apoplexy. It is well known that the “diving reflex” redistribution of cerebral blood flow to the high metabolically active regions occurs when the hypoxic insult is prolonged and partial. The perirolandic sparing in our case could be explained by this phenomenon, wherein the patient acutely developed hypoxia, which was profound and prolonged but not prolonged enough for deep grey matter sparing.
Tuberculous Meningitis: Neuroimaging Features, Clinical Staging and Outcome
Authors: Al-Edrus S.A. , Muda Sobri , Nordiyana M. , Merican J.S.
Published: April 2015

Forty-two patients diagnosed with tuberculous meningitis in Kuala Lumpur Hospital based on clinical criteria, cerebrospinal fluid analysis and response to antituberculous treatment over a seven year period were included in this study. Relevant information was obtained from patients' medical case notes and neuroimaging findings were evaluated. The clinical presentation of patients was staged according to Medical Research Council for tuberculous meningitis. Fisher's Exact Test was used to determine the correlation between the neuroimaging features, clinical staging and outcome of patients. 52.4% of patients had stage 2 disease, 28.6% stage 3 and the remainder stage 1 disease. 95.2% of patients had various neuroimaging abnormalities and only 4.8% had normal neuroimaging findings. The commonest neuroimaging findings were hydrocephalus and meningeal enhancement. 47.6% of patients survived without any complication. 23.8% developed morbidity either with minor or major neurological deficit and 28.6% had died at the end of the study period. Among patients with negative neuroimaging findings, one died and another one survived without any complication. Among patients with abnormal neuroimaging findings, 25% developed morbidity, 27.5% died and 47.5% survived without complication. The only neuroimaging feature significantly correlated with clinical outcome was the presence of hydrocephalus. Therefore, hydrocephalus is important in the prognosis of the disease and should be considered an indicator of poor clinical outcome. There was no significant correlation between clinical staging and clinical outcome, nor was there a significant correlation between clinical staging and individual neuroimaging features.
Typical Meningioma with Atypical MR Imaging Features Masquerading Malignancy
Authors: Kao Hung-Wen , Chen Cheng-Yu , Hsueh Chun-Jen , Lo Chung-Ping , Juan Chun-Jung , Chang Wei-Chou , Huang Guo-Shu
Published: April 2015

Meningiomas are the most common extraaxial tumors of intracranial neoplasms. They are usually benign with characteristic pathologic and imaging features. However, a histologically typical meningioma can have unusual or misleading imaging features that may not be suggestive of meningioma. Unusual imaging features such as large meningeal cysts, ring enhancement, and various metaplastic changes can be particularly misleading. Here we present a fibrous meningioma with atypical magnetic resonance (MR) imaging features in a 76-year-old woman.
Vertebral Body Signal Changes in Spinal Cord Infarction: Histopathological Confirmation
Authors: Srikanth S.G. , Chandrashekhar H.S. , Shankar J.J.S. , Ravishankar S. , Shankar S.K.
Published: April 2015

Spinal cord infarctions are rare. They are difficult to diagnose clinically and remain undiagnosed even after extensive investigations. Magnetic Resonance (MR) features include hyperintensity of the cord on T2W images. Few cases of spinal cord infarction associated with vertebral body infarction are reported in the literature. We describe another five cases of spinal cord infarction with histopathological confirmation of the vertebral body signal changes. MR examinations of five patients who presented with acute spontaneous spinal cord syndrome were reviewed. Abnormal MR features of the spinal cord included signal changes within the parenchyma, best demonstrated on T2W images. These cord changes were associated with vertebral body T2 hyperintensity in all the patients and in one patient, the computed tomography guided biopsy of vertebral body lesion reported infarction. MR is sensitive to detect spinal cord infarctions and associated vascular and bony changes. The associated signal abnormalities in the bone marrow are a corroborative sign in the diagnosis of spinal cord infarction which was proved by histopathology.
Imaging of Rathke's Cleft Cysts: Criteria for a Differential Diagnosis
Authors: Riva G. , Meli G.A. , Chiaramonte R. , Puglisi C.G. , Pero G.
Published: April 2015

Rathke's cleft cysts are a congenital disorder of the pituitary gland and derive from abnormalities of the development of the adenohypophisis. The variability of the MRI signal of Rathke's cleft cyst hampers the differential diagnosis with the other cystic lesions of the pituitary gland. Nevertheless a comparison between the various findings reported from by author we reviewed indicates that a description of useful criteria for a differential diagnosis is possible. We suggest that the mean age at onset, the symptoms, the magnetic signal intensity, the location within the gland, the relations with the surrounding structures and the behaviour after contrast injection should always be considered in the diagnostic work-up of Rathke 's cleft cysts. There is no consensus in the literature on the correct therapeutic protocol. We suggest following up a small asymptomatic Rathke's cleft cyst (except mucoid cysts) because they do not generally enlarge. Surgery is instead the gold standard for symptomatic Rathke's cleft cysts, large Rathke's cleft cysts and mucoid Rathke's cleft cysts. Mucoid Rathke's cleft cysts, even when small, may cause an intense pituitary inflammation which could lead to irreversible endocrine dysfunction.
MR Imaging in Anderson-Fabry Disease: What are We Expected to Find?
Authors: Mortilla M. , Borsini W. , Antonello M. , Buchner S. , Fonda C.
Published: April 2015

Anderson-Fabry disease (FD) is a genetic disorder of glycosphingolipid metabolism that can involve CNS and is easily detectable with MRI. We reviewed 32 MRI performed in ten patients to detect an eventual specific pattern of the disease suggesting that finding vascular lesions in young adults must be addressed to diagnose different pathologies including FD.
Cerebral MR Perfusion Imaging Analysis of Peritumoral Tissue
Authors: Aprile I. , Roscetti M. , Giulianelli G. , Muti M. , Ottaviano P.
Published: April 2015

Highly malignant gliomas have an infiltrating growth making it impossible to establish the exact limits of the lesion with magnetic resonance images after contrast medium administration because the peripheral component of the lesion does not enhance. On the contrary, cerebral metastases have an expansive growth and therefore lack a peripheral component beyond the enhanced area. In some cases the MR perfusional technique can demonstrate neoplastic tissue even with little damage to the brain-blood barrier and therefore with no enhancement. Our study aimed to estimate in which cases the MR perfusion technique will characterize peripheral neoplastic tissue that fails to enhance in gliomas in order to make a differential diagnosis between gliomas and metastases. We studied 60 tumours in 53 patients with MR perfusion and conventional sequences. We evaluated the presence of hyperperfused tissue in CBV maps outside the enhanced area after contrast administration and estimated the tumoral tissue CBV. None of the metastases (24 cases) had hyperperfused peritumoural tissue which was present instead in 22/36 gliomas (infiltrating aspect in CBV maps). Moreover all the gliomas with infiltrating aspect had CBV values of the solid component of the lesion higher than gliomas with a non infiltrating aspect with a threshold value between 4.4 and 6.3. It was therefore possible to characterize 22 gliomas with infiltrating aspect in the perfusion maps and with CBV values higher than the threshold value. In addition, 17 metastases with a non infiltrating aspect were characterized with CBV values higher than the threshold. Fourteen gliomas and seven metastases both with a non infiltrating aspect in the perfusion maps and with CBV values below the threshold were not characterized. In conclusion, MR perfusion succeeded in characterizing 39 lesions out of 60.
Diffusion-Weighted Magnetic Resonance Imaging and ADC Maps in the Diagnosis of Intracranial Cystic or Necrotic Lesions
Authors: Crasto S. Greco , Soffietti R. , Rudà R. , Cassoni P. , Ducati A. , Davini O. , De Lucchi R. , Rizzo L.
Published: April 2015

This study evaluated the usefulness of diffusion-weighted (DW) magnetic resonance imaging (MRI) and ADC maps in the differential diagnosis of brain abscesses from cystic or necrotic neoplasms. MR images of 49 patients with 54 lesions were examined retrospectively. All patients underwent conventional MRI and DWI, and ADC values were calculated by placing ROIs of 30 mm2 manually over the cystic part of the lesions. On DWI, all cystic portions of abscesses were hyperintense. Mean ADC values were 0.48×10 mm2/s (range 0.41–0.54×10 mm/s) for pyogenic abscesses, 0.73×10 mm2/s (range 0.65–0.91×10 mm/s) for mycotic abscesses and 0.6 mm2/s for Nocardia abscess. Cystic areas appeared hypointense on DWI in 33/44 tumours (mean value ADC 1.96 mm2/s). Eleven tumours (11/44) appeared hyperintense on DWI: eight metastases from lung cancer (mean ADC value 0.86 mm2/s, range 0.75–1.2 mm2/s), two GBMs (mean 0.7 mm2/s, range 0.67–0.76 mm2/s) and one anaplastic astrocytoma (ADC value 1.24 mm2/s). ADC values may help in differentiating pyogenic abscess from brain tumors or metastatic lesions.
Lacunes and other Holes: Diagnosis, Pathogenesis, Therapy
Authors: Bradač G.B. , Daniele D. , Bergui M. , Cerrato P. , Ferrio M.F. , Stura G. , Coriasco M.
Published: April 2015

Lacunar ischemic lesions are related to a pathology involving perforators, due to direct changes in the arteries or to an indirect mechanism, such as cardiac or artery to artery embolism, or to hypoperfusion in cases of cardiac failure, or proximal occlusion of large arteries. Changes involving the large intracranial arteries have progressively been taken into consideration as a cause of the disease. This latter aspect is interesting since possible endovascular treatment can be proposed in selected cases. In patients with lacunar syndrome an extended clinical and neuroradiological approach is indicated to choose the most appropriate therapy. Not all lesions recognizable on CT/MR are the expressions of ischemic lesions, this is another important aspect that should be considered in the differential diagnosis.
Characterization of Glioblastoma by Contrast-Enhanced Flair Sequences
Authors: Aprile I. , Giorgi C. , Guiducci A. , Conti G. , Ottaviano I. , Ottaviano P.
Published: April 2015

The tissues placed on the edge of a glioblastoma's necrotic cavities are more vascularized than other pseudocystic central nervous system (CNS) tumours, both benign and malignant. The post-contrast enhancement is greater in Fluid-Attenuated Inversion-Recovery (FLAIR) images than in Spin Echo T1-weighted (SE T1w) sequences above all in the CNS tissues with a low concentration of gadolinium. The purpose of this study was to distinguish pseudocystic glioblastomas from other cystic CNS tumors by comparing post-contrast pseudocystic rim enhancement in FLAIR and SE T1-w magnetic resonance (MR) images. We investigated 32 extensive sets of MR images relating to histologically diagnosed pseudocystic CNS tumors; 14/32 were glioblastoma. Fast Spin Echo (FSE) T2-weighted and Proton Density, SE T1w and FSE FLAIR sequences were acquired in all the studies. After contrast media administration SE T1w and FLAIR sequences were acquired. In post-contrast T1w SE and T2w FLAIR acquisitions, pseudocyst rim enhancement was evaluated assigning scores: 4 = rim enhancement completely surrounds perimeter; 3 = rim enhancement in ≥50% of perimeter; 2 ? rim in < 50% of perimeter; 1 = rim enhancement absent. Mean scores were calculated and the results were compared with statistical methods (Student's t test) for glioblastomas and all other tumors. Moreover differences between FLAIR and SE scores was assessed in each patient. If the difference was 0 glioblastoma was assumed, if the difference was ≥ 1 another tumor was assumed; the sensitivity and specificity of this diagnosis compared to the histological diagnosis were assessed. Mean Tl-weighted SE scores did not differ in glioblastomas and other tumors. FLAIR scores in glioblastomas were less than half those of other tumors (p < 0.005). Glioblastoma diagnosis based on score difference identified 13 true positives (glioblastomas), 16 true negatives (non glioblastomas), two false positives and two false negatives. The sensitivity for glioblastoma was 86.7% and the specificity was 94.1%. Comparison of post-contrast rim enhancement in T1w SE and FLAIR sequences distinguishes glioblastomas from other pseudocystic CNS tumors, assisting the differential diagnosis of glioblastomas, that in many cases are not distinguishable from metastases even with advanced MR techniques.
MR CSF Flow Examination as a Non-Invasive Method of Determining Shunt-Independent Hydrocephalus in Children with Implanted Ventriculoperitoneal Shunt
Authors: Szafirska M. , Urbanik A. , Herman-Sucharska I. , Kwiatkowski S. , Swierczyna A.
Published: April 2015

The study discusses the value of MR examination of CSF flow through the cranial part of the ventriculoperitoneal shunt in the evaluation of shunt-dependent hydrocephalus. Sixteen patients aged eight to 18 years were examined in the course of many years of treatment using the ventriculoperitoneal shunt. No clinical manifestations of shunt obstruction had been observed in any of the patients prior to MR examination. A Signa Horizon 1.5T (GEMS) unit was used. Axial and sagittal T1- and T2-weighted images were performed to find the ventriculoperitoneal shunt canal. A 2D CINE/GR/PC sequence was performed in the plane perpendicular to the shunt canal. CSF-flow was calculated by the Flow Analysis program. Patients were divided into two groups: 1) no CSF-flow was noted in five children indicating shunt-independent hydrocephalus; 2) CSF-flow was present (average flow volume from 0.1 to 1.9 ml/min) in 11 children, distinguishing the group with shunt-dependent hydrocephalus. Conclusions: 1) MR CSF flow examination will establish the absence or presence of CSF flow and determine its direction and velocity. 2) With no clinical manifestations of shunt impatency the absence of flow in the shunt canal found in MR CSF flow examination may indicate shunt-independent hydrocephalus. 3) When the CSF flow in the shunt is found in MR shunt-dependent hydrocephalus is diagnosed.
Parent Artery Occlusion for Peripheral Anterior Inferior Cerebellar Artery Aneurysm
Authors: Lv Xianli , Li Youxiang , Liu Aihua , Zhang Jingbo , Wu Zhongxue
Published: April 2015

Most cases of aneurysms associated with the distal portion of the anterior inferior cerebellar artery resulted in a hearing disturbance from the surgical procedure, although aneurysms far from the auditory artery had no deficit from trapping. We describe a patient with an aneurysm at the distal segment of the anterior inferior cerebellar artery (AICA) treated endovascularly by parent artery occlusion.
Worster-Drought Syndrome with Ectopic Neurohypophysis and Pituitary Hypoplasia
Authors: Purkayastha S.
Published: April 2015

Worster-Drought syndrome (WDS) (congenital bilateral perisylvian syndrome, congenital pseudobulbar paresia) is characterized by neuronal migration defect, pseudobulbar paralysis, epilepsy, neuromotor retardation and perisylvian dysplasia. Pituitary abnormalities are rare disorders. We describe one case with an interesting association of congenital bilateral perisylvian syndrome with pituitary hypoplasia and posterior pituitary ectopia.
Peritumoral Apparent Diffusion Coefficient as a Metric of Response in Patients with Recurrent Glioblastoma Multiforme Treated with Bevacizumab and Irinotecan
Authors: Andre J.B. , Lu S. , Spearman K. , Raval S.N.
Published: April 2015

Bevacizumab and irinotecan have shown promising results in patients with recurrent glioblastoma multiforme (GBM), which traditionally carries a poor prognosis after first-line therapies have been exhausted. Retrospectively documenting the short-term effects of this chemotherapeutic regimen on recurrent GBM, as evidenced by comparative magnetic resonance images obtained two weeks prior to, and one-month following initiation of treatment, we hypothesize that peritumoral apparent diffusion coefficient (ADC) values will decrease on post-treatment scans. Brain MR data were collected from August 2005 to December 2006, in which post-contrast T1-weighted images demonstrated measurable enhancement or GBM tumor mass. Pre- and post-treatment MR images for ten consecutive patients were collected, each having failed temozolomide and radiation therapy. Pre- and post-treatment recurrent GBM bulk tumor and peritumoral T2 signal abnormality were measured in three dimensions. Diffusion of peritumoral T2 signal abnormality was evaluated on pre- and post-treatment ADC. All patients witnessed a significant decrease in tumor bulk ranging from 15.3% to 96.7% with a mean reduction of 48.2%, having received an average of two cycles of chemotherapy. FLAIR images demonstrated a mean volumetric reduction in peritumoral T2 signal abnormality of 44.3%. ADC measurements demonstrated an average reduction in peritumoral ADC of 20.6%, which was statistically significant (p-value < .005). Recurrent GBM tumor bulk demonstrated a 48.2% mean reduction, with corresponding decrease in peritumoral ADC values of 20.6%, suggesting that ADC may represent a valuable metric in the evaluation of the chemotherapeutic response of recurrent GBM, when treated with bevacizumab and irinotecan.
Intracranial Primary Synovial Sarcoma: Radiologic-Pathologic Correlation
Authors: Katsaros V.K. , Katsarou A.-A. , Papadopoulou A. , Floros D. , Marangos N.
Published: April 2015

We present a very rare case of spontaneous intracranial synovial sarcoma. A 15-year-old female was admitted to our institution for a cervical spine MRI, reporting a gradual pain of the dorsal neck after an injury three months previously. After obtaining the first sequence we discovered a large skull base mass. We immediately performed a skull base MRI. MR arteriography, MR venography, CT and DSA were also performed. A large space-occupying lesion was demonstrated, extending from the right petrous bone to the occipital bone at the level of the foramen magnum and the right atlantooccipital junction. CT revealed calcifications. The MR venography demonstrated diminished flow in the right transverse and sigmoid sinus, as well in the right internal jugular vein. Otorhinolaryngological evaluation revealed a slight ipsilateral conductive hearing loss. The whole mass was macroscopically removed via a retrosigmoid, transmastoid, infratemporal approach. Postoperative course was uneventful, except for complete palsy of the ipsilateral hypoglossal nerve. The final pathological examination including immunohistochemical picture, showed findings consistent with synovial sarcoma (monophasic spindle-cell type).
Spinal Epidural Haematoma Related to Oral Anticoagulant Overdose
Authors: Bayir A. , Akilli B. , Cengiz S.L.
Published: April 2015

The most important complication during the treatment of oral anticoagulants is bleeding and it is seen most commonly in the skin, urinary system, gastrointestinal tract and central nervous system. Spinal epidural bleeding related to oral coagulant overdose is a rare complication and it may require urgent surgical treatment depending on the neurological clinical chart. This paper describes a patient with spinal epidural haematoma defined by imaging methods due to paraparesis which developed during oral coagulant usage and its treatment.
Spontaneous Extensive Spinal Epidural Abscess without Any Identifiable Risk Factor
Authors: Purkayastha S.
Published: April 2015

Spinal epidural abscess is a rare medical emergency which if left untreated results in catastrophic and irreversible neurological damage. Risk factors (compromised immunity, spinal column disruption, source of infection) are present in the majority of patients. We describe a case of spontaneous spinal epidural abscess with any identifiable risk factor.
Transarterial Embolization of Tentorial Dural Arteriovenous Fistulas with Onyx 18
Authors: Lv Xianli , Jiang Chuhan , Li Youxiang , Yang Xinjian , Wu Zhongxue
Published: April 2015

Dural arteriovenous fistulas (DVAFs) have been reported to be treated transarterially with Onyx 18. We present a series of tentorial DAVFs treated by transarterial embolization with Onyx 18 over an 18-month period. Eight patients with tentorial DAVFs were treated between September 2005 and February 2007. All patients were treated transarterially with Onyx 18. The clinical presentation, treatment strategies and results were studied. Eight patients presented with intracranial hemorrhage or progressive neurological deficits. Retrograde leptomeningeal venous drainage was documented in every patient, classifying the lesions as Cognard Type IV. Post treatment angiography demonstrated complete obliteration in six cases. Clinical follow up ranged from six to 14 months. One patient experienced neurological decline after endovascular treatment and exhibited clinical improvement. There were no episodes of rehemorrhage or new neurological deficits. Outcomes were excellent in seven patients, fair in one case. Transarterial embolization of tentorial DAVF is feasible and may result in complete occlusion of the fistulous connection with liquid nonadhesives.
Dural Arteriovenous Fistula Involving the Transverse Sigmoid Sinus Presenting as Chemosis
Authors: Lv Xianli , Zhang Jingbo , Li Youxiang , Jiang Chuan , Wu Zhongxue
Published: April 2015

Dural arteriovenous fistulas (DAVFs) not directly shunting into the cavernous sinus are a rare cause of chemosis. An unusual case of a transverse sigmoid sinus DAVF associated with chemosis related to high intravenous pressure is presented. A 39-year-old man presented with a two year history of left chemosis. Ocular examination disclosed left episcleral and retinal venous congestion, and optic disc paleness. Visual acuity and visual field were normal. Angiography revealed a DAVF supplied by a branch arising from the left postauricular artery, the left middle meningeal artery and the left occipital artery, which drained into the vein of Trolard into the superior sagittal sinus and the sphenoparietal sinus via the mild dilated vein of Labbé. Endovascular treatment was performed by transarterial embolization with Onyx-18, which resulted in occlusion of the fistula and complete clinical cure confirmed at discharge. Chemosis may be caused by an arteriovenous lesion remote from the optic organ as a result of rerouting venous drainage promoting the intracavernous pressure. Transarterial embolization of a DAVF may result in complete cure if advantageous arterial anatomy allows for flow control and occlusion of the fistulous connection with liquid nonadhesives.
MR Perfusion Imaging of Intracranial Tumors
Authors: Aprile I. , Armadori M. , Conti G. , Ottaviano I. , Ranaldi A. , Ottaviano P.
Published: April 2015

This retrospective study evaluated magnetic resonance (MR) perfusion imaging in the study of intracranial tumors; 218 patients were studied with 509 MR examinations. The first aim was to establish the usefulness of perfusion imaging for the differential diagnosis between neoplastic tissue and other lesions both in the first MR examination and in the post therapeutic controls (differentiation of tumor recurrence from radionecrosis). Then we evaluated the presence of infiltrating neoplastic tissue in CBV maps outside the enhancement area to differentiate infiltrating gliomas from metastases. In addition, post surgical evaluation was performed to identify residual neoplastic tissue, mainly if bleeding or inflammatory post surgical cerebral damage did not allow a definitive diagnosis with conventional morphologic images. Lastly, it was assessed whether hypervascularization (evaluated in CBV maps) is a favourable prognostic factor for a positive outcome to radiotherapy. The diagnostic gain of perfusion imaging in all these cases was established evaluating our case records.
Evolutive Study of Relapsing-Remitting Multiple Sclerosis with Cervical Proton Magnetic Resonance Spectroscopy
Authors: Riccioli L. Albini , Marliani A.F. , Clementi V. , Bartolomei I. , Agati R. , Leonardi M.
Published: April 2015

We used quantitative proton magnetic resonance spectroscopy (1H-MRS) to evaluate mean relative concentrations ratios for NAA, Cr, Cho and mI during the study of cervical spinal cord plaques in a relapsing-remitting multiple sclerosis (RRMS). A cervical spine MR exam was repeated five times on the following days for two months starting from the onset of a relapse phase, using a 3T whole-body system, with the voxel placed along the demyelinazation lesion. The quantification results were compared with the healthy metabolites content. Quantitative cervical spectroscopy is a reliable tool and can offer important metabolic information as already used on the brain to evaluate the severity, progression and pathogenesis of multiple sclerosis.
Ventral Thoracic Spinal Cord Herniation: A Commonly Misdiagnosed and Treatable Cause of Myelopathy
Authors: Alkan O. , Kizilkilic O. , Goksel B. Karakurum , Yildirim T. , Sarica F. Birol
Published: April 2015

Idiopathic ventral spinal cord herniation is a rare cause of progressive myelopathy that demonstrates unique radiological features. We describe a case of thoracic spinal cord herniation through an anterior dural defect and discuss the characteristic findings on magnetic resonance imaging and computed tomographic myelography. A 36-year-old man presented to our clinic with progressive leg weakness and spasticity in both legs. Magnetic resonance imaging of the thoracic spinal canal demonstrated C-shaped anterior kinking of an atrophied spinal cord and enlarged dorsal subarachnoid space at the T5-T6 level. Computed tomographic myelography showed ventral herniation of the spinal cord and no evidence of an intradural spinal arachnoid cyst. Ventral spinal cord herniation is a commonly misdiagnosed entity. Knowledge of the characteristic imaging appearance of this treatable condition is important for proper diagnosis and treatment.
Intracranial Aneurysms and Vascular Malformations: Diagnosis and Therapy
Authors: Grobovschek M. , Himmer M. , Wolfsgruber P. , Weymayr F. , Kissela C.
Published: April 2015

The first part of our study describes the treatment of our patients with intracranial vascular malformations (aneurysms/AVMF – arteriovenous malformations) in a region of about 500,000 inhabitants. The second part will compare currrent treatment and the changes in treatment (microsurgery, endovascular interventional techniques, etc.) also in relation to topography and demography.
An Unusual Cause of Dyspnea: Myelomatous Involvement of Cricoid Cartilage
Authors: Öztürk M. , Mavili E. , Gorkem S. B , Cagli S. , Yüce I.
Published: April 2015

Extraosseous multiple myeloma involving the cricoid cartilage is exceedingly rare. CT is invaluable for detecting this lesion. Herein, we describe a patient with worsening dyspnea due to involvement of the cricoid cartilage with multiple myeloma. CT not only detected the lesion but also revealed additional classical lytic lesions of multiple myeloma. In patients with worsening dyspnea laryngeal involvement should be included in the differential diagnosis.
Visualization of the Superior Ophthalmic Veins by 3 Tesla 3D-TOF-MR Angiography
Authors: Uchino A. , Egashira R. , Nomiyama K. , Takase Y. , Kudo S.
Published: April 2015

The superior ophthalmic veins (SOVs) are sometimes visualized on three-dimensional time-of-flight magnetic resonance (3D-TOF-MR) angiograms obtained with a 3 Tesla system. The purpose of this retrospective study was to determine the incidence of visualization of normal SOVs on 3D-TOF-MR angiograms, and their characteristic features. We reviewed 3D-TOF-MR angiograms of 345 consecutive patients obtained with a 3 Tesla MR device. Patients comprised 170 males and 175 females, aged five to 93 years. Most of the patients had, or were thought to have, cerebrovascular disease. The SOV was visualized in 13 of the 345 patients (3.8%). The visualized SOV was on the left side in seven of the 13, and on the right side in two. Both the right and left SOVs were visualized in four patients. The left SOV was more clearly visualized in two of these patients, whereas the SOVs were equally visible on both sides in the other two. There was a female predominance (M:F = 1:12) but no relation between age and visualization of SOVs. None of the visualized SOVs were dilated, and no dilated cavernous sinus was seen. The facial veins and angular veins were also visualized, continuing to the SOVs, suggesting rapid retrograde flow in the facial veins. SOVs are sometimes visualized on 3D-TOF-MR angiograms. This phenomenon should not be misdiagnosed as an asymptomatic dural carotid-cavernous fistula.
Reversible MRI Findings of Porphyric Encephalopathy
Authors: Soysal A. , Dogan P. , Dayan C. , Caliskan B.G. , Arpaci B.
Published: April 2015

We describe the magnetic resonance imaging (MRI) findings in two patients admitted to our institution with neuropsychiatric symptoms and severe abdominal pain diagnosed as acute intermittent porphyria (AIP). MRI revealed multiple lesions which regressed following treatment. We suggest reversible cerebral vasospasm underlies the MRI abnormalities and the cerebral symptoms in porphyria.
Dyke Davidoff Masson Syndrome
Authors: Saini H. Singh , Parakh F. P. , Maheshwari M. , Singh G. , Karrer V. , Aman S.
Published: April 2015

We describe a case of hemitrophy in a 12-year-old child presenting with seizures, hemiplegia and mental retardation. Hemiatrophy of one cerebral hemisphere is not frequently encountered in clinical practice. When this develops early in life (during the first two years), certain cranial changes like ipsilateral hypertrophy of the skull and sinuses occur. Asymmetry of cerebral hemispheric growth with atrophy on one side, ipsilateral osseous hypertrophy and hyper-pneumatization of sinuses with contralateral paresis are features of Dyke Davidoff Masson Syndrome (DDMS). Probably vascular occlusion was most important cause of hemiatrophy in our case.
Direct Intratumoral Pre-surgical Embolization of Orbital Hemangioblastoma
Authors: Wu Y.-M. , Wong H.-F. , Ng S.H.
Published: April 2015

Orbital hemangioblastomas of extraretinal origin are extremely rare and few cases have been reported. We describe a 48-year-old woman with progressive right visual loss and proptosis. Computed tomography showed an avidly enhanced transpatial solid mass in the right orbit with outward protrusion. The mass was presumed to be of extraretinal origin because of its unusually large size, but there was only mild involvement of the eyeball. The histopathologic characteristics of this tumor were identical to those seen in central nervous system hemangioblastomas. The hypervascularity of the lesion would have made surgical intervention difficult. Preoperative embolization was indicated and was performed by direct tumor puncture and injection of N-butyl cyanoacrylate with a satisfactory result.