Combining methionine-PET and MRI fluid-attenuated inversion-recovery mismatch to determine glioma molecular subtype.

BACKGROUND AND PURPOSE: 11 C-methionine (MET)-PET is a useful tool in neuro-oncology. The T2-fluid-attenuated inversion recovery (FLAIR) mismatch sign on MRI is a characteristic finding in lower grade gliomas with isocitrate dehydrogenase (IDH) mutations and the absence of the 1p/19q codeletion; however, the T2-FLAIR mismatch sign has low sensitivity in differentiating gliomas and does not aid in identifying glioblastomas with IDH mutations. We therefore investigated the efficacy of the combination of the T2-FLAIR mismatch sign and MET-PET for accurately determining the molecular subtype of gliomas of all grades. METHODS: The present study comprised 208 adult patients diagnosed with supratentorial glioma confirmed by molecular genetics and histopathology. The ratio of the maximum lesion MET accumulation to the mean normal frontal cortex MET accumulation (T/N) was measured. The presence or absence of the T2-FLAIR mismatch sign was determined. The presence or absence of the T2-FLAIR mismatch sign and the MET T/N ratio were compared between glioma subtypes to evaluate individual and combined utility in identifying gliomas with IDH mutations and no 1p/19q codeletion (IDHmut-Noncodel) or gliomas with IDH mutations (IDHmut). RESULTS: The addition of MET-PET to MRI for the presence of the T2-FLAIR mismatch sign improved diagnostic accuracy, with the area under the curve values increasing from .852 to .871 for IDHmut-Noncodel and from .688 to .808 for IDHmut. CONCLUSIONS: The combination of the T2-FLAIR mismatch sign and MET-PET may provide improved diagnostic utility in differentiating gliomas according to molecular subtype, particularly in determining IDH mutation status.

Successful Cesarean Section Deliveries in a Patient with a History of Developmental Venous Anomaly-Induced Hemorrhage.

While hemorrhage can occur because of developmental venous anomalies (DVAs), there is no established opinion concerning their association with pregnancy and childbirth. In the present report, we discuss the case of a now 39-year-old woman with DVA in whom pregnancy and childbirth were successful. When she was 28, she experienced disturbance of consciousness and paralysis on the left side of the body, and brain computed tomography revealed cerebral hemorrhage coupled with subarachnoid hemorrhage. Cerebral angiography revealed a DVA with an arteriovenous shunt, with superficial drainage surrounding the hematoma. No associated cavernous hemangiomas were observed, and the patient was diagnosed with DVA-induced hemorrhage and treated via conservative therapy. Later, at the ages of 32 and 35, she gave birth via Caesarean section under general anesthesia. At the age of 37, she experienced sudden headache and nausea, following which she was again diagnosed with DVA-induced hemorrhage. Fortunately, she experienced no exacerbation of symptoms such as paralysis. However, she currently has mild, residual paralysis on the left side of the body, and she regularly walks to the hospital using a cane for follow-up examinations.

A Rare Case of Symptomatic Carotid Stenosis Caused by Mechanical Stimulation by Thyroid Cartilage and Frequent Swimming.

BACKGROUND: Bony structures around the carotid artery such as the styloid process and hyoid bone can cause dissection, compression, plaque formation, and plaque rupture of the carotid artery. To the best of our knowledge, this case is the first finding of thyroid cartilage being the cause of a lesion corresponding to adjacent common carotid artery (CCA) atherosclerosis. CASE DESCRIPTION: A 51-year-old man with a history of hypertension and dyslipidemia suddenly experienced right facial numbness and dysphasia while front crawl swimming, which he usually did 3 times weekly. Diffusion-weighted magnetic resonance imaging showed high intensity areas in the left frontal and parietal lobes. He was diagnosed with acute cerebral infarction and was administered with tissue plasminogen activator. Angiography of the left CCA revealed mild stenosis with an intravascular filling defect, and carotid duplex ultrasonography of the CCA on the second day after symptom onset showed plaque and intraluminal thrombus at the stenotic site. Plain and contrast-enhanced computed tomography showed that thyroid cartilage contacted the left CCA at the stenotic site, and the left CCA moved backward and forward with the thyroid cartilage during neck rotation. We determined that mechanical stimulation by the thyroid cartilage had induced the plaque during the frequent neck rotation that is a feature of front crawl swimming. CONCLUSIONS: Evaluation of anatomical interactions between the carotid artery and bony structures including the thyroid cartilage is important to ensure that appropriate treatment is selected to prevent further ischemia.