Clear cell carcinoma of the base of the tongue: MR imaging findings.

Clear cell carcinoma of the base of the tongue is a rare minor salivary gland neoplasm, and to our knowledge, the MR imaging appearance of this entity has not been described. We present the MR imaging findings in such a case and review the differential diagnosis for tongue base masses in an adult.

Neuropathologic findings in a Guillain-Barré patient with strokes after IVIg therapy.

Strokes have been rarely associated with immunoglobulin G (IVIg) therapy. A 70-year-old woman with stable polycythemia vera developed Guillain-Barré syndrome and received IVIg, 8 days following which she became comatose due to bilaterally symmetric cerebral infarcts. Autopsy showed intravascular aggregates of fibrin-IgG but also platelets and a necrotizing microangiopathy in the infarcts.

Diffusion-weighted echo-planar MR imaging of CNS involvement in systemic lupus erythematosus.

RATIONALE AND OBJECTIVES: The purpose of this study was to determine the range of findings at diffusion-weighted magnetic resonance (MR) imaging in patients with systemic lupus erythematosus (SLE) and central nervous system involvement. MATERIALS AND METHODS: Diffusion-weighted MR images were reviewed in 20 patients with SLE and correlated with clinical symptoms and findings at computed tomography, conventional MR imaging, MR angiography, or conventional angiography. RESULTS: Diffusion-weighted MR imaging showed acute or subacute lesions in nine of 20 patients (45%). In the other 11, it showed no abnormal findings or chronic lesions. In four of the nine patients with lesions, diffusion-weighted imaging primarily showed hyperintense lesions with decreased apparent diffusion coefficient (ADC), which indicates acute or subacute infarcts. In four other patients, it primarily showed iso- or slightly hyperintense lesions with increased ADC, suggesting vasogenic edema. In two of these four patients, the findings were consistent with hypertensive encephalopathy. In the other two, small hyperintense foci on diffusion-weighted images with decreased ADC were seen within the vasogenic edema. These foci presumably represent microinfarcts associated with SLE vasculopathy. In the ninth patient, diffusion-weighted imaging showed a small linear hyperintense lesion with normal ADC in the left parietooccipital region. CONCLUSION: Diffusion-weighted imaging shows primarily two patterns of acute or subacute parenchymal lesions in patients with SLE: acute or subacute infarction and vasogenic edema with or without microinfarcts.

Functional MR imaging of vision in the deaf.

RATIONALE AND OBJECTIVES: Early loss of a sensory modality has been associated with cortical reorganization in both animal models and humans. The purpose of this study was to map visual activation with functional magnetic resonance (MR) imaging and to document possible developmental reorganization in the temporal lobe caused by early deafness. MATERIALS AND METHODS: Six prelingual, profoundly deaf subjects were compared with a similar group of six hearing subjects. Three visual tasks were performed by both groups: attention to movement in the field-of-view periphery, shape matching, and mental rotation. Echo-planar coronal MR imaging was performed at 1.5 T. RESULTS: Regions of interest encompassing the middle and posterior aspects of the superior and middle temporal gyri demonstrated a significantly (P < .05) increased activation in deaf subjects compared with hearing subjects, particularly on the right side (P < .05) and during the tasks involving motion. The most specific effect was noted during the mental-rotation task. CONCLUSION: These results support the hypothesis that portions of the temporal lobe usually involved in auditory processing are more active during certain visual tasks in deaf compared with hearing subjects. Cortical reorganization may be an important factor in the deaf population when considering the physiology of temporal lobe lesions and predicting surgical outcomes. Functional MR imaging may be helpful during preoperative assessment in individuals with deafness.

Diffusion anisotropy of the internal capsule and the corona radiata in association with stroke and tumors as measured by diffusion-weighted MR imaging.

BACKGROUND AND PURPOSE: Diffusion-weighted MR images have enabled measurement of directionality of diffusion (anisotropy) in white matter. To investigate differences in the anisotropy for various types of pathologic findings and the association between the anisotropy of tracts and neurologic dysfunction, we compared the anisotropy of the posterior limb of the internal capsule and the corona radiata between patients with stroke and those with tumors and between patients with and without hemiparesis. METHODS: Thirty-three patients consisting of 11 with tumors and 22 with ischemic disease (16 acute infarction, four old infarction, and two transient ischemic attack) and nine control patients were studied with a 1.5-T MR imager. Diffusion-weighted images were obtained with diffusion gradients applied in three orthogonal directions. The diffusion anisotropy measurements were obtained from regions of interests defined within the internal capsule and the corona radiata. RESULTS: The diffusion anisotropy was significantly reduced in all internal capsules and coronae radiata involved by infarcts, tumors, and peritumoral edema compared with that of the control patients (P <.0001). This reduction was most prominent in the tracts involved by tumors (P <.05). The anisotropy of the internal capsules and coronae radiata was significantly decreased in cases with moderate-to-severe hemiparesis as compared with those with no or mild hemiparesis (P <.0001). Diffusion anisotropy tended to be also reduced in normal-appearing internal capsules and coronae radiata that were remote from the involved segment of the corticospinal tract. CONCLUSION: The degree of impaired diffusion anisotropy may vary in different pathologic conditions and correlate with neurologic dysfunction. The measurement of diffusion anisotropy may provide additional information relating to neurologic function and transneuronal effects.

Human herpesvirus 6-meningoencephalitis in an HIV patient with progressive multifocal leukoencephalopathy.

Human herpesvirus 6 (HHV6) has been reported as a rare cause of meningoencephalitis and leukoencephalitis. We present an HIV-infected patient with lesions of progressive multifocal leukoencephalopathy (PML), but also meningoencephalitis apparently due to HHV6. Immunohistochemistry for HHV6 antigens and in situ polymerase chain reaction for HHV6 genome showed many positive lymphocytes and microglia in the meningeal and cortical lesions. More importantly, dead and dying neurons were conspicuous; some were undergoing neuronophagia and some displayed evidence of HHV6 infection. A pathogenic role for this almost universal, and usually commensal, virus in inflammatory brain lesions and PML is briefly discussed.

MR volumetric analysis of the human basal ganglia: normative data.

RATIONALE AND OBJECTIVES: The authors undertook this study to identify a precise, semiautomated, reproducible magnetic resonance (MR) imaging technique for measuring the basal ganglia, to establish normative volumetric data, and to verify the presence of previously reported asymmetries. MATERIALS AND METHODS: Twenty-eight healthy adults underwent cranial MR examination. The volumes of the various components of the basal ganglia were measured by means of a combination of thresholding and manual tracing techniques performed with specialized software. The validity of these measurements was assessed by fashioning, imaging, and measuring a practical basal ganglia phantom. Measurement accuracy was also established by means of inter- and intrarater reliability indexes. Normalized volumes were statistically analyzed with analysis of variance and paired t tests. RESULTS: The absolute values of the various components of the basal ganglia varied widely even though the volumes were normalized to differences in intracranial volume. The right caudate nucleus volume was significantly (P < .000001) larger than the left in both men and women and in both right-handed and non-right-handed subjects. This asymmetry led to an increase in the overall volume of the basal ganglia on the right. CONCLUSION: The authors have defined a precise, reproducible technique for measuring various components of the basal ganglia and have established normative data. The basal ganglia, similar to other brain structures, exhibit hemispheric lateralization.

Efficacy of targeted CT angiography in evaluation of intracranial internal carotid artery disease.

RATIONALE AND OBJECTIVES: This study evaluated the efficacy of targeted computed tomographic (CT) angiography in the diagnosis of intracranial internal carotid artery (ICA) disease and compared the results of routine and targeted CT angiography. MATERIALS AND METHODS: Fifty-four patients (24 male and 30 female patients aged 2 months to 87 years) were examined with CT angiography. Digital subtraction angiography (DSA) was performed in 42. CT angiograms were reconstructed with the maximum-intensity projection (MIP) algorithm. Targeted CT angiography was performed by individually reconstructing a single ICA territory. Each ICA was divided into four segments, and findings of routine MIP CT angiography, routine MIP plus targeted CT angiography, and DSA were reviewed independently by two neuroradiologists for vascular lesions involving each segment. Routine and targeted CT angiograms were also evaluated to determine how well both ICAs were visualized. RESULTS: Routine CT angiography was rated good or excellent for ICA visualization in 64% of cases, compared with 81% for targeted CT angiography (P = .0005). The overall agreement between routine CT angiography and DSA and between routine plus targeted CT angiography and DSA was 92% and 94%, respectively. There was no statistically significant difference between the percentages of vascular lesions detected with routine CT angiography alone and with routine plus targeted CT angiography. Both methods tended to show false-positive findings of steno-occlusive disease, but targeted CT angiography showed details of aneurysms and stenotic lesions that were easily overlooked with routine CT angiography alone. CONCLUSION: Routine plus targeted CT angiography, while providing superior image quality, did not have much clinical effect; further assessment may be needed.

Characteristics and pitfalls of contrast-enhanced, T1-weighted magnetization transfer images of the brain.

RATIONALE AND OBJECTIVES: This study was undertaken to clarify the difference in signal pattern on contrast material-enhanced T1-weighted magnetic resonance (MR) magnetization transfer (MT) images between enhancing and nonenhancing lesions in various intracranial diseases and to determine the necessity of nonenhanced MT images for evaluating lesional contrast enhancement. MATERIALS AND METHODS: MR images of 116 patients who underwent nonenhanced T1-weighted imaging, nonenhanced MT imaging, and contrast-enhanced MT imaging were reviewed. The increase in signal intensity of lesions relative to normal brain was compared between nonenhanced T1-weighted images and contrast-enhanced MT images. Signal intensity of lesions was compared with that of the striate nucleus and white matter on contrast-enhanced MT images. True enhancement was determined by comparison with nonenhanced MT images. RESULTS: In all, 143 lesions, including 86 enhancing and 57 nonenhancing lesions, were identified among 63 patients. Almost all (99%) of the enhancing lesions were hyperintense to striate nucleus on contrast-enhanced MT images, and most (>87%) showed moderate to marked signal intensity increase from nonenhanced T1-weighted images to contrast-enhanced MT images. Most (>95%) of the nonenhancing lesions showed mild or no increase in relative signal intensity, and most (75%) were iso- or hypointense to striate nucleus on contrast-enhanced MT images. A few nonenhancing lesions (4%-6%), however, showed increase in signal intensity that was indistinguishable from true enhancement without comparison to non-enhanced MT images. CONCLUSION: Nonenhanced MT images should be obtained to assess pathologic enhancement accurately.

Heschl and superior temporal gyri: low signal intensity of the cortex on T2-weighted MR images of the normal brain.

PURPOSE: To study the normal signal intensity pattern in the primary auditory cortex (first Heschl gyrus [HG]) and the surrounding cortices in the superior temporal gyrus (STG) and middle temporal gyrus (MTG) on T2-weighted magnetic resonance (MR) images. MATERIALS AND METHODS: Coronal T2-weighted fast spin-echo MR images in 30 neurologically normal patients (60 hemispheres) were retrospectively analyzed. Two raters evaluated the cortical signal intensity of the first HG and the neighboring STG and compared them with those of the MTG and the subcortical white matter. The cortical signal intensities between the first HG and the STG were also directly compared. Coronal MR images, which included images of the anterior and posterior halves of the first HG, were evaluated separately. RESULTS: All first HGs were hypointense to the MTG and were either iso- or hypointense to the STG. Cortical hypointensity was especially prominent in the posterior half; the first HG was isointense to the white matter in 33 (55%) hemispheres. The STG was hypointense to the MTG in 54 (90%) hemispheres and in the anterior halves of 36 (60%) hemispheres. CONCLUSION: These findings demonstrate lower signal intensity of the cortex on T2-weighted images in the first HG and surrounding STG compared with that of the MTG.

Diffusion-weighted echo-planar MR imaging: clinical applications and pitfalls -- a pictorial essay.

Diffusion-weighted imaging (DWI) provides unique information about various pathological changes of the brain. DWI is sensitive for the detection of hyperacute infarcts, and useful in distinguishing acute or subacute infarcts from chronic infarcts. DWI is useful in differentiating cytotoxic edema from vasogenic or interstitial edema, which may help to determine prognosis. DWI is useful in differentiating cystic or necrotic tumors from abscesses or epidermoids. DWI can discriminate nonenhanced tumor infiltration from vasogenic edema, and differentiate dysmyelination from demyelination.

Central brain herniation secondary to juvenile diabetic ketoacidosis.

We present the CT, MR, and autopsy findings of central brain herniation in a 9-year-old boy undergoing treatment for diabetic ketoacidosis (DKA). Severe cerebral edema resulting in central brain herniation is an uncommon complication of the treatment of DKA but carries with it high morbidity and mortality. Radiologic imaging and autopsy findings in this case revealed striking infarctions of central brain structures.

Fibro-osseous lesions of the central nervous system: report of four cases and literature review.

Fibro-osseous lesions, also reported as calcifying pseudoneoplasms of the neural axis, are uncommon lesions of the CNS. We report four additional cases: two extraaxial and two intraaxial, in patients ages 33, 47, 49, and 59 years at presentation. Fibro-osseous lesions involving the CNS demonstrate variable proportions of fibrous stroma, bone, palisading spindle to epithelioid to multinucleated cells in association with a highly distinctive, perhaps pathognomonic, chondromyxoid-like matrix often distributed in a nodular pattern. This histopathologically distinctive lesion can be seen in many regions of the neuraxis, often with a dural association, and most commonly along the vertebral column. It appears to be a slow-growing lesion and, with wide excision, the prognosis is excellent. The etiology remains unclear, but the preponderance of data favors a reactive rather than neoplastic process. If this putative pseudotumor is not recognized histopathologically, a neoplastic or infectious differential might result in inappropriate investigations and potentially harmful therapies.

Functional MRI study of auditory and visual oddball tasks.

To seek neural sources of endogenous event-related potentials, brain activations related to rare target stimuli detection in auditory and visual oddball tasks were imaged using a high temporal resolution functional MRI technique. There were multiple modality specific and modality non-specific activations. Auditory specific activations were seen in the bilateral transverse temporal gyri and posterior superior temporal planes while visual specific activations were seen in the bilateral occipital lobes and their junctions with the temporal lobes. Modality non-specific activations were seen in multiple areas including the bilateral parietal and temporal association areas, bilateral prefrontal cortex, bilateral premotor areas, bilateral supplementary motor areas and anterior cingulate gyrus. Results were consistent with previous intracranial evoked potential recording studies, and supported the multiple generator theory of the endogenous event-related potentials.

Value of CT angiography in the evaluation of a peripheral anterior inferior cerebellar artery aneurysm: case report.

We report a case of a peripheral anterior inferior cerebellar artery (AICA) aneurysm in a 66-year-old woman. Computed tomography angiography (CTA) demonstrated a saccular aneurysm in the left AICA. A subsequent vertebral digital subtraction angiography using our standard injection technique failed to demonstrate the aneurysm. However, the aneurysm was visualized on a follow-up injection performed with an increased contrast dose and injection rate. CTA proved to be critical in the detection of this aneurysm which could have been easily overlooked on a conventional angiogram.

Fibro-osseous lesions involving the brain: MRI.

We present the MRI findings in two patients with "fibro-osseous lesions" involving the central nervous system. A left temporal lobe mass was present in one patient and an extra-axial mass at the skull base in the other. In both cases, calcification was present, with low signal intensity on T1- and T2-weighted images.

Cerebral giant aneurysm with extensive vasogenic edema.

An unusual presentation of a giant intracranial aneurysm is demonstrated. The patient was a 58-year-old woman who developed sudden onset of headache followed by generalized seizures. CT scan showed a high-density lesion in the middle cranial fossa with extensive vasogenic edema. Possible mechanisms for the edema are discussed.

A case of subacute combined degeneration: MRI findings.

The specific spinal cord lesion caused by vitamin B12 deficiency is known as subacute combined degeneration (SCD). Neuropathological studies of SCD show lesions mainly in the posterior and lateral columns, involving the cortico-spinal and spino-cerebellar tracts. We report a case of SCD in a 19-year-old man who presented with 4 weeks history of gradually progressing tingling in both hands. MRI of the cervical spine demonstrated symmetrical areas of T2 signal abnormality involving the dorsal columns of the cervical cord from the C2 through C5 levels associated with spinal cord expansion. He was treated with vitamin B12 supplements and experienced gradual improvement in his clinical symptoms. Repeat MRI of the cervical spine after 2 months revealed slight decrease in the area of abnormal signal.