Intraventricular textiloma with granuloma formation following third ventricle colloid cyst resection - a case report.

Despite precautions, cotton and gauze pads used for dissection or to achieve haemostasis during neurosurgical procedures can inadvertently be left behind and result in clinically symptomatic or asymptomatic and radiologically apparent mass lesion, sometimes referred to as "textilomas" or "gossypibomas", often mimicking recurrent tumour or abscess on neuroimaging studies. We report the neuroimaging evaluation, including computed tomography (CT), magnetic resonance imaging (MRI) and spectroscopy (H1-MRS), in a case of textiloma developing after the treatment of a third ventricle colloid cyst.

[Diagnostic value of diffusion weighted imaging in assessment of malignant focal liver lesions].

INTRODUCTION: The study was designed to determine if there was a difference between apparent diffusion coefficient (ADC) values using diffusion weighted imaging (DWI) MRI technique between different malignant focal liver lesions. PATIENTS AND METHODS: The study included 63 patients with focal hepatic lesions: fourteen patients (22.2%) with hepatocellular carcinoma (HCC), 16 patients (25.4%) with hepatic metastatic colorectal tumors, 17 patients (26.9%) with cavernous haemangioma and 16 patients (25.4%) with hepatic cysts. MRI was performed with 1.5T scanner, using EPI sequence with ADC values being determined for all lesions based on three b values. RESULTS: ADC values were statistically different among the groups (F = 70.7, p < 0.01): HCC patients 1.11 +/- 0.29 x 10(-3) s/mm2, metastatic tumours 2.18 +/- 0.15 x 10(-3) s/mm2, haemangioma 2.22 +/- 0.32 x 10(-3) s/mm, cysts 3.08 +/- 0.03 x 10(-3) s/mm2. Furthermore, there was statistically significant difference between benign lesions (haemangiom and cysts, 2.36 +/- 0.43 x 10(-3) s/mm2), and malignant diseases (HCC and secondary tumors, 1.52 +/- 0.58 x 10(-3) s/mm2), t = 5,6, p < 0.01. CONCLUSION: DWI technique could be helpful in defining the focal liver lesions.

[Magnetic resonance cholangiopancreatography: diagnostic significance in malignant diseases of bile and pancreatic ducts].

Magnetic resonance cholangiopancreatography (MR CP) is a relatively new, noninvasive method in patients with pancreaticobiliary diseases, which is comparable to invasive endoscopic retrograde cholangiopancreatography (ERCP). One of the most common indications for MRCP is malignant obstruction of the bile and pancreatic ducts. Standard imaging protocol includes routine abdominal study followed by a sequence for MRCP adapted to each of the patients and site of the malignant process. MRCP is a simple to perform, does not exposure the patients to radiation, requires no anesthesia, is less operator dependent and allows better visualization of ducts proximal to an obstruction. Thus, during one examination only, it is possible to assess not only pancreaticobiliary system but also abdominal structures, which increases diagnostic value of MR and is therefore, optimal method in evaluation of these patients.

Triple-way therapeutic approach for paraganglioma-dependent erythrocytosis: drugs and surgery plus "multi-manner" apheresis.

Paragangliomas are tumors arising from the extra-adrenal paragangliar neural crest cells. The sympathoadrenal neuroendocrine system consists of extra-adrenal paragangliar cellular layer along the paravertebral and para-aortic axis, and the adrenal medullae. Paraganglioma should be included in the differential diagnosis of secondary erythrocytosis due to its possible ectopic erythropoietin (EPO) secretion. Thus, in this report we present a 24-year-old female patient with onset of unregulated ectopic EPO secretion, and consecutive erythrocytosis followed by hypertension, secondary to paraganglioma of multifocal retroperitoneal localization. Clinical, laboratory, and radiological investigations confirmed both an elevated EPO level and the presence of multiple paraganglioma. This paraneoplastic-mediated medical condition with high risk of cellular hyperviscosity syndrome (CHVS) requires prompt diagnosis and rapid therapeutic interventions. Initially, simple phlebotomy procedures were used; following that, tumors were surgically removed. In the course of the disease, this tumor relapsed, and urgent apheresis, as a treatment of life-threatening state, was used. The therapy performed resulted in a rapid blood viscosity depletion and a significant (P < 0.01) serum EPO reduction, as well as the general clinical benefit. Therefore, we conclude that the use of our own "multi-manner" apheresis (erythrocythapheresis plus plasma exchange), for long-time interval (until further causative therapy), effectively cross-bridged the possible hazards of EPO-dependent CHVS.

[Comparison of detection of brain lesions in multiple sclerosis in magnetic resonance imaging at magnetic field strength of 1.0 and 3.0 Tesla].

To estimate the relative sensitivity of MR examination for brain lesions in multiple sclerosis at 1.0 Tesla (T) and 3.0 T using identical acquisition conditions. 54 patients with multiple sclerosis were examined both at 1.0T (Siemens Impact Expert) and 3.0T (Philips Intera) using T1-weighted spin echo (T1W-SE) with and without gadolinium contrast injections, T2W SE and fluid attenuated inversion recovery (FLAIR) imaging. Images were examined independently by three experienced neuroradiologists using focal lesion counting. 3.0T scans compared with 1.0T scans demonstrate a 27.3%, increase in the number of detected contrast enhanced lesions and an 22.7% increase in the number of detected lesions on FLAIR MR tomograms. Highfield 3.0T MR imaging demonstrates better sensitivity in the detection of focal brain lesions in multiple sclerosis. This improvement is more apparent in contrast enhanced lesion detection and less noticeable in FLAIR detected lesions.