Starry sky appearance of tuberculoma

CNS tuberculosis accounts for only 10% of all cases of tuberculosis, carries a high mortality and morbidity. Tuberculoma of the brain is an important clinical entity. The main challenge in the management of brain tuberculoma is its diagnosis. Hereby, referring case of a 12 years old male child who presented with clinical picture of tuberculosis but radiologically NCC, hence posing a diagnostic dilemma as clinically it was in the favor of tuberculosis whereas radiologically inclination was towards neurocysticercosis. Based on clinical manifestations it was suggestive of meningitis, CSF picture was suggestive of hypoglycorrhachia. CT chest showed miliary pattern and neuroimaging showing multiple ring enhancing lesions. High index of clinical suspicion is required to make a diagnosis and evaluation with reports.

Role of Multiparametric MRI in Diagnosis of Prostate Cancer

Aims: The main objectives of our study were to evaluate the role of Multiparametric MRI (mp-MRI) in diagnosis of carcinoma prostate and to compare the various MRI sequences used in MRI in evaluating carcinoma prostate with histopathological diagnosis kept as reference standard. Materials and Methods: This prospective cross-sectional study of 40 patients was performed by using various sequences used in mp-MRI i.e. T2 weighted imaging (T2WI), Diffusion Weighted Imaging (DWI), Magnetic Resonance Spectroscopy (MRS) and Dynamic Contrast Enhanced study (DCE). Findings of mp-MRI sequences were compared with histopathological diagnosis. Statistical analysiswasperformed using SPSS computer statistical program for window release 16. Results: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of DCE in diagnosing carcinoma prostate were 88.89%, 50.00%, 94.12% and 33.33% respectively where assensitivities, specificities, PPVs, NPVs of DWI and MRS were same in our study i.e. 94.44%, 75.00%, 97.14% and 60.00%respectively. Overall sensitivity, specificity, PPV, NPV of mp-MRI by combining these sequences were found to be 97.22%, 75%, 97.22% and 75% respectively. Diagnostic accuracies of DWI, DCE and MRS were 92.5%, 85% and 92.5% respectively and overall diagnostic accuracy after combining these sequences in mp-MRI was 95%. Conclusions: mp-MRI including all the sequences has very good role in evaluation of carcinoma prostate. Diagnostic accuracy of mp-MRI increases when all sequences used together to assess prostatic lesions, so all the sequences should be used together in prostate cancer evaluation rather than using individual sequences.

Fat Quantification in the Vertebral Body: Comparison of Modified Dixon Technique with Single-Voxel Magnetic Resonance Spectroscopy

OBJECTIVE: To compare the lumbar vertebral bone marrow fat-signal fractions obtained from six-echo modified Dixon sequence (6-echo m-Dixon) with those from single-voxel magnetic resonance spectroscopy (MRS) in patients with low back pain. MATERIALS AND METHODS: Vertebral bone marrow fat-signal fractions were quantified by 6-echo m-Dixon (repetition time [TR] = 7.2 ms, echo time (TE) = 1.21 ms, echo spacing = 1.1 ms, total imaging time = 50 seconds) and single-voxel MRS measurements in 25 targets (23 normal bone marrows, two focal lesions) from 24 patients. The point-resolved spectroscopy sequence was used for localized single-voxel MRS (TR = 3000 ms, TE = 35 ms, total scan time = 1 minute 42 seconds). A 2 × 2 × 1.5 cm³ voxel was placed within the normal L2 or L3 vertebral body, or other lesions including a compression fracture or metastasis. The bone marrow fat spectrum was characterized on the basis of the magnitude of measurable fat peaks and a priori knowledge of the chemical structure of triglycerides. The imaging-based fat-signal fraction results were then compared to the MRS-based results. RESULTS: There was a strong correlation between m-Dixon and MRS-based fat-signal fractions (slope = 0.86, R² = 0.88, p 20%). CONCLUSION: Given its excellent agreement with single-voxel-MRS, 6-echo m-Dixon can be used for visual and quantitative evaluation of vertebral bone marrow fat in daily practice.

Association of iron metabolism with cognitive function in elderly patients with type 2 diabetes mellitus / 中华内分泌代谢杂志

Objective To investigate the association of iron overload with metabolic changes in hippocampal tissues, and to explore the relationship between iron metabolism abnormality and cognitive function in elderly patients with type 2 diabetes mellitus( T2DM) . Methods A total of 97 elderly inpatients with T2DM were enrolled. According to the Mini-mental state examination ( MMSE) score, the type 2 diabetic patients were divided into mild cognitive impairment ( MCI) and non-mild cognitive impairment ( Non-MCI) groups. A retrospective analysis was performed for their clinical data and laboratory parameters, including serum ferritin, MMSE, Montreal cognitive assessment ( MoCA) , carotid intima-media thickness, ankle brachial index, and the ELISA method was used to detect soluble transferring receptor ( sTfR ) . Proton MR spectroscopy ( 1 H-MRS ) was performed in the hippocampus of 26 patients. Results Compared with Non-MCI group, MCI group revealed higher age(P<0.01), higher incidence of carotid plaque (P<0.01), decreased sTfR(P=0.049) and left hippocampal height(P=0.034). Age, sTfR, and carotid plaque were independent risk factors for MCI in elderly patients with T2DM. Conclusion The abnormal iron metabolism may contribute to the occurrence of MCI in the elderly patients with T2DM.

Arterial Spin Labelling Perfusion, Proton MR Spectroscopy and Susceptibility-Weighted MR Findings of Acute Necrotizing Encephalopathy: a Case Report

In this study, we report arterial spin labelling perfusion, proton MR spectroscopy and susceptibility-weighted MR findings of acute necrotizing encephalopathy in a child with rotavirus infection.

Multimodality Imaging Approaches in Alzheimer's disease. Part II: 1H MR spectroscopy, FDG PET and Amyloid PET / Abordagem e multimodalidade de imagem em doença de Alzheimer. Parte II: espectroscopia, FDG-PET, e imagem Amilóide

ABSTRACT. In this Part II review, as a complement to the Part I published in this supplement, the authors cover the imaging techniques that evaluates the Alzheimer's disease according to the different metabolic and molecular profiles. In this section MR spectroscopy, FDG-PET and amyloid PET are deeply discussed.

RESUMO Nesta revisão Parte II, como complemento da revisão Parte I publicada nesta edição, os autores descrevem as técnicas de imagem que avaliam a doença de Alzheimer de acordo com os diferentes perfis metabólicos e moleculares que caracterizam esta doença. Nesta seção são discutidos em profundidade a espectroscopia por ressonância magnética, FDG-PET and imagem com marcadores de peptide beta amilóide.

Magnetic Resonance Spectroscopy Finding in a Patient with Cerebral Fat Embolism

No abstract available.

MR Spectroscopy and Diffusion Weighted Imaging Findings of Primary Non-Hodgkin Lymphoma of the Breast: Two Case Reports

Primary non-Hodgkin lymphoma (NHL) of the breast is a very rare disease, and the mammographic and ultrasonographic findings of breast lymphoma are variable. There are several reports of magnetic resonance (MR) imaging findings in patients with breast lymphomas; however, few reports have described the findings observed on MR spectroscopy or the features of diffusion weighted (DW) imaging. The authors report the findings of classical MR imaging, MR spectroscopy and DW imaging of a 48-year-old woman and a 40-year-old woman with primary non-Hodgkin's lymphoma of breasts. Mammography and breast ultrasonography revealed a mass with circumscribed margin. The mass showed strong enhancement after contrast injection on MR imaging. DW imaging showed reduced diffusion and high-amplitude choline (Cho) peak at 3.22 ppm was detected by single voxel MR spectroscopy which was consistent with malignancy.

Investigation of Correlations of Double Inversion Recovery and MR Spectroscopy on Breast MR Imaging

PURPOSE: To evaluate the correlation of lesion-to-normal ratio (LNR) of signal intensity from double inversion recovery MR imaging and total choline-containing compound (tCho) resonance from single voxel MR spectroscopy in breast cancers. MATERIALS AND METHODS: Between August 2008 and December 2009, 28 patients who were diagnosed as breast cancer and had undergone both double inversion recovery (DIR) MR imaging and MR spectroscopy (MRS) were included in this study. The signal intensities of the lesion (L) and ipsilateral normal breast tissue (N) were measured in region of interest of each breast cancer in DIR and contrast enhance MR image (CE-T1WI) to calculate the LNR value for each technique. MRS was performed using single-voxel MR spectroscopy. The height, width and area of tCho resonance were compared with each LNR of DIR and CE-T1WI. We used Pearson's correlation coefficient (r) for correlation analysis and the significance level was p=0.05. RESULTS: There was no statistically significant correlation between LNR of CE-T1WI and height (r=-0.322, p=0.094), width (r=-0.233, p=0.232) and area (r=-0.309, p=0.109) of MRS tCho. There was no statistically significant correlation between LNR of DIR and height (r=0.067, p=0.735), width (r=-0.287, p=0.139) and area (r=0.012, p=0.953) of MRS tCho, either. The Pearson's correlation coefficient was 0.186 between LNRs of CE-T1WI and DIR (p=0.344). CONCLUSION: There was no statistically significant correlation between LNR of DIR and relative amount of tCho resonance of MRS.

Gliomatosis Cerebri Type 1 Mimicking an Ischemic Stroke and Progressing to a Type 2: a Case Study and Literature Review.

Aims: To report a rare clinical case of gliomatosis cerebri, which presented with non-specific clinical, laboratory, and radiological findings. We provide images and stress the importance of differential diagnosis based on imaging, especially magnetic resonance (MR) spectroscopy. Case Presentation: A 73-year-old woman developed a right hemiplegia suggestive of ischemic stroke. Cerebral magnetic resonance imaging (MRI) highlighted a diffuse tumor-related infiltration involving several lobes without contrast enhancement, corresponding to the specific description and definition of gliomatosis cerebri type 1. With the aid of MR spectroscopy, we correctly diagnosed the disease preoperatively, which was finally confirmed pathologically by stereotactic biopsy. During radiological follow-up, a contrast enhancement occurred on cerebral MRI, suggestive of progression to a gliomatosis cerebri type 2. Given a poor performance status, this elderly patient received palliative treatment. Discussion: Gliomatosis cerebri is a relatively rare but well-known entity, which affects mostly middle aged patients. It often presents with confounding clinical and imaging features, thus additional examinations such as MR spectroscopy are almost always necessary before reaching the correct diagnosis before biopsy. Conclusion: Contrast enhancement on cerebral MRI, which is usually absent, is found in case of transformation from type 1 gliomatosis cerebri to type 2. Some features on MR spectroscopy are helpful for gliomatosis cerebri diagnosis: N-acetylaspartate levels are diminished, levels of myoinositol are significantly elevated, but Cho/Cr ratio may be normal.

Magnetic Resonance Findings in Two Episodes of Repeated Cerebral Fat Embolisms in a Patient with Autologous Fat Injection into the Face

We report magnetic resonance image (MRI) and magnetic resonance spectroscopy (MRS) findings in a patient of cerebral fat embolism (CFE) occurred in a 26-year-old woman after an autologous fat injection into the face. After initial neurologic symptom onset, MRI and MRS data were obtained two times to investigate repeated CFE. We obtained the MRS data in the two different time intervals and two different echo times to compare the lesions with normal brain parenchyma. The results of MRS data showed that a decrease in N-acetyl-aspartate, an increase in lactate and a very high early peak of free lipids between 0.9 and 1.4 ppm were obtained at the acute infarcted lesion as compared with normal brain parenchyma. In addition, these findings were more clearly detected on short echo time spectrum rather than long spectrum. A close relationship between the clinical manifestations and MRI and MRS findings of the brain can helpful to distinguish CFE with other conditions and to evaluate the cause materials of infarctions rather than conventional MRI or diffusion-weighted imaging.

A Case of Metachromatic Leukodystrophy Confirmed by Molecular Genetic Analysis / 대한소아신경학회지

Metachromatic leukodystrophy (MLD) is the rare neurometabolic disease caused by the deficiency of the enzyme arylsulfatase A resulting in a deficiency of sulfatide degradation and the target gene is ARSA gene. We report a case of the late infantile form of MLD that was confirmed by means of enzyme assay and gene analysis with typical brain MRI and MR spectroscopy finding.

Utility of in vitro proton magnetic resonance spectroscopy in aetiological characterisation of brain abscesses.

Purpose: Brain abscesses often present an aetiological dilemma. Microscopy is insensitive and culture techniques are time consuming. Hence, a new rapid technique in vitro Proton Magnetic Resonance Spectroscopy ( 1 HMRS) was evaluated for its usefulness in the identification of aetiology of brain abscesses. Materials and Methods: A total of 39 pus specimens from brain abscesses were subjected to in vitro 1 HMRS. These pus specimens were also processed by conventional culture methods. The spectral patterns generated by in vitro 1 HMRS were further correlated with culture results. Results: Pus specimens which showed the presence of anaerobes on culture revealed the presence of multiplet at 0.9 ppm (100%), lactate-lipid at 1.3 ppm (100%), acetate at 1.92 ppm (100%) and succinate at 2.4 ppm (75%). Pus specimens that revealed the presence of facultative anaerobes on culture showed a pattern B, i.e., the presence of lactate-lipid at 1.3 ppm (100%), acetate at 1.92 ppm (88.88%) along with the multiplet at 0.9 ppm (100%). Pattern C was seen in aerobic infection which showed the presence of lactate-lipid at 1.3 ppm (100%) along with the multiplet at 0.9 ppm. Pus from two tuberculous abscesses showed the complete absence of multiplet at 0.9 ppm. Conclusions: We observed in this study that it was possible to differentiate bacterial and tuberculous brain abscesses using in vitro 1 HMRS. Further, it was also possible to distinguish between aerobic and anaerobic brain abscesses on the basis of spectral patterns. In vitro 1 HMRS of fungal and actinomycotic brain abscess are also presented for its unusual spectra.

MR Spectroscopy and Perfusion MR Imaging Findings of Intracranial Foreign Body Granuloma: a Case Report

We report a case of intracranial foreign body granuloma that showed features of a high grade tumor on magnetic resonance (MR) imaging. However, the relative cerebral blood volume was not increased in the enhancing mass on perfusion MRI and the choline/creatine ratio only slightly increased on MR spectroscopy. The results suggest that the lesion is benign in nature. Perfusion MRI and MR spectroscopy may be helpful to differentiate a foreign body granuloma from a neoplastic condition.

MR Imaging and Proton Spectroscopic Study of Stroke-like Episodes in MELAS / 实用放射学杂志

Objective To study the characteristics of MR imaging and proton MR spectrscopy(~1H MRS)of stroke-like lesions in MELAS.Methods Clinical,MR imaging and proton spectroscopic findings of stroke-like lesions in 7 patients with confirmed MELAS were analyzed retrospectively.Results A total of 12 MR investigations had been performed in 7 patients.Stroke-like lesions showed by MR imaging included superacute in 12,acute in 12,subacute in 10 and chronic stage in 6.Early stroke-like lesions were demonstrated as focal edematous foci mainly involved cortex/subcotical areas of occipital,temporal and parietal lobes.At MR diffusion imaging,stroke-like lesions in the superacute(＜3 days)stage were showed as well-circumscribed lesions with high signal intensities for cytotoxic edema.During the acute(4～7 days),sub-acute(2～4 weeks)and chronic(＞4 weeks)stages,the lesions gradually expanded,and became blur,and presented with vasogenic edema mainly.Proton spectroscopy showed a prominently elevated lactate,varied decrease of NAA concentration and other brain motabolites in the stroke-like lesions early after onset,and depicted gradual decrease of lactate level and partial recovery of NAA concentration subsequently.Conclusion Stroke-like lesions in MELAS mainly involve the cerebral cortex and subcortical areas,in which cytotoxic edema appears early but for a short period.In ~1H MRS,the lesions are characterized by a double lactate peak with decrease of NAA concentration.

~1H-MRS and Diffusion Tensor Imaging Study in Minimal Hepatic Encephalopathy / 实用放射学杂志

Objective To evaluate the value of proton magnetic resonance spectroscopy(~1H-MRS))and diffusion tensor imaging(DTI)in minimal hepatic encephalopathy(MHE).Methods Twenty-nine with cirrhosis(15 cases with MHE diagnosed according to number-connection test A and digital symbol test and 14 age-matched controls underwent ~1H-MRS and DTI examinations.~1H-MRS of left basal ganglia were acquired using STEAM sequences.Peak area of each metabolite,including NAA,Cr,Cho,mIns and Glx and their ratios to Cr were measured,respectively.Fractional anisotropy(FA),mean diffusivity(MD)were calculated in deep gray matter nuclei and mainly white matter regions in both cerebral hemispheres.The MD and FA values from different regions in different groups were compared.Results NAA/Cr and Glx/Cr levels showed no significant difference among the groups(P＞0.05).Ratios of mIns/Cr and Cho/Cr showed no differences in MHE group compared to controls(P＞0.05),whereas were significantly different in MHE and cirrhosis without MHE(P＜0.05).The MD values from different regions had a significant difference among various groups(P＜0.05),and there were no significant changes in FA among the groups(P＞0.05).Significantly increased MD was found in five regions of brain in MHE and only caudate nuclei in cirrhosis without MHE compared to controls.Conclusion Patients with MHE have abnormal metabolite changes in basal ganglia;the increase in MD with no concomitant changes in FA in cirrhosis with MHE that indicates the presence of reversible interstitial brain edema.MRS and DTI may be sensitive tests for detecting MHE.

Study of ~1H MR Spectroscopy of Vertebral Body Marrow / 实用放射学杂志

Objective To study the changing of vertebral body marrow fat fraction(FF) in different age and sex and the relation-ship between FF and bone mineral densities (BMD). Methods Eighty-five healthy volunteers aged from 21 to 70 years old and twenty patients with osteoporosis based on T score after dual X-ray absorptionmetry examination underwent proton magnetic reso-nance spectroscopy (MRS) in L_3 vertebral bodies. The volunteers were divided into five groups according to the age(10 years and 16～18 cases in each group). Results The FF values in 21～30 years group,31～40 years group,41～50 years group,51～60 years group , >60 years group and the osteoporotic group were 30.7%±4.4%, 35.5%±6.8% , 41.9%±6.6%, 46.8%±5.5%, 51.7%±5.2% and 59.2%±7.4%, respectively. The FF values in L_3 vertebral bone marrow in men were high than that in women in the same age group (P<0.05) except >60 years group. There was negative correlation between marrow fat content and T score in osteoporotic group(γ=-0.6, P<0.01). Conclusion The vertebral marrow fat content in healthy adults was significantly in-creased with the aging. MRS may be used as a new way to evaluate the physiological and pathological process of bone marrow.

MR Spectroscopy in Evaluating the Bone Marrow of Vertebra / 实用放射学杂志

Objective To assess the value of MRS in evaluating vertebral bone marrow. Methods A total of 152 female volunteers (mean age 58±14 years, ranged 30～80 years) were recruited in this study. All subjects underwent vertebral MRS examination after routine MRI examination (sagittal T_2WI, T_1WI and axial T_2WI). Single voxel (SV) was chosen for the 1H MRS acquisition at L_2～L_4 vertebral body with PRESS sequence. MRS parameters were measured by SAGE 7.0 software. Results The fat fraction (FF%) of vertebra ascend with aging;the water line width (LW) decrease with aging and there was not obvious tendency with lipid LW. Conclusion Vertebral MRS can be considered as a noninvasive examination added to routine spine MRI to demonstrate the changes of vertebral bone marrow.

Clinical Value of MR Spectroscopy in Preoperative Grading of Astrocytic Tumors / 实用放射学杂志

Objective To explore the value of MR spectroscopy in preoperative grading of astrocytic tumors.Methods 52 cases with astrocytomas proved by pathology,including 20 diffuse astrocytomas,14 anaplastic astrocytomas and 18 glioblastomas,underwent MR spectroscopy with multi-voxel PRESS sequence.Results ①Astrocytic tumors were characterized by increased Cho and decreased NAA,while Lipids were present in high-grade astrocytic tumors;②Cho/Cr(r＝0.656,P=0.000),Lip1.3/Cr(r＝0.559,P=0.001) and Glx/Cr(r＝0.482,P=0.005) in the solitary tumor's regions had a significant positive correlation with the grading of astrocytic tumors, while Cho/NAA(r＝0.395,P=0.025),Lip0.9/Cr(r＝0.386,P=0.029) had a positive correlation with the tmor grading;③When Cho/Cr＝2, the sensitivity, specificity,positive predictive value and negative predictive value for diagnosis of WHO4 astrocytic tumors were 94.4%,64.3%,77.3% and 90% respectively;④When Lip1.3/Cr＝0.526, the sensitivity, specificity,positive predictive value and negative predictive value for diagnosis of WHO4 astrocytic tumors were 88.9%,92.9%,94.1% and 86.7% respectively. Conclusion MR spectroscopy is helpful in preoperative grading of astrocytic tumors.

Multidisciplinary Functional MR Imaging for Prostate Cancer

Various functional magnetic resonance (MR) imaging techniques are used for evaluating prostate cancer including diffusion-weighted imaging, dynamic contrast-enhanced MR imaging, and MR spectroscopy. These techniques provide unique information that is helpful to differentiate prostate cancer from non-cancerous tissue and have been proven to improve the diagnostic performance of MRI not only for cancer detection, but also for staging, post-treatment monitoring, and guiding prostate biopsies. However, each functional MR imaging technique also has inherent challenges. Therefore, in order to make accurate diagnoses, it is important to comprehensively understand their advantages and limitations, histologic background related with image findings, and their clinical relevance for evaluating prostate cancer. This article will review the basic principles and clinical significance of functional MR imaging for evaluating prostate cancer.