ABSTRACT
The purpose of this study is to test the sensitivity of the volumetric analysis compared to the visual analysis of the hippocampal formations of a group of 153 patients with clinical diagnosis of temporal lobe epilepsy and candidates to temporal lobectomy, evaluated by magnetic resonance (MR), using a 0.5 Tesla machine and inversion-recovery T1-weighted images and 5 mm coronal slices. There was agreement between the prospective visual analysis and another retrospective visual analysis carried out by two independent observers (C = 0.748 and C = 0.720). There was also agreement between the retrospective analysis of the two investigators (C = 0.733). There was genuine agreement (C = 0.788) between the results of the qualitative and quantitative analyses carried out prospectively. Volume measurements showed a nonsignificant tendency to lateralize more cases of clinically presumed hippocampal atrophy. Our results confirm the reliability of a qualitative visual analysis and indicate the utility of hippocampal volumetry as a supplementary, objective and quantitative measure of hippocampal sclerosis.
Subject(s)
Epilepsy, Temporal Lobe/pathology , Hippocampus/pathology , Magnetic Resonance Imaging/methods , Temporal Lobe/pathology , Adult , Aged , Atrophy , Child, Preschool , Female , Humans , Male , Middle Aged , Prospective Studies , SclerosisABSTRACT
Ossification of the posterior longitudinal ligament (OPLL) is an uncommon cause of compressive myelopathy in the Caucasian population. A case of spastic paraparesis in a Caucasian man whose radiological investigation showed OPLL is presented. The radiographs of the cervical spine showed a strip of bony density posterior to the vertebral bodies, extending from C2 to T1. Computerized tomography (CT) and CT myelography showed OPLL at the same level. Magnetic resonance showed an area of increased signal on T2-weighted sequences at C7-T1 level suggestive of myelomalacia. The patient underwent an open-door laminoplasty (C2 to C7) with improvement of the paraparesis. OPLL should be included in the differential diagnosis of cervical myelopathy. It can be easily detected by plain radiographs and CT of the cervical spine. A review of the clinical and radiological features and the treatment of OPLL is presented.
Subject(s)
Ossification of Posterior Longitudinal Ligament/complications , Paraparesis, Tropical Spastic/etiology , Spinal Cord Compression , Humans , Male , Middle Aged , Myelography , Ossification of Posterior Longitudinal Ligament/surgery , Spinal Cord/diagnostic imagingABSTRACT
O uso da tomografia computadorizada tem determinado um grande avanço no estudo das patologias orbitárias, especialmente dos tumores. Este trabalho foi realizado com o objetivo de se determinar o padräo tomográfico dos tumores orbitários de pacientes atendidos nos nossos serviços e de realizar uma revisäo da literatura acerca deste assunto. Foram analisados 31 casos de pacientes submetidos à tomografia computadorizada das órbitas, com cortes de 2 a 3 mm e incremento de 4 mm; nos planos axial e coronal, e que, posteriormente, foram submetidos a um protocolo para melhor análise dos casos. A média de idade dos pacientes foi de 13,58 anos, com predomínio do sexo masculino. Os tumores mais frequentemente encontrados foram, na ordem: o neuroblastoma (32,25 por cento), o retinoblastoma (19,34 porcento), o rabdomiossarcoma, a leucemia mielóide, o melanoma primário e o metastático, com 6,45 por cento cada, o hemangiopericitoma, o linfoma, o meningeoma de nervo óptico, o abscesso retro-orbitário, o adenocarcinoma de glândula lacrimal e a metástase de osteossarcoma, cada um com 3,23 por cento. Foi observado, também, que cada tipo de tumor possui um padräo distinto ao exame tomográfico e que este fato, aliado às particularidades clínicas de cada lesäo, auxiliam de forma importante na elaboraçäo do diagnóstico. Conclui-se que a tomografia computadorizada apresenta, como maiores vantagens para análise de tumores orbitários, o fato de poder determinar um diagnóstico diferencial entre as diferentes doenças da regiäo, além de auxiliar na conduta terapêutica mais adequada
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Orbital Neoplasms , Tomography, X-Ray ComputedABSTRACT
We studied 5 patients with medically refractory temporal lobe epilepsy using special methods of MRI, in order to localize the epileptogenic area. Coronal sequences were obtained with 5 mm sections from the posterior margin of the brainstem to the base of the frontal lobe using: "Inversion recovery T1" (TR = 2500 msec, TE = 26 msec, T1 = 600 msec) to analyse loss of internal structure and atrophy of the hippocampus, and morphology of the temporal lobe; and Spin-echo T2w (TR = 250 msec, TE = 120 msec) looking for abnormal high intensity signal. In two cases with left focal EEG the MRI showed atrophy, loss of internal structure and abnormal high intensity signal in the hippocampus, and atrophy of the anterior temporal lobe, ipsilaterally. One case with independent bilateral foci at the EEG showed atrophy, loss of internal structure and abnormal high intensity signal in the right hippocampus. Other case with right focal EEG showed bilateral atrophy of the anterior temporal lobes. Another case was normal. We conclude that this methodology can facilitate the surgical indication in temporal lobe epilepsy.
Subject(s)
Epilepsy, Temporal Lobe/diagnosis , Magnetic Resonance Imaging , Adult , Electroencephalography , Epilepsy, Temporal Lobe/therapy , Female , Humans , Male , Middle AgedABSTRACT
Métodos especiais de MRI foram utilizados em 5 pacientes com epilepsia do lobo temporal refratários ao tratamento clínico, com a finalidade de localizar a área epileptogênica. Imagens coronais com espessura de 5mm foram obtidas da borda posterior do tronco cerebral até a base do lobo frontal, utilizando-se as sequências "Inversión Recovery T1" (TR=2500 msec, TE=26 msec, T1=600 msec) para avaliar perda de estrutura interna e atrofia do hipocampo e morfologia do lobo temporal; Spin-echo T2w (TR=2500 msec, TE=120 msec) visando a avaliar sinais de alta intensidade anormais. Em 2 casos com focos esquerdos no EEG, a MRI mostrou atrofia, perda de estrutura interna e aumento de sinal no hipocampo, e atrofia do lobo temporal anterior, ipsilateralmente. Um caso com focos bilaterais independentes no EEG teve atrofia, perda da estrutura interna e aumento de sinal no hipocampo direito. Um caso com EEG focal direito mostrou atrofia em ambos os lobos temporais anteriores. Outro caso näo mostrou anormalidades. Concluimos que esta metodologia pode facilitar a indicaçäo cirúrgica em epilepsia do lobo temporal
