ABSTRACT
An acquired immunodeficiency syndrome (AIDS) patient developed acute symptoms suggestive of a lower spinal cord lesion. Magnetic resonance imaging was performed and demonstrated an enhancing lesion of the conus medullaris. Surgical biopsy revealed Toxoplasma gondii. Disease processes involving the spinal cord in AIDS patients are reviewed and differential diagnosis for the lesion in this patient is discussed.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Magnetic Resonance Imaging , Myelitis/diagnosis , Organometallic Compounds , Pentetic Acid , Toxoplasmosis/diagnosis , Adult , Contrast Media , Gadolinium DTPA , Humans , Male , Myelitis/complications , Opportunistic Infections/diagnosis , Toxoplasmosis/complicationsABSTRACT
The purpose of this study was to determine the role of neuroimaging in the management of patients with metastatic germ cell tumors. Retrospective evaluation of 299 patients treated in 1986 and 1987 for initial presentation or recurrence of testicular, retroperitoneal, and mediastinal germ cell tumors was performed to determine indications for neuroimaging, frequency and site of CNS metastases, and occurrence of other CNS abnormalities. Sixty-six patients required CNS imaging with myelography, CT, or MR. Studies were normal in 24 patients. Twenty patients had CNS metastases including 11 with intracranial metastases, eight with spine lesions, and one with both brain and spine involvement. Sixteen had cerebral or cerebellar atrophy of unclear origin and functional significance. Two patients had ventriculomegaly without symptoms of hydrocephalus. Four patients had questionable lesions that were never confirmed. None of the 25 asymptomatic patients with elevated serum tumor markers had brain metastases. Fifteen of 17 patients with focal neurologic deficits and three of six patients with seizures had CNS metastases. CNS imaging to detect germ cell tumor metastases is most useful in the presence of neurologic deficits or seizures but is not useful in patients with unexplained elevation of serum tumor markers in the absence of neurologic deficits.
Subject(s)
Brain Neoplasms/secondary , Diagnostic Imaging , Neoplasms, Germ Cell and Embryonal/secondary , Spinal Neoplasms/secondary , Adolescent , Adult , Brain Neoplasms/diagnosis , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Myelography , Neoplasms, Germ Cell and Embryonal/diagnosis , Radiographic Image Enhancement , Retrospective Studies , Spinal Neoplasms/diagnosis , Tomography, X-Ray ComputedABSTRACT
The purpose of this study was to determine the role of neuroimaging in the management of patients with metastatic germ cell tumors. Retrospective evaluation of 299 patients treated in 1986 and 1987 for initial presentation or recurrence of testicular, retroperitoneal, and mediastinal germ cell tumors was performed to determine indications for neuroimaging, frequency and site of CNS metastases, and occurrence of other CNS abnormalities. Sixty-six patients required CNS imaging with myelography, CT, or MR. Studies were normal in 24 patients. Twenty patients had CNS metastases including 11 with intracranial metastases, eight with spine lesions, and one with both brain and spine involvement. Sixteen had cerebral or cerebellar atrophy of unclear origin and functional significance. Two patients had ventriculomegaly without symptoms of hydrocephalus. Four patients had questionable lesions that were never confirmed. None of the 25 asymptomatic patients with elevated serum tumor markers had brain metastases. Fifteen of 17 patients with focal neurologic deficits and three of six patients with seizures had CNS metastases. CNS imaging to detect germ cell tumor metastases is most useful in the presence of neurologic deficits or seizures but is not useful in patients with unexplained elevation of serum tumor markers in the absence of neurologic deficits.
Subject(s)
Brain Neoplasms/secondary , Diagnostic Imaging , Neoplasms, Germ Cell and Embryonal/secondary , Spinal Cord Neoplasms/secondary , Adult , Brain Neoplasms/diagnosis , Humans , Male , Mediastinal Neoplasms/diagnosis , Neoplasm Recurrence, Local/diagnosis , Neoplasms, Germ Cell and Embryonal/diagnosis , Retroperitoneal Neoplasms/diagnosis , Retrospective Studies , Spinal Cord Neoplasms/diagnosis , Testicular Neoplasms/diagnosisABSTRACT
Tiazofurin is an experimental chemotherapeutic agent currently undergoing clinical evaluation. We report our results with magnetic resonance (MR) in demonstrating reversible cerebral abnormalities concurrent with the use of this drug. The abnormalities on MR were correlated with findings on CT as well as with cerebral angiography. The utility of MR in the evaluation of patients receiving this new agent is illustrated.
Subject(s)
Antineoplastic Agents/adverse effects , Brain Diseases/chemically induced , Brain Diseases/diagnosis , Magnetic Resonance Imaging , Ribavirin/adverse effects , Ribonucleosides/adverse effects , Female , Humans , Middle Aged , Ribavirin/analogs & derivativesABSTRACT
Cranial MR images of 53 patients with neurofibromatosis were reviewed to determine the nature, extent, and number of intracranial abnormalities present. All patients studied met tentative definitions established for the diagnosis of neurofibromatosis. Twenty-three were scanned for evaluation of known CNS of cranial nerve involvement; the remainder were neurologically asymptomatic patients without suspected lesions referred for screening. Single lesions were noted in 32 patients. Multiple lesions were identified in 14 patients. Seven had normal scans. In 23 patients small focal areas of increased signal on T2-weighted scans within the brain were though to represent heterotopias. Eight patients had chiasmal gliomas and two had optic nerve gliomas. Nine patients had parenchymal gliomas, two had ischemic changes, and one had a colloid cyst. Extraaxial lesions included acoustic neuromas (five patients), meningiomas (four), trigeminal neurofibromas (one), and dysplasia of a sphenoid wing (two). Of the 30 asymptomatic patients referred for screening, lesions were found in 23. MR was found to be an excellent method of imaging known disease and of detecting lesions in asymptomatic patients. Because of the large number of asymptomatic lesions detected in this population, a screening MR study is recommended in patients with neurofibromatosis.
