Radiation Therapy without Surgery for Spinal Metastases: Clinical Outcome and Prognostic Factors Analysis for Pain Control.

The purpose of radiation therapy (RT) for patients with spinal metastases is pain relief and control of paralysis. The aim of the present study was to assess pain relief using RT and to evaluate prognostic factors for pain control. We evaluated 97 consecutive patients, of mean age 62.7 years (range 28 to 86), with spinal metastases that had been treated by RT. We evaluated the effects of RT using pain level assessed using a drug grading scale based on the World Health Organization standards. The following potential prognostic factors for pain control of RT were evaluated using multivariate logistic regression analysis: age, gender, tumor type, performance status (PS), number of spinal metastases, and a history of chemotherapy. Among the 97 patients who underwent RT for pain relief, 68 patients (70.1%) presented with pain reduction. PS (odds ratio: 1.931; 95% confidence interval: 1.244 to 2.980) was revealed by multivariate logistic regression analysis to be the most important prognostic factor for pain control using RT. In conclusion, we found that RT was more effective for patients with spinal metastases while they maintained their PS.

Subpial schwannoma of the cervical spinal cord mimicking an intramedullary tumor.

We report a rare case of a subpial schwannoma of the cervical cord mimicking an intramedullary tumor in a 65-year-old woman. The magnetic resonance imaging findings are presented and discussed.

Glucocorticoid treatment of brain tumor patients: changes of apparent diffusion coefficient values measured by MR diffusion imaging.

Glucocorticoids (GCC) generally are administered to patients with brain tumors to relieve neurological symptoms by decreasing the water content in a peritumoral zone of edema. We hypothesized that diffusion imaging and apparent diffusion coefficient (ADC) values could detect subtle changes of water content in brain tumors and in peritumoral edema after GCC therapy. The study consisted of 13 patients with intra-axial brain tumor, and ADC was measured in the tumor, within peritumoral edema, and in normal white matter remote from the tumor before and after GCC therapy. ADC also was measured in normal white matter in four control patients with no intracranial disease who were treated with GCC for other indications. Conventional MR images showed no visually evident interval change in tumor size or the extent of peritumoral edema in any subject after GCC therapy, which nonetheless resulted in a decrease in mean ADC of 7.0% in tumors (P < 0.05), 1.8% in peritumoral edema (P > 0.05, not significant) and 5.8% in normal white matter (P < 0.05). In patients with no intracranial disease, GCC therapy decreased mean ADC in white matter by 5.4% (P < 0.05). ADC measurement can demonstrate subtle changes in the brain after GCC therapy that cannot be observed by conventional MR imaging. Measurement of ADC proved to be a sensitive means of assessing the effect of GCC therapy, even in the absence of visually discernible changes in conventional MR images.

Comparison of growth hormone-producing and non-growth hormone-producing pituitary adenomas: imaging characteristics and pathologic correlation.

PURPOSE: To identify characteristic features of growth hormone (GH)-producing pituitary adenomas. MATERIALS AND METHODS: A total of 174 pathologically proven pituitary adenomas were evaluated retrospectively on magnetic resonance (MR) images to determine the signal intensity (on T2-weighted images), maximum diameter, and amount of suprasellar and infrasellar extension. For microadenomas, sellar depth was also measured. GH-producing adenomas were classified at histologic evaluation as densely or sparsely granulated. Specimens from 38 adenomas were stained to assess the amounts of fibrous tissue, iron, and amyloid they contained. Results were correlated with the size and hormonal activity of adenomas by using the chi2, unpaired t, and Mann-Whitney U tests. RESULTS: Among 174 pituitary adenomas, 42 were GH-producing adenomas. Of these, 16 were densely granulated, and 24 were sparsely granulated (two histologic specimens were lost). Signal intensity was evaluated among 153 adenomas. On T2-weighted MR images, hypointensity was seen more commonly in adenomas that produced GH (16 of 40 cases [40%]; P <.001) than in those that did not; hypointensity was nearly exclusive to densely granulated GH-producing adenomas. The amounts of amyloid, fibrous tissue, and iron contained in adenomas demonstrated little relationship with signal intensity. Average suprasellar extension was significantly smaller in adenomas that produced GH (-0.8 mm) than in those that did not (5.3 mm) (P <.001). GH-producing adenomas tended to demonstrate infrasellar extension rather than suprasellar extension. Average sellar depth associated with GH-producing microadenomas (13.3 mm) was significantly greater than for non-GH-producing microadenomas (9.7 mm; P <.001). CONCLUSION: Characteristic features regarding growth direction and T2 signal intensity can be identified for GH-producing adenomas.