Pineal and Suprasellar Germinoma Cooccurence with Vertebra Plana: A Case Report

Germinoma is the most common type of intracranial germ cell tumors (GCTs). Pineal gland and suprasellar region are the most frequent sites of central nervous system (CNS) involvement. Intracranial masses caused by Langerhans cell histiocytosis (LCH) mimics features of CNS GCTs. LCH frequently involve spine and is the most common cause of vertebra plana in children. A 15-year-old boy presented with progressing symptoms of polydipsia, polyuria, general headache, nausea and severe back pain. Brain MRI showed brain tumor with simultaneous involvement of suprasellar region and pineal gland. An excisional biopsy of suprasellar mass was done. The pathologic assessment confirmed the diagnosis of germinoma. Patient's treatment continued accordingly. A spine MRI, done due to persistent backache, showed a vertebra plana. We reevaluated the primary diagnosis suspecting LCH. Germinoma of CNS was confirmed and a biopsy of vertebral lesion resulted in hemangioma. Thus we report a case of CNS germinoma with co-occurrence of vertebra plana. We emphasized the importance of histopathologic diagnosis of pineal/suprasellar masses and primary investigation of other CNS regions including spine for possible metastasis or comorbidities.

Accuracy of color Doppler ultrasonography and magnetic resonance imaging in diagnosis of placenta accreta: a survey of 82 cases

Background: placenta adhesive disorder [PAD] is one of the most common causes of postpartum hemorrhage and peripartum hysterectomy. The main risk factors are placenta previa and prior uterine surgery such as cesarean section. Diagnosis of placenta adhesive disorders can lead to a decrease of maternal mortality and morbidities

Objective: the purpose of this study was to compare the accuracy of color Doppler ultrasonography and magnetic resonance imaging [MRI] in the diagnosis of PADs

Materials and Methods: in this is cross-sectional study, Eighty-two pregnant women who were high risk for PAD underwent color Doppler ultrasound and MRI after 18 weeks of gestation. The sonographic and MRI findings were compared with the final pathologic or clinical findings. P<0.05 was considered statistically significant

Results: mean maternal age was 31.42+/-4.2 years. The average gravidity was third pregnancy. 46% of patients had placenta previa. The history of the previous cesarean section was seen in 79 cases [96%]. The diagnosis of placenta adhesive disorder was found in 17 cases [21%]. Doppler sonography sensitivity was 87% and MRI sensitivity was 76% [p=0.37]. Doppler sonography specificity was 63% and MRI specificity was 83% [p=0.01]

Conclusion: women with high-risk factors for PAD should undergo Doppler ultrasonography at first. When results on Doppler sonography are equivocal for PAD, MRI can be performed due to its high specificity

utility of perfusion CT and CT angiography on early diagnosis and the management of vasospasm after subarachnoid hemorrhage

Subarachnoid hemorrhage is one of the most important and dangerous neurologic emergencies worldwide. It is characterized by a sudden and severe headache caused most commonly by the rupture of intracranial aneurysm. Cerebral vasospasm is the most important cause of disability and death in whom survived from the first event. Early diagnosis and management of cerebral vasospasm could prevent and reduce its morbidity and mortality. Thus, an ideal technique must be able to detect the vasospasm before the occurrence of neurological deficits. Perfusion computed tomography could assess vascularity of brain including cerebral blood flow, cerebral blood volume, time to peak and mean transit time. For this application, perfusion computed tomography and computed tomography angiography techniques offer significant advantages and can result in early diagnosis of vasospasm. In this review, we discuss the utility of these two techniques and their safety in the diagnosis and the management of vasospasm following subarachnoid hemorrhage

Natural oral contrast agents for gastrointestinal magnetic resonance imaging

Magnetic resonance imaging is an exclusive imaging method which can distinguish injured tissues from the healthy tissues or organs without using ionizing radiation. Magnetic resonance imaging is able to provide quantitative data regarding the anatomical and physiological features of each specific organ. Magnetic resonance imaging is a non-invasive method, but contrast agents are necessary to enhance the visualization of inaccessible organs in some organs such as gastrointestinal [GI] imaging. Various types of contrast agents have been used in studies including intravascular administration and oral materials. Oral contrast agents can be the artificial materials or natural factors. Natural contrast agents consist of fruit juice or pulps. Some advantages have been reported regarding the natural types of contrast agents over the artificial agents including better taste and tolerability. We briefly reviewed the different types of contrast agents and focused on the studies in which natural oral contrast agents used to investigate their efficacy in increasing the gastrointestinal magnetic resonance imaging clarity

Autoimmune pancreatitis: a case report

Autoimmune pancreatitis is a fibro-inflammatory form of chronic pancreatitis. It is diagnosed by the combination of imaging studies such as a CT scan and pancreatography, laboratory analyses that include IgG4 and/or autoantibodies, histopathological evaluations and positive response to corticosteroid therapy. We report the case of a 41-year-old female with a history of jaundice and increasing abdominal pain for two weeks prior to her clinic visit. Laboratory results were significant for an increase in alkaline phosphatase [ALP] and erythrocyte sedimentation rate [ESR]. Magnetic resonance cholangiopancreatography [MRCP] confirmed areas of stenosis and dilatation in the pancreatic duct and in the intra- and extra-hepatic bile ducts similar to primary sclerosant cholangitis. Laboratory analyses showed increased levels of IgG4 with the presence of antinuclear antibodies.

role of magnetic resonance spectroscopy in differentiation between neoplastic and non-neoplastic focal brain lesions

The ability to differentiate between neoplastic and non-neoplastic focal brain lesions is critical for appropriate management of patient. Due to low specificity of magnetic resonance imaging [MRI] adequate data for differentiating would not be provided. Magnetic resonance spectroscopy [MRS] is one of the newly supplementary methods for determining molecular structures and better differentiation among brain lesions. The applicability of MRI plus MRS in changing the histopathology is undetermined. In order to evaluate the benefits of magnetic resonance spectroscopy combined with the conventional magnetic resonance imaging, we reviewed related literature till 2013

Intraorbital arteriovenous malformation treated by transcatheter embolization; a case report

To report the clinical and radiological findings and management of a patient with intraorbital arteriovenous malformation [AVM] treated by transcatheter embolization of the feeding artery. A 15-year-old female patient was referred with a one year history of left eye proptosis without prior trauma. Orbital CT scan and MRI demonstrated a large intraconal mass lesion extending to the extraconal space in the inferior orbit; angiograms revealed an intraorbital AVM. Superselective catheterization of the feeding artery and embolization with absorbable gelatin particles [Gelfoam] and non-absorbable polyvinyl alcohol particles were performed in two separate sessions followed by surgical debulking. Signs and symptoms were diminished after 14 months. lntraorbital AVMs can be treated by embolization of the feeding artery followed by surgical removal of the AVM nidus when the lesion is accessible