Computed tomographic evaluation of sellar and parasellar tumors

The advent of computerized cranial tomography made a greater advance in the diagnosis of very wide variety of intracranial lesions. Authors analyzed 58 pathologically proven sellar and parasellar tumors examined at Kyung Hee Un-iversity Hospital from Oct. 1977 to Jun. 1981 and the results were as follows; 1. The distribution of the tumors is 28 pituitary adenomas, 18 craniopharyngiomas, 5 meningiomas, 4 germinomas, 2 astrocytomas, and 1 sphenoid mucocele. 2. In pituitary adenoma, the precontrast CT scan of tumors appeared as isodensity in 11 cases, mixed density in 8 cases, high density in 6 cases, and low density in 3 cases, and associated with destruction of sellar turcica in 15 cases, calcification in 3 cases, and hydrocephalus in 2 cases. The postcontrast CT scan study revealed 24 cases of contrast enhancement, including 17 cases of homogenous and 7 cases of ring or rim enhancement. 3. In craniopharyngioma, the precontrast CT scan of tumors appeared as low density in 12 cases, isodensity in 4 cases and high density in 2 cases and associated with calcification in 16 cases, hydrocephalus in 15 cases and destruction of sellar turcica in 2 cases. The postcontrast CT scan study revealed no enhancement in 10 cases and contrast enhancement in 8 cases including 6 of ring enhancement and 2 heterogenous enhancement.

Computed tomographic findings of cerebral paragonimiasis

Paragonimiasis is widely distributed in Far East and Southeast Asia, particularly in Korea. The centralnervous system is the most frequent location for paragonimiasis outside the lungs. We analized the computedtomographic findings of 17 cases which were diagnosed pathologically and clinically as cerebral paragonimiasis.The results were as follows; 1. The ratio of male to female was 10:7 and about 88% of cases were under the age of40 years. 2. The common location so cerebral paragonimiasis were the occipital (12 cases ) and temporal (11 cases) lobes. 3. Precontrast CT findings of cerebral paragonimiasis were low density with calcifications in 6 cases,low and isodensities in 4 cases, mixed densities in 3 cases, only low density in 2 cases and only calcification sin 2 cases. Hydrocephalus (7 cases), mass effect (6 cases), atrophic change(6 cases) and cyst formation (3 cases)were associated. 4. The shape of calcifications in CT scan were soap-bubble or ring in 6 cases, nodular or oval in6 cases, stippled in 4 cases and amorphous conglomerated in 2 cases. 5. The contrast-enhanced 8 cases were 5 ringor rim like, 2 nodular and 1 irregular enhancements, while 9 cases were not enhanced.

Computed tomographic evaluation of intracranial metastasis

CT was proved to be the most accurate diagnostic tool in the analysis of brain metastasis than any otherclassical methods. The authors studied CT findings of intracranial metastasis in 31 cases proven clinically andhistologically. The results were as follows; 1. Age distribution of the cases was 15 males and 16 females withpeak age of 6th decade in males and 4th decade in females. 2. Metastatic lesions were multiple in 18 cases andsingle in 13 cases. 3. The most common degree of edema was grade III, 43% of total metastatic foci. Markededematous low densities with relatively small nodular high densities in precontrast scan and variable contrastenhancement of the nodular densities were the most frequent CT findings. 4. No specific characterstics accordingto the primary cancer was noted. All four cases of choriocarcinoma showed hemorrhagic tendency.

Computed tomographic findings of hepatocellular carcinoma

It is well known that CT is very useful in the evalution of hepatocellular carcinoma. The computed tomographicfindings of 56 patients diagnosed as hepatocellular carcinoma were reveiwed and analyzed. The resuls were asfollows; 1. The male to female ratio was 3:1 and the age ranged from 31 to 73 years with average age of 54 years.2. Alpha-fetoprotein was positive in 19 out of 38 cases (50%). 3. All lesions were seen as areas of low densityexcept 1 case(0%) of isodensity, and 40 cases (72%) appeared to be solitary while 15(26%) were multifocal. The lowdensity was homogenous in 13 cases (24%) and inhomogenous in 42 cases (76%), and 18 cases out of 42 cases ofinhomogenous low density showed peripheral and/or central nodular enhancement. The additional findings werecontour change in 37 cases (66%), metastasis in 35 cases (63%), splenomegaly in 23 cases (42%) and ascites in 22cases (39%). 4. In postcontrast scans, 41 cases (80%) out of 51 cases showed the change of density after contrastinfusion. The presnece and extent of tumors were better seen after contrast infusion in 30 cases (59%), betterseen before contrast infusion in 11 cases (21%) and no significant difference before and after contrast infusionin 10 cases (20%). 5. The sites of involved lobe were right lobe in 38 cases (68%), left lobe in 5 cases (9%) andboth lobes in 13 case (23%). 6. 35 cases (63%) showed evidence of metastasis to regional lymph nodes, organ ortissuses.

Computed tomography of intracranial tuberculosis

CT is a valuable method in determining number, location and extent of lesions, although a definite diagnosisis often not possible on CT. In intracranial tuberculosis, CT was helpful in the diagnosis, assessing the degreeof hydrocephalus and evaluating the effectiveness of antituberculous therapy. Twenty-one cases of clinical lyproven intracranial tuberculosis were studied by CT in our hospital during last 3 years. Of them, eighteen caseswere tuberculous meningitis and the rests were tuberculoma. The results were as follows; 1. Tuberculous meningitis presented the following three patterns of CT findings according to its disease process. a. In early stage of the disease, suspcious multiple isodense small nodules in the cerebral and cerebellar hemispheres showed dense enhancement in postcontrast scan representing miliary tubercles. b. In later stage of the disease, precontrastscan showed partial or total obliteration of the basal and sylvian cisterns with mild dilatation of ventricularsystem. Postcontrast scan showed dense enhancement of basal and sylvian sisterns. This type of finding was themost common in our series. c. Moderate to marked dilatation of ventricle with or without a cluster ofcalcifications in suprsella area on precontrast scan was seen in far later stage or as a sequellae of the disease. No enhancement was noted in postcontrast study. 2. Tuberculoma showed an isodense or slightly hyperdense area inthe cerebral or cerebellar hemisphere with associated minimal edema in precontrast study. Postcontrast scan showeda small ring enhancement with central lucent area.