Brain and Spinal Cord MRI Findings in Thai Multiple Sclerosis Patients.

BACKGROUND: Previous studies have demonstrated different MRI characteristics in Asian and Western patients with multiple sclerosis (MS). However, the number of studies performed on Thai patients is still limited. Furthermore, these studies were conducted before the revision of the McDonald criteria in 2017. METHODS: A retrospective descriptive study was performed on Thai patients diagnosed with MS, according to the McDonald criteria (2017), in a tertiary care hospital in Thailand. RESULTS: Thirty-two patients were included (twenty-seven female and five male patients). The mean age was 37.8 years. Most (28 patients) had relapsing remitting MS. Brain MRIs were available for all 32 patients, all of which showed abnormalities. The most common locations were the periventricular regions (78.1%), juxtacortical regions (75%) and deep white matter (62.5%). Dawson's fingers were identified in 20 patients (62.5%). Tumefactive MS was noted in two patients. Gadolinium-enhancing brain lesions were noted in nine patients (28.1%). Optic nerve lesions were found in seven patients. Six of the seven patients showed short segmental lesions with predominant posterior-half involvement. Spinal MRIs were available for 26 patients, with abnormalities detected in 23. Most (11 patients) had lesions both in the cervical and in the thoracic spinal cord. In total, 22 patients (95.7%) showed lesions at the periphery, most commonly at the lateral column. Fifteen patients showed lesions shorter than three vertebral segments (65.2%). Enhancing spinal lesions were noted in 14 patients. Dissemination in space was fulfilled in 31 patients (96.9%). CONCLUSION: Some of the MRI findings in our study were similar to those of previous studies in Thailand and Asia, emphasizing the difference between Asian and Western MS.

Evaluation of Perienhancing Area in Differentiation between Glioblastoma and Solitary Brain Metastasis.

PURPOSE: Accurate differential diagnosis between glioblastoma and brain metastasis is important. We aimed to differentiate these tumors by evaluation of the perienhancing area. MATERIALS AND METHODS: Thirty patients with glioblastoma and solitary brain metastasis were included. The diameters of perienhancing and enhancing areas were measured, and the percentage of enhancing area was calculated. We measured Apparent diffusion coefficient (ADC) of perienhancing and enhancing areas. Intratumoral necrotic areas were measured. RESULTS: The enhancing area of glioblastoma was 56.61% and metastasis was 42.55% (p = 0.08). The ADC values of the perienhancing part of GBM was 0.7 and metastasis was 0.79 (p = 0.052). The ADC value of the enhancing part of the GBM was 0.82 and metastasis was 0.8 (p-value = 0.72).  The intratumoral necrotic area of glioblastoma (152.25 mm3) was higher than in metastasis (0 mm3) (p-value = 0.003) with a cutoff area of 11.8 mm2. CONCLUSION: The ADC values of the perienhancing area were lower in glioblastoma with a near-significant p-value. Other perienhancing parameters demonstrated no significant difference between both tumors. The intratumoral necrotic area of glioblastoma is larger than metastasis.
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Grading Gliomas Capability: Comparison between Visual Assessment and Apparent Diffusion Coefficient (ADC) Value Measurement on Diffusion-Weighted Imaging (DWI).

BACKGROUND: To compare diagnostic accuracy between DWI visual scale assessment and ADC value measurement of solid portion of the tumor in grading gliomas. METHODS: This retrospective study included 38 patients who had pathologically proven gliomas between January 2013 and August 2018 with 18 low grade and 20 high grade tumors. All patients underwent MRI and biopsy. Two readers reviewed DWI visual scale independently. Disagreement was resolved by consensus. One reviewer measured ADC value of entire solid part of the tumor in single axial slice with greatest dimension of tumor which was chosen by consensus. Two data sets of visual scale and ADC value were analyzed and comparison of diagnostic accuracy in glioma grading was done by using area under the curve (AUC) of receiver operating characteristic curve (ROC). RESULTS: Visual scale and ADC value could be used to distinguish between low and high grade gliomas with a statistically significant difference. (P-value 0.002 and <0.001). Almost all high grade gliomas had visual scale 5. The sensitivity, specificity, PPV NPV and accuracy were 50%, 100%, 100% , 64.3%,73.68% respectively. The cutoff level for the ADC value was determined to be 1119.48 x10-6 mm2/s in differentiation between low and high grade gliomas with the sensitivity, specificity, PPV, NPV, accuracy of 90%, 88.89% , 90%, 88.9% and 89.47% respectively. There was no statistically significant difference(P-value = 0.163). CONCLUSION: Both Visual scale and ADC value were capable of differentiating between low and high grade gliomas. Although visual scale may not replace ADC measurement, larger scale prospective study is needed for validate this initial result.
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Preoperative MRI evaluation of meningioma consistency: A focus on detailed architectures.

OBJECTIVES: Meningioma is one of the most common primary intracranial tumors. Diagnosis by imaging is not difficult. However evaluation of tumor consistency is an important factor affecting the surgical outcomes. The purpose of our study is to discover the relationship of different findings on pre-operative MRI, with a focus on detailed architectures, and different degrees of intra-operative stiffness of meningioma. Consistency of meningioma is also analyzed in compression to semi-quantitative pathological grading of fibrosis. PATIENTS AND METHODS: Sixty patients who underwent pre-operative MRI and primary surgery at our hospital were included in prospective fashion. Pre-operative MRI parameters, including general data and detailed internal architectures, were recorded. Intra-operative grading of tumor consistency was performed by the neurosurgeon. Pathological report according to WHO 2007 was performed with additional semi-quantitative grading of fibrosis. This study is focused on correlation of operative grade and MRI findings. RESULTS: Meningioma with hard consistency shows significant correlation with several features including en plaque appearance (p = 0.0427), higher ADC value (p = 0.0046) and ratio (p = 0.0016), absent of prominent enhanced rim (p = 0.0306), absent of enostotic spur (p = 0.0040) and absent of vascular core (p = 0.0133) in univariate analysis but no significant correlation is found in multivariate analysis in all except ADC ratio. Higher ADC ratio increase relative risk of hard consistency of meningioma by a factor of 41.22 (ORs = 41.22; 95%CI = 1.19-1426.24, P = 0.04). Good to very good inter-rater agreements are found. No significant correlation between tumor consistency and WHO grading was shown (p = 0.606). However, near significant p-value (p = 0.055) is found with increase degree of fibrosis in pathology as increase degree of tumor consistency. CONCLUSION: We found that en plaque appearance, higher ADC value and ADC ratio, absent of prominent capsular enhancement and absent of vascular core were suggestive of hard consistency in univariate analysis but not independent factors. Additionally, semi-quantitative pathological grading of fibrosis showed near significant correlation with tumor consistent.

DIFFERENCES OF MRI FEATURES BETWEEN TUBERCULOUS AND BACTERIAL SPONDYLITIS IN A TB-ENDEMIC AREA.

Pyogenic and tuberculous spondylitis are common causes of infectious spondylitis. The purpose of this study was to determine the specific MRI findings that can differentiate these two types of infectious spondylitis. This study retrospectively analyzed MRIs in patients diagnosed with infectious spondylitis from January 1, 2005 to December 31, 2009. Tuberculous spondylitis was diagnosed by histopathological findings of caseous granuloma, while pyogenic spondylitis was diagnosed by positive cultures of tissue, fluid, or blood. Locations and extents of the lesions, and the findings using individual imaging criteria were recorded. Statistical analysis was performed with the Fisher's exact test. A significant difference was considered at.p < 0.05. During the study period, 33 patients met the criteria. Of those, 24 patients had tuberculous spondylitis and nine had pyogenic spondylitis. Two suggestive findings for tuberculous spondylitis were abscesses with thin and smooth walls (75% in tuberculous spondylitis vs 0% in pyogenic spondylitis, p < 0.001) and well-defined paraspinal soft tissue (66.7% in tuberculous vs 11.1% in pyogenic spondylitis, p = 0.007). These two MRI findings may be helpful for differentiating between tuberculous and pyogenic spondylitis.

MR findings in spinal tuberculosis in an endemic country.

INTRODUCTION: Spinal tuberculosis (TB) accounts for 50% or more of skeletal tuberculosis. MRI is a helpful tool for spinal TB. MR findings in spinal TB however, may have several different patterns. METHODS: The MRI features of spinal TB and classification as usual and unusual findings are reported. The MR images in 52 proven spinal TB patients in Srinagarind Hospital from 1996 to 2005 were retrospectively reviewed. RESULTS: There were five characteristics of unusual manifestations, including multiple skip lesions, vertebral body involvement, lamina and spinous process involvement, single vertebral collapse, and intramedullary tuberculoma. The skip lesion of spinal TB was the only distribution pattern significantly identified as being an unusual characteristic by multiple logistic regression. CONCLUSION: The most common unusual pattern of spinal TB is skip lesions (11.5%). The distribution of this pattern is statistically significant as an important MRI feature for defining unusual spinal TB.

Cerebral angiographic findings in patients with non-traumatic subarachnoid hemorrhage.

BACKGROUND: Even though ruptured intracranial aneurysm is a major cause of non-traumatic subarachnoid hemorrhage (SAH), non-aneurysmal SAH has a good prognosis with few neurologic complications. The gold standard for detecting the vascular pathology is digital subtraction cerebral angiography (DSA). OBJECTIVE: The primary objective of the present study was to clarify cerebral angiographic findings in patients with non-traumatic subarachnoid hemorrhage (SAH); to define the incidence of nonaneurysmal SAH. The secondary aim was to review the clinical data of all of the patients diagnosed with non-traumatic SAH in order to determine the associated etiology. MATERIAL AND METHOD: This retrospective, descriptive study, was conducted at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, between January 2005 and November 2010. The authors reviewed the medical records, cranial computed tomography (CT) and DSA of patients with non-traumatic SAH. The DSA findings were assessed and the correlation with clinical data and CT pattern determined. RESULTS: The author included and analyzed the records of 118 non-traumatic SAH patients (66 females, 52 males). The DSA discovered vascular lesions in 62.6% of cases (57.6% aneurysm, 4.2% arteriovenous malformation (AVM) and 0.8% Moyamoya disease). A total of 76 aneurysms were found in 68 cases. The location of the aneurysms included: 35.5% anterior communicating artery, 17.1% posterior communicating artery, 15.7% middle cerebral artery, 11.8% internal carotid artery 2.6% basilar artery, 1.3% vertebrobasillar junction and 10.5% others. The prevalence of nonaneurysmal SAH was 42.4% (50/118). In the multivariate analysis, hypertension was the factor most strongly associated with aneurysmal SAH on the DSA (p = 0.029). The location of SAH on Sylvian fissure was most frequently associated with the cause of aneurysms. In another way, tentorial cerebelli SAH was most commonly associated with a non-aneurysm cause. CONCLUSION: The present study revealed that the major cause of non-traumatic SAH is cerebral aneurysm. The factors associated with aneurysmal SAH included: hypertension and Sylvian fissure SAH. Tentorial cerebelli SAH was most commonly associated with a non-aneurysm cause.

Communicating hydrocephalus as a complication of eosinophilic meningoencephalitis.

The authors reported an adult patient with communicating hydrocephalus in eosinophilic meningoencephalitis. He presented with localized peritonitis and then developed eosinophilic meningoencephalitis. Angiostrongylus cantonensis was the causative agent. This was confirmed by the positive serology test. His consciousness did not recover after supportive treatment. The MRI of the brain showed diffuse enlargement of the ventricular system two weeks after the diagnosis was made. The parameters for hydrocephalus were measured and were compatible with the Gyldensted's criteria.

Predictive CT features in ruptured abdominal aortic aneurysm.

OBJECTIVE: To evaluate the CT findings including size of aneurysm, hyperattenuation crescent sign and focal discontinuity of mural calcification to predict the risk of ruptured aneurysm. MATERIAL AND METHOD: Records of 27 patients, who underwent Multislices Computed Tomography (MDCT) and required operative repair of abdominal aortic aneurysm from July 2000 to July 2003 were retrospectively reviewed Two radiologists evaluated the images by consensus, analyzing the aneurysm size, hyperattenuation crescent sign, and focal discontinuity of mural calcification. RESULTS: The authors found that the mean maximum AP diameters of the aneurysm in the ruptured and nonruptured group were 6.95 cm and 5.50 cm, respectively. All patients in the ruptured group had an aneurysm size of more than 5.0 cm. The hyperattenuation crescent sign and focal discontinuity of mural calcification had a high specificity for predicting ruptured aneurysm, 95% and 100%, respectively. There was statistical significant difference between the ruptured aneurysm and non-ruptured groups in the patients who had maximum aneurysm size more than 5 cm with positive hyperattenuation crescent sign (p < 0.041). CONCLUSION: A maximum size of aneurysm greater than 5 cm with positive hyperattenuation crescent sign is a suggestive sign to predict ruptured aneurysm.

Stroke in Asia.

The epidemic of cardiovascular disease across most of Asia is at a different stage from that in the West; the incidence and prevalence of stroke are increasing steadily, associated with nutritional changes and aging of the population. Epidemiologic data, crucial in combating stroke, have been relatively sparse in Asian populations, but a few international collaborative studies on stroke have been in progress for several years. Through these, we now know that ischemic stroke is actually the most frequent type of cerebrovascular accident in Asia, although hemorrhagic stroke remains more common in Asia than in the West. Also, the percentage of ischemic stroke attributable to intracranial vascular disease is much higher than in the West. In Japan and a few other countries, stroke rates are declining; however, increasing rates in most other countries make primary prevention of critical importance in minimizing the severe impact of this epidemic in Asia.

Comparison of high-resolution computed tomography with pulmonary function testing in symptomatic smokers.

PURPOSE: To compare high-resolution computed tomography (HRCT) of lungs with pulmonary function in smokers diagnosed with emphysema. MATERIAL AND METHOD: The authors retrospectively reviewed 17 patients with a history of smoking and dyspnea, who underwent HRCT of the lungs and pulmonary function testing. HRCT scores were determined and compared to pulmonary function (FEV1, FEV1/FVC, and DLCO). RESULTS: The HRCT of all 17 patients (17/17; 100%) were typical of centrilobular emphysema; with a mean score of 12.88+/-9.18 (range, 4 to 34). Decreased FEV1 (<80% predicted) was found in 8 patients (47%), decreased FEV1/FVC (<70% predicted) in 13 patients (76%) and decreased DLCO (<80% predicted) in 3 patients (18%). The severity of emphysema revealed by HRCT was inversely correlated with the pulmonary function test: DLCO (r=-0.842, p=0.000) and FEV1 (r=-0.597, p= 0.011), but not FEV1/FVC (r=-0.400, p=0.112). CONCLUSION: HRCT allows detection of emphysema in symptomatic smokers even when pulmonary function appears to be normal. The greater the involvement of emphysema revealed by the HRCT, the poorer the pulmonary function. The authors, therefore, conclude that HRCT is the most sensitive modality for diagnosing early emphysema in smokers with dyspnea.