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Spinal metastases (SM) is the commonest form of solid tumors osseous metastasis, for which surgical dissection is often performed when combined with spinal cord compression. Leptomeningeal metastasis (LM) results from dissemination of cancer cells to both the leptomeninges (pia and arachnoid) and cerebrospinal fluid (CSF) compartment. The spread of LM may occur via multiple routes, such as hematogenous, direct infiltration from metastatic brain lesions, or via iatrogenic seeding of CSF. Signs and symptoms associated with LM are generalized and various while early diagnosis of LM is challenging. Cytological evaluation of the CSF and gadolinium enhanced MRI brain and spine is the gold standard for diagnosing LM and CSF can help assess treatment response. While a number of other potential CSF biomarkers have been investigated both for the diagnosis as well as monitoring of LM, none have been established as a component of the standard evaluation of all LM or suspected LM patients. Management goals of LM include improving patient's neurologic function, quality of life, preventing further neurologic deterioration and prolonging survival. In many cases, it may be reasonable to pursue a palliative and comfort focused course, even from the initial LM diagnosis. Surgery is not recommended considering the risk of seeding with cerebrospinal fluid. A diagnosis of LM carries a poor prognosis with an estimated median survival of only 2-4 months despite therapy. Spinal metastases combined with leptomeningeal metastasis (SM+LM) is not uncommon and its treatment is similar to LM. LM can appear at the same time as SM or directly invaded by SM, which is thought regarding the pathophysiology of LM remains speculative and not systematically studied. The present article reports a 58-year-old woman who was first diagnosed with SM, but worsened after surgery repeated MRI examinations confirmed coexisting LM. Relevant literature was reviewed to summarize the epidemiology, clinical manifestations, imaging characteristics, diagnosis and treatment of SM+LM, so as to improve the understanding of the disease and promote early diagnosis. It should be vigilant to merge LM for the patient with SM when atypical clinical manifestations, rapid disease progression or inconsistent with imaging occurred. Repeated examinations of cerebrospinal fluid cytology and enhanced MRI should be considered when SM+LM is suspected to achieve timely adjustment of diagnosis and treatment strategy for better prognosis.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Meníngeas , Neoplasias da Coluna Vertebral/cirurgia , Qualidade de Vida , Prognóstico , Imageamento por Ressonância MagnéticaRESUMO
@#BACKGROUND: Traumatic aortic dissection (TAD) has a low incidence but extremely high mortality. It always presents atypical clinical manifestations that are easily missed or misdiagnosed. This study mainly aims to describe the imaging characteristics and management of TAD patients. METHODS: A retrospective analysis of 27 blunt TAD patients was performed between 2013 and 2020. Demographic features, imaging characteristics, and management were analyzed. RESULTS: Twenty-seven patients with type B aortic dissection (age 56.04±16.07 years, 20 men) were included. Aortic intimal tears were mostly initiated from the aortic isthmus. The sizes of the proximal intimal tears in the greater curvature were larger than those in the lesser curvature (1.78±0.56 cm vs. 1.24±0.52 cm, P=0.031). Compared with those in the control group, the maximum diameters of the aortic arch, thoracic aorta, and abdominal aorta in the TAD patients were all significantly widened (all P<0.050). Multivariate logistic regression analysis showed that the maximum diameter of the thoracic aorta was an independent risk factor for TAD, with a predictive value with an area under the receiver operating characteristic curve (AUC) of 0.673. Finally, 26 patients successfully underwent delayed thoracic endovascular aortic repair (TEVAR), and the remaining one patient was treated conservatively. No progression of aortic dissection or death occurred during the six-month follow-up period. CONCLUSIONS: In blunt trauma, the aortic isthmus is the most common site of proximal intimal tears. An accurate diagnosis of TAD requires an overall consideration of medical history and imaging characteristics. Delayed TEVAR might be an effective therapeutic option for TAD.
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Objective To investigate the changes of brain CT imaging in patients with cerebral cysticercosis during the period of anti-cysticercus chemotherapy. Methods A total of 380 inpatients that were conformed to the practical diagnostic criteria of cerebral cysticercosis were enrolled in this study in the Third Affiliated Hospital of Shandong Academy of Medical Sciences from May 2010 to May 2015. All the patients were given anti-cysticercus chemotherapy (albendazole and praziquantel). All the patients received brain CT scan, and of which 210 received enhanced scan. The data of CT imaging were systematically reviewed. Results Before the treatment, the CT images of the patients showed single or multiple small cystic (s) with low density and small nodule-like cephalomere with high density. The re-examinations of CT showed that there were 81.58% (310/380) of the patients whose low density foci were completely absorbed, there were 16.32% (62/380) of the patients whose foci were mostly absorbed, and there were 2.11% (8/380) of the patients whose foci were calcified. Along with the prolongation of treatment time, the side effects were gradually reduced, and in the third course of treatment, the foci were absorbed or calcified in most of the patients. Conclusion CT examination can diagnose the lesion site, range and classification of cerebral cysticercosis, and can evaluate the effect of the therapy according to the changes of CT imaging during the period of anti-cysticercus chemotherapy.
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Objective To investigate the changes of brain CT imaging in patients with cerebral cysticercosis during the period of anti-cysticercus chemotherapy. Methods A total of 380 inpatients that were conformed to the practical diagnostic criteria of cerebral cysticercosis were enrolled in this study in the Third Affiliated Hospital of Shandong Academy of Medical Sciences from May 2010 to May 2015. All the patients were given anti-cysticercus chemotherapy (albendazole and praziquantel). All the patients received brain CT scan, and of which 210 received enhanced scan. The data of CT imaging were systematically reviewed. Results Before the treatment, the CT images of the patients showed single or multiple small cystic (s) with low density and small nodule-like cephalomere with high density. The re-examinations of CT showed that there were 81.58% (310/380) of the patients whose low density foci were completely absorbed, there were 16.32% (62/380) of the patients whose foci were mostly absorbed, and there were 2.11% (8/380) of the patients whose foci were calcified. Along with the prolongation of treatment time, the side effects were gradually reduced, and in the third course of treatment, the foci were absorbed or calcified in most of the patients. Conclusion CT examination can diagnose the lesion site, range and classification of cerebral cysticercosis, and can evaluate the effect of the therapy according to the changes of CT imaging during the period of anti-cysticercus chemotherapy.
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Objective: To analyze the imaging characteristics of vertebral "shell" phenomenon of thoracolumbar fractures after posterior reduction and to explore the relationship between vertebral "shell" and fracture healing.