Asunto(s)
Leucoencefalitis Hemorrágica Aguda/patología , Leucoencefalitis Hemorrágica Aguda/rehabilitación , Recuperación de la Función , Corticoesteroides/administración & dosificación , Adulto , Humanos , Leucoencefalitis Hemorrágica Aguda/tratamiento farmacológico , Imagen por Resonancia Magnética , Masculino , PsicometríaRESUMEN
PURPOSE: To estimate the incidence of occult metastases to the brain and skeleton in patients suspected of having non-small cell lung cancer (NSCLC) (stage higher than T1Nomo) with surgically resectable disease, to assess the accuracy of screening magnetic resonance (MR) imaging and radionuclide bone scanning for help in identifying occult metastases, and to determine the effectiveness of a high dose of MR contrast material. MATERIALS AND METHODS: Twenty-nine patients suspected of having NSCLC localized to the lung or to the lung and regional nodes underwent preoperative MR imaging with contrast material enhancement and radionuclide bone scanning for detection of brain or skeletal metastases. Patients were followed up for 12 months to determine the incidence of clinical metastatic disease. RESULTS: Eight (28%) patients had occult metastatic disease to the brain or skeleton. Brain metastases were identified on MR images in five of six patients. Bone metastases were identified on MR images in four of five patients and on bone scans in three of five patients. MR imaging was no more accurate than bone scanning for skeletal evaluation. A high dose of MR contrast material allowed detection of more metastases and of small lesions. CONCLUSION: Contrast-enhanced MR imaging of the brain is indicated for the exclusion of brain metastases in patients with clinically operable known or possible NSCLC and a large (> 3-cm) lung mass. Skeletal imaging may be indicated if an isolated brain metastasis is detected.
Asunto(s)
Neoplasias Óseas/secundario , Neoplasias Encefálicas/secundario , Carcinoma de Pulmón de Células no Pequeñas/secundario , Neoplasias Pulmonares/patología , Anciano , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/epidemiología , Huesos/diagnóstico por imagen , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/epidemiología , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Carcinoma de Pulmón de Células no Pequeñas/epidemiología , Medios de Contraste , Femenino , Humanos , Incidencia , Imagen por Resonancia Magnética , Masculino , Proyectos Piloto , Valor Predictivo de las Pruebas , Estudios Prospectivos , Cintigrafía , Sensibilidad y EspecificidadRESUMEN
The purpose of this article is to assess lossy image compression of digitized chest radiographs using radiologist assessment of anatomic structures and numerical measurements of image accuracy. Forty posterior-anterior (PA) chest radiographs were digitized and compressed using an irreversible wavelet technique at 10, 20, 40, and 80:1. These were presented in a blinded fashion with an uncompressed image for A-B comparison of 11 anatomic structures as well as overall quality assessments. Mean error, root-mean square (RMS) error, maximum pixel error, and number of pixels within 1% of original value were also computed for compression ratios from ratios from 5:1 to 80:1. We found that at low compression (10:1) there was a slight preference for compressed images. There was no significant difference at 20:1 and 40:1. There was a slight preference on some structures for the original compared with 80:1 compressed images. Numerical measures showed high image faithfulness, both in terms of number of pixels that were within 1% of their original value, and by the average error for all pixels. Our findings suggest that lossy compression at 40:1 or more can be used without perceptible loss in the representation of anatomic structures. On this finding, we will do a receiver-operator characteristic (ROC) analysis of nodule detection in lossy compressed images using 40:1 compression.
Asunto(s)
Intensificación de Imagen Radiográfica , Radiografía Torácica/métodos , Artefactos , Humanos , Pulmón/diagnóstico por imagen , Radiografía Torácica/normas , Sistemas de Información RadiológicaRESUMEN
A 73-year-old man developed acute, painful, ophthalmoplegia. The pain improved with oral steroids and a diagnosis of Tolosa-Hunt syndrome was made. Review of his angiogram revealed a low flow dural arteriovenous shunt that drained posteriorly. Dural arteriovenous shunts may thus be another cause of "sinister" Tolosa-Hunt syndrome.
Asunto(s)
Fístula Arteriovenosa/complicaciones , Arterias Carótidas/anomalías , Seno Cavernoso/anomalías , Duramadre/irrigación sanguínea , Malformaciones Arteriovenosas Intracraneales/complicaciones , Oftalmoplejía/etiología , Anciano , Fístula Arteriovenosa/congénito , Fístula Arteriovenosa/fisiopatología , Velocidad del Flujo Sanguíneo , Humanos , Malformaciones Arteriovenosas Intracraneales/fisiopatología , Masculino , Oftalmoplejía/diagnóstico , Oftalmoplejía/tratamiento farmacológico , Prednisona/uso terapéuticoRESUMEN
In a study of 10 patients with degenerative brain disease that manifested as simultanagnosia, our aims were (1) to elucidate their clinical, neuropsychologic, and radiologic findings to determine whether these patients might represent a group distinguishable from those with typical Alzheimer's disease and (2) to help clinicians recognize this entity. All patients were initially examined by ophthalmologists because of visual difficulties, and the simultanagnosia remained undiagnosed until nonophthalmologic complaints developed. Optic ataxia developed in six patients, and all patients had mildly impaired eye movements. All 10 patients could identify colors appropriately. Nine patients had language deficits (anomia, decreased auditory comprehension, alexia, and agraphia) but were fluent and had relative preservation of sentence repetition, and four performed in the normal range on a test of associative fluency. Two patients scored in the normal range on memory tests, all had preserved insight, and nine had no family history of degenerative dementia. The mean age at onset of the disorder was 60 years (range, 50 to 69). Neuroimaging disclosed prominent bilateral occipitoparietal atrophy in nine patients and generalized atrophy in one. With this unusual but consistent clinical, neuropsychologic, and anatomic profile, these patients are clinically distinguishable from those with typical Alzheimer's disease, but until a specific cause has been found, we cannot be certain that they constitute a specific biologic entity. Clinicians should consider this diagnosis in relatively young patients who have slowly progressive nonocular visual complaints.
Asunto(s)
Demencia/diagnóstico , Percepción Visual , Anciano , Demencia/complicaciones , Demencia/fisiopatología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Nistagmo Patológico/etiología , Lóbulo Occipital/patología , Lóbulo Parietal/patología , Lóbulo Temporal/patología , Tomografía Computarizada por Rayos X , Pruebas de Visión , Agudeza Visual , Campos VisualesRESUMEN
Spontaneous bilateral carotid-cavernous fistulae and cervical artery dissection is reported in a 20-year-old woman with Ehlers-Danlos syndrome Type IV. The clinical features of 16 previously published cases of spontaneous carotid-cavernous fistulae associated with Ehlers-Danlos syndrome Type IV are reviewed, for a total of 17 cases. The mean age of the 14 women and three men was 31.6 years. Only direct fistulae were encountered. Diagnostic neuroangiography carried morbidity and mortality rates of 36% and 12%, respectively; neuroradiological treatment resulted in death in one of six patients. The possible value of desmopressin in the management of these patients is discussed. In view of the risks of arterial puncture and surgery, the authors emphasize the importance of early recognition of Ehlers-Danlos syndrome.
Asunto(s)
Fístula Arteriovenosa/diagnóstico , Arteria Carótida Interna/diagnóstico por imagen , Seno Cavernoso/diagnóstico por imagen , Síndrome de Ehlers-Danlos/diagnóstico , Adulto , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/terapia , Desamino Arginina Vasopresina/uso terapéutico , Síndrome de Ehlers-Danlos/complicaciones , Síndrome de Ehlers-Danlos/terapia , Embolización Terapéutica , Femenino , Humanos , RadiografíaRESUMEN
A prospective study was done of complications associated with 134 consecutive diagnostic spinal cord arteriograms in 96 patients (63 men and 33 women aged 17-78 years). Patients were examined for either arteriovenous malformation (n = 88) or tumor (n = 8), as indicated by myelography. Among the complications, 11 (8.2%) were local, five (3.7%) were systemic nonneurologic, and three (2.2%) were neurologic (two were associated with full recovery in less than 24 hours, and one was associated with full recovery in less than 1 week). No specific clinical or technical factors were significantly associated with the development of neurologic complications. Details of the clinical profile, angiographic technique, and pathologic findings for each patient were recorded and analyzed with respect to the potential risk for arteriographic complications. Diagnostic spinal cord arteriography had an acceptable risk within the range of other neuroangiographic diagnostic procedures.
Asunto(s)
Angiografía/efectos adversos , Hematoma/etiología , Enfermedades del Sistema Nervioso/etiología , Médula Espinal/diagnóstico por imagen , Adulto , Anciano , Malformaciones Arteriovenosas/diagnóstico por imagen , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad , Premedicación , Estudios Prospectivos , Factores de Riesgo , Neoplasias de la Médula Espinal/diagnóstico por imagenRESUMEN
Gadolinium-labeled diethylenetriaminepentaacetic acid was used as a contrast agent for stereotactic magnetic resonance (MR) imaging in six selected patients with brain tumors who underwent stereotactic biopsy. Regions of contrast enhancement demonstrated by computed tomography (CT) and MR imaging in four of the six patients correlated with areas of malignant neovascularity and endothelial proliferation within solid tumor. Radiation necrosis produced contrast enhancement indistinguishable from that of recurrent neoplasm. Isolated tumor cells within intact white matter were identified in biopsy specimens obtained outside of regions that were depicted as abnormal by contrast material-enhanced CT, as well as by precontrast and postcontrast T1- and T2-weighted MR images.
Asunto(s)
Astrocitoma/patología , Neoplasias Encefálicas/patología , Glioblastoma/patología , Adulto , Anciano , Astrocitoma/diagnóstico por imagen , Encéfalo/patología , Neoplasias Encefálicas/diagnóstico por imagen , Glioblastoma/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Técnicas Estereotáxicas , Tomografía Computarizada por Rayos XRESUMEN
Thirty-one patients with vascular malformations of the posterior fossa were studied to determine their clinical presentation and radiologic diagnosis. The most common clinical presentations were acute hemorrhage (68%, 21/31) and progressive or fluctuating focal neurologic deficits resembling those found in other pathologic processes (19%, 6/31). Trigeminal neuralgia and hemifacial spasm occurred in these patients, but they were rarely initial presenting symptoms. Computed tomography, after infusion of contrast medium, was abnormal in 95% (20/21) of the patients. Angiography established or confirmed the diagnosis in most of the patients; however, a negative angiogram, especially in cases with recent hemorrhage, does not exclude the diagnosis.
Asunto(s)
Hemorragia Cerebral/etiología , Fosa Craneal Posterior/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Cráneo/diagnóstico por imagen , Adolescente , Adulto , Anciano , Encéfalo/diagnóstico por imagen , Angiografía Cerebral , Niño , Femenino , Humanos , Malformaciones Arteriovenosas Intracraneales/complicaciones , Malformaciones Arteriovenosas Intracraneales/terapia , Masculino , Persona de Mediana Edad , Recurrencia , Tomografía Computarizada por Rayos XRESUMEN
Six patients with small cell lung cancer developed a slowly progressive neurologic syndrome characterized by apathy, abulia, memory loss, gait ataxia, and corticospinal tract signs 26 to 50 months (mean, 35.2 months) after prophylactic cranial irradiation and systemic chemotherapy. In each case this was accompanied by CT and/or MRI evidence of changes in the periventricular white matter. These patients are long-term survivors (41 to 69 months) and do not have CNS metastases.
Asunto(s)
Encefalopatías/etiología , Encéfalo/diagnóstico por imagen , Carcinoma de Células Pequeñas/terapia , Neoplasias Pulmonares/terapia , Adulto , Anciano , Neoplasias Encefálicas/prevención & control , Neoplasias Encefálicas/secundario , Carcinoma de Células Pequeñas/complicaciones , Femenino , Humanos , Neoplasias Pulmonares/complicaciones , Espectroscopía de Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Results of contrast material-enhanced computed tomography (CT) and T2-weighted spin-echo magnetic resonance (MR) imaging were correlated with pathologic findings in 25 patients treated surgically for refractory partial epilepsy. Of 12 lesions present, ten (83%) were detected by MR imaging and seven (58%) by CT scanning. Of nine low-grade gliomas, eight were detected by MR imaging and four by CT scanning. One posttraumatic scar and one case of temporal lobe atrophy were better demonstrated by MR imaging. A small, thrombosed arteriovenous malformation was the only lesion detected by CT scanning but not by MR imaging. No lesions were detected in 13 patients with mild gliosis and one patient with a 1.2-cm grade 1 astrocytoma. Although more sensitive than CT for detection of structural lesions in patients with refractory partial epilepsy, MR imaging resulted in a 25% false-negative diagnostic rate when a repetition time of 2,000 msec and echo time of 60 msec were used. Multi-echo imaging with at least one long echo time may be needed to increase the sensitivity of MR imaging in these patients.
Asunto(s)
Epilepsias Parciales/diagnóstico , Espectroscopía de Resonancia Magnética , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Encéfalo/patología , Epilepsias Parciales/diagnóstico por imagen , Epilepsias Parciales/patología , Reacciones Falso Negativas , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Pixel-calibrated volume measurements of muscle and fat in the bony orbit were made from CT scans of 72 patients with Graves' disease, with and without ophthalmopathy, to define characteristic changes present in clinical subgroups. Measurement abnormalities were detected in 87% of Graves' patients with clinically detectable ophthalmopathy and in 70% of hyperthyroid patients without clinical eye signs. Abnormal enlargement of the fat compartment in addition to muscle enlargement was found in 46% of patients with clinical ophthalmopathy; 8% of patients had only increased size of the fat compartment with normal muscle volumes. The ratio of muscle to fat and the volumes of orbital muscle and fat all varied widely in each clinical subgroup. Statistically significant (p less than 0.0001) total muscle-volume increase (range = 3.68-17.06 cm3) and borderline significant (p less than 0.06) fat-compartment increase (range = 6.05-22.63 cm3) were documented in all clinical subgroups. The degree of change of muscle and fat volumes was independent of the clinical group. Abnormal changes were found in the contralateral orbit in six of seven patients who appeared to have unilateral ophthalmopathy on clinical examination. A higher frequency of medial and inferior muscle enlargement was documented in all clinical subgroups.
Asunto(s)
Tejido Adiposo/diagnóstico por imagen , Enfermedad de Graves/diagnóstico por imagen , Músculos/diagnóstico por imagen , Órbita/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Percutaneous transcatheter arterial embolization has played an increasingly important role in the management of vascular lesions in the head. Embolization can promote thrombosis within vascular tumors and malformations, reduce bleeding and decrease the need for transfusion intraoperatively, and facilitate surgical approaches to otherwise unresectable lesions. It is important for the clinician to be aware of this interventional technique because many of the patients who are considered for embolization are triaged through several different clinical areas, and much can be gained from the collaboration of the clinician, the surgeon, and the angiographer. We performed 31 therapeutic particulate embolization procedures for extra-axial head lesions in 23 patients by using flow-directed techniques. Of these procedures, 11 resulted in vascular occlusion and 15 resulted in 80 to 95% obstruction, as demonstrated by angiography. In 14 patients, embolization was performed preoperatively both to decrease blood loss and to occlude inaccessible or unresectable portions of a lesion. In nine patients, embolization was the sole means of treatment for occluding an abnormal vascular shunt. Two patients (9%) experienced a minor transient neurologic change after the procedure.
Asunto(s)
Angiografía , Malformaciones Arteriovenosas/terapia , Embolización Terapéutica/métodos , Neoplasias de Cabeza y Cuello/terapia , Cabeza/irrigación sanguínea , Adolescente , Adulto , Anciano , Malformaciones Arteriovenosas/diagnóstico por imagen , Angiografía Cerebral , Niño , Preescolar , Duramadre/irrigación sanguínea , Neoplasias Faciales/terapia , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Hemangioma/terapia , Histiocitoma Fibroso Benigno/terapia , Humanos , Masculino , Neoplasias Meníngeas/terapia , Meningioma/terapia , Persona de Mediana Edad , Neoplasias Nasales/secundario , Neoplasias Nasales/terapia , Paraganglioma/terapia , Cuidados Preoperatorios , Cuero Cabelludo/irrigación sanguínea , Neoplasias Craneales/terapiaRESUMEN
Computer interpolation of stereotaxic computerized tomography (CT) scanning data allows the transposition of a tumor volume in stereotaxic space. A stereotaxically directed and computer-monitored CO2 laser is then utilized to vaporize that volume as the surgeon monitors the position of a cursor representing the laser beam against planar contours of the tumor displayed on an operating room computer monitor. Computer-assisted stereotaxic laser microsurgery provides precise three-dimensional control for aggressive resection of deep-seated tumors from neurologically important areas with acceptable postoperative results. Thus, a significant cytoreduction can be achieved in addition to providing a tissue diagnosis and internal decompression. The authors report 83 computer-assisted stereotaxic laser procedures for tumor excision in 78 patients. The tumors were located in the thalamus/basal ganglia in 15 patients, ventricular system in five, corpus callosum in four, brain stem in three, and deep and centrally in the hemispheres in 51. Histologically, there were 26 glioblastomas, seven grade III astrocytomas, 14 grade II astrocytomas, 14 metastatic tumors, nine vascular lesions, and eight miscellaneous lesions. Resection of these subcortical lesions was confirmed by postoperative contrast-enhanced CT scanning. Neurological examinations performed 1 week after the 83 procedures revealed that 48 patients had improved from their preoperative level and 23 were unchanged (12 were neurologically normal preoperatively). Twelve patients had an increase in a preoperative neurological deficit, three of whom died in the postoperative period: one from infection, one from pulmonary emboli, and one from brain-stem edema. The average survival period (37.6 weeks) of patients having glioblastomas treated by this technique and irradiation was no different from that of patients having glioblastomas in more favorable locations treated by conventional surgery and irradiation. Patients with circumscribed lower-grade astrocytomas did better in terms of morbidity and completeness of resection than those with infiltrative neoplasms. Other circumscribed lesions, such as metastatic tumors, vascular lesions, and intraventricular tumors, were easily resected by the technique described.
Asunto(s)
Neoplasias Encefálicas/cirugía , Glioma/cirugía , Terapia por Láser , Adolescente , Adulto , Anciano , Neoplasias Encefálicas/secundario , Niño , Preescolar , Computadores , Femenino , Glioblastoma/cirugía , Glioma/secundario , Humanos , Lactante , Malformaciones Arteriovenosas Intracraneales/cirugía , Masculino , Persona de Mediana Edad , Técnicas EstereotáxicasRESUMEN
Neurotoxicity is a potential complication of combined chemotherapy and whole-brain radiotherapy in long-term survivors of carcinoma. Clinical features of this neurotoxicity are similar to those manifested in the leukoencephalopathy of pediatric patients with leukemia who have been treated prophylactically with whole-brain radiotherapy and chemotherapy. Magnetic resonance imaging, because of its ability to distinguish cortical gray matter and white matter and its utility for studying demyelinating diseases, was used in the assessment of five long-term survivors of carcinoma who had clinical evidence of neurotoxicity. On magnetic resonance examinations, all five patients had profound abnormalities in the periventricular white matter. These changes were considerably more pronounced than those seen on computed tomographic scanning. Thus, magnetic resonance imaging may serve as a useful procedure for early detection of neurotoxicity in patients with carcinoma who have received cerebral radiotherapy and chemotherapy.
Asunto(s)
Antineoplásicos/efectos adversos , Encéfalo/patología , Espectroscopía de Resonancia Magnética , Neoplasias/terapia , Radioterapia/efectos adversos , Anciano , Encéfalo/efectos de los fármacos , Encéfalo/efectos de la radiación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
The size and morphology of particulate polyvinyl alcohol (PVA) sponge prepared by a blender technique for embolotherapy were analyzed by light and scanning electron microscopy. Techniques for preparation and sizing of PVA sponge particles are described. Two types of particulate material, differing in both size and morphology, were found. Large particles (greater than 50 micron) had irregular shapes and sharp, jagged edges. Smaller particles (2-50 micron) were more numerous. Attempts to characterize the smaller particles were unsuccessful. Preparation of PVA sponge particles using the blender technique is a viable choice in external carotid neuroembolization procedures. However, the potential effects of small particles possibly causing cranial nerve palsies does need consideration.