Magnetic resonance evaluation of brain metastases from systemic malignances with two doses of gadobutrol 1.0 m compared with gadoteridol: a multicenter, phase ii/iii study in patients with known or suspected brain metastases.

OBJECTIVES: To determine the efficacy and safety of 2 doses of gadobutrol 1.0 M (0.1 and 0.2 mmol/kg body weight [BW]), compared with gadoteridol 0.5 M (0.2 mmol/kg BW), in contrast-enhanced magnetic resonance imaging (CE-MRI) of brain metastases in patients with known or suspected brain metastases from systemic malignancies. The study also compared the usefulness of gadobutrol in treatment planning for stereotactic radiosurgery (SRS). MATERIALS AND METHODS: This was a Phase II/III, multicenter, single-blind, randomized, controlled, crossover, intraindividual comparison study. Each patient underwent one MRI study examination with gadobutrol and the other with gadoteridol, each at a dose of 0.1 mmol/kg BW, administered twice, for a total dose of 0.2 mmol/kg BW. Image acquisition was carried out after the first and second doses of gadobutrol, but only after the second dose of gadoteridol. Contrast agents were assigned in a randomized order and their administration separated by an interval of 1 to 14 days. Images were evaluated through blinded readings by 3 independent experienced radiologists. Treatment planning for SRS was assessed in a blinded manner, as a consensus between a diagnostic neuroradiologist and a radiation oncologist, in addition to the clinical investigator's assessment. The safety and tolerability of gadobutrol and gadoteridol were evaluated in all patients who received the study drugs. The primary efficacy variable was the number of lesions detected in CE-MRI images; the secondary efficacy variables were the degree of contrast enhancement and border delineation of lesions, and experts' confidence in treatment planning for SRS. RESULTS: A total of 175 patients were enrolled and randomized, with 164 (93.7%) included in the safety analysis set, and 151 (86.2%) evaluable in the efficacy analysis. The mean number of detected lesions per patient using the average of the 3 blinded readers was 6.28, 6.92, and 6.87 for gadobutrol 0.1 and 0.2 mmol/kg BW, and gadoteridol 0.2 mmol/kg BW, respectively. Noninferiority of gadobutrol (both doses) to gadoteridol 0.2 mmol/kg BW was demonstrated. The degree of contrast enhancement and the border delineation of each lesion were categorized as "good" or "excellent" for most lesions for both agents. Almost all enhanced images were rated as "confident" in treatment planning for SRS. Sixty-five (43%) and 62 (41%) patients in the gadobutrol 0.1 and 0.2 mmol/kg BW groups, respectively, were selected as eligible for SRS treatment. The percentage of images assessed as "gadobutrol was better than gadoteridol" was higher than that assessed as "gadoteridol was better than gadobutrol" for both doses of gadobutrol. Eight adverse events were reported as being related to the study drug in 7 patients (4.3%) in each group. CONCLUSION: In this study, a single dose of gadobutrol was shown to be noninferior to a double dose of gadoteridol at detecting brain metastases, and could be effectively used for treatment planning in patients eligible for SRS. A dose of gadobutrol 0.1 mmol/kg BW is recommended as the clinical dose for the detection of brain metastases.

[Soluble fibrin is not excreted in urine and its plasma level is elevated in nephrotic syndrome].

Soluble fibrin (SF) is produced by activated blood coagulation reaction and is useful to diagnose thrombotic diseases. We measured plasma and urine SF levels in nephritic patients to assess the hypercoagulability state associated with the disease. Before they received anti-coagulation or anti-platelet therapies, 60 patients underwent measurement of plasma SF and D-dimer levels by Latex agglutination turbidimetric immnoassay (LA). Urinary SF levels were also measured by LA. Plasma and urinary thrombin antithrombin III complex (TAT) levels were measured by enzyme immunoassay (EIA). Plasma SF levels showed a good correlation with plasma TAT levels but only weak positive correlations were observed between plasma D-dimer and SF or TAT levels. Plasma SF and D-dimer levels were significantly higher in the Iatients with nephrotic-range hypoalbuminemia (< or =3 g/dL) than those without it. Contrarily there was no significant difference in plasma TAT levels between these two groups of patients. In almost all patients, urinary SF levels were under the detection limit. However, TAT was excreted into urine more frequently in patients showing the nephrotic range of hypoalbuminemia at 38.2% than in non-nephrotic patients at 8.0%. Thus, plasma SF levels more precisely indicate activated blood coagulation reaction than plasma TAT levels in nephrotic patients, probably because the plasma SF is not excreted into urine, while plasma TAT is.

[Visualization of brain perfusion by contrast-enhanced ultrasonography: preliminary study in rabbits].

PURPOSE: We evaluated the usefulness of an agent for contrast-enhanced ultrasonography (galactose parmitine acid: Levovist) in visualizing brain perfusion in rabbits. MATERIALS AND METHODS: Six rabbits were involved in this study. A hole in the skull bone was made under anesthesia and used as an acoustic window. An ischemic model (3 of 6 rabbits) was made by surgically occluding the M1 portion of the middle cerebral artery. Power Doppler images (PDI) and B-mode Harmonic images (HI) before and after intravenous injections of the contrast medium (150 mg/body) were obtained using the HDI5000 (ATL) equipped with a linear-type 5-12 Mhz probe. RESULTS: Smaller arteries were clearly visualized by contrast-enhanced PDI. However, enhancement of brain parenchyma was not clear on PDI. Enhancement of brain parenchyma was observed clearly on contrast-enhanced HI. Enhancement was strong during the first pass and then diminished quickly. In ischemic models, hypoperfusion in the right cerebral hemisphere (the occluded side) were clearly observed on contrast-enhanced HI. CONCLUSION: Brain perfusion in rabbits can be observed on contrast-enhanced Harmonic ultrasonographic imaging. It is suggested to be useful for human clinical cases, including hypoxic ischemic brain injury in infants.

[Usefulness of Cho/Cr ratio in proton MR spectroscopy for differentiating residual/recurrent glioma from non-neoplastic lesions].

PURPOSE: We evaluated the clinical usefulness of the Cho/Cr ratio of proton MR spectroscopy(1H-MRS) to differentiate residual/recurrent glioma from non-neoplastic lesions. PATIENTS AND METHODS: 20 cases of glioma were involved in this study(astrocytoma grade I-II: 7, oligodendroglioma: 1, astrocytoma grade III: 2, glioblastoma: 10). Seven of the patients underwent surgical resection only, 4 underwent surgical resection and radiotherapy(40-60 Gy), and 9 underwent surgical resection and radiotherapy with concurrent chemotherapy(14-60 Gy). 1H-MRS was performed on a 1.5 Tesla clinical MR unit using a 3D-chemical shift imaging sequence(1500 msec/270 msec/1 (TR/TE/excitations), and the Cho/Cr ratio was calculated in the voxel where neoplastic lesion was most suspected on MRI. The presence of lactate + lipid peak was also evaluated. All spectra were obtained after the contrast enhanced study. RESULTS: Cho/Cr ratios were significantly higher in cases of residual/recurrent tumors(mean +/- SD = 1.70 +/- 0.96) than in non-neoplastic lesions(mean +/- SD = 1.04 +/- 1.16) (Mann-Whitney U-test p = 0.047). If a Cho/Cr ratio of more than 1.5 was used as a marker of tumor presence, its sensitivity was 64%, specificity 83%, and accuracy 70%. One false-positive case that of radiation necrosis whose spectrum showed a high Cho/Cr ratio with markedly elevated lactate + lipid peak. CONCLUSION: The Cho/Cr ratio of 1H-MRS provides additional information to MRI in differentiating residual/recurrent gliomas from non-neoplastic lesions.

[Choroid plexus carcinoma of the foramen Luschka: a case report].

Choroid plexus carcinoma(CPC) is a rare intracranial neoplasm that usually arises in the supra-tentorial region of infants. We report an adult case of CPC that arose in the foramen Luschka. A 61-year-old woman presented with a 10-year history of dysarthria. CT showed an iso- to slightly high density mass in the left foramen Luschka. The tumor appeared as a low- to iso-intensity area in T1-weighted MR images, and as an iso- to high-intensity area in T2-weighted images. The tumor showed homogeneous enhancement with the administration of contrast medium. Imaging findings were non-specific and the differential diagnosis was difficult.

[A case of intravascular lymphomatosis with sinus thrombosis].

We report a rare case of intravascular lymphomatosis with massive tumor in the superior sagittal sinus (SSS), which caused sinus thrombosis. A 63-year-old man was incidentally found to have an enhancing mass in the superior sagittal sinus on MRI. The tumor manifested spontaneous regression during with 4 month's follow-up. Five months after the initial MR examination, T2-weighted MR images revealed a area of hyperintensity in the right occipital lobe. The area showed hypointensity on diffusion-weighted image and showed hyperintensity on ADC mapping, findings that are compatible with vasogenic edema.

[Imaging findings of elongated styloid process syndrome (Eagle's syndrome): report of two cases].

Elongated styloid process syndrome, which is synonymous with Eagle's syndrome, is a rare disease. Although an elongated styloid process is not always symptomatic, if it compresses the cranial nerves and/or carotid artery, a patient can present with sore throat, dysphasia, or dysphoria of the throat. We present two cases of elongated styloid process syndrome, focusing on the imaging findings. The elongated styloid processes were visualized by panoramic photograms. However, CT images, especially 3DCT images, were useful in visualizing the elongated styloid process itself as well as the relationship between the styloid process and surrounding soft tissue.

Central neurocytoma with craniospinal dissemination.

We report a case of central neurocytoma that manifested tumor recurrence with craniospinal dissemination. Imaging studies before surgery showed a markedly enhanced tumor with small cysts and calcification, which invaded the adjacent brain parenchyma, located in the posterior horn of the right lateral ventricle. Proton MR spectroscopy showed markedly elevated choline and lactate peaks with a strongly diminished N-acetylaspartate peak. Two years after neurosurgical intervention, the tumor showed multiple craniospinal dissemination in the middle cranial fossa and the intradural extramedullary space of the spine.