[Coexistence of acoustic neuroma and pineal region tumor in patient with sudden deafness]. / Wspólistnienie nerwiaka stuchowego i guza szyszynki u chorego z nagla gluchota.

INTRODUCTION: Acoustic neuroma usually presents as an unilateral tumor, seldom - bilateral and rarely in coexistence with other central nervous system neoplasms. The following paper reports such a case of a 21-year-old male patient presented with sudden deafness in left ear accompanied with tinnitus and vertigo. Symptoms started 4 weeks prior hospitalization. Their aggravation has been observed 7 days before admission to the hospital. Audiometry revealed moderate sensorineural hearing loss in left ear (for low and middle frequencies), brainstem auditory evoked potentials were absent on the left side and ENG examination showed left peripheral vestibular impairment. Initially patient received i.v. vasodilatators showing 20-25 dB improvement in low frequencies after 3 days of treatment. MRI study revealed in the left internal acoustic meatus mass (7 x 7 x 14 mm) suggesting acoustic neuroma and an oval mass (7 x 9 x 14 mm) in the pineal gland presenting radiological features of pinealoma. Patient has been qualified for neurosurgical treatment. Acoustic neuroma has been removed by suboccipital approach and pinealoma has been left for further observation as it was found incidentally. Histopathological examination confirmed diagnosis of left VIII nerve schwannoma. The left facial palsy (House-Brackmann III/IV grade) and profound hearing loss appeared after surgery. The postoperative course shows no evidence of acoustic neuroma recurrence.

[Phenotypic evaluation of patients with Pendred syndrome]. / Ocena fenotypowa pacjentów z zespolem Pendreda.

INTRODUCTION: The Pendred syndrome (PS) is an autosomally recessively inherited disease. Its diagnosis requires identification of the classical triad of symptoms, including hypoacusis, thyroid goitre and iodine organification defect in the thyroid, which may lead to thyroid functional disorders of hypothyroidism. SP is accompanied by anatomical anomalies. The objective is the hearing and balance system evaluation and the analysis of the inner ear structure and also the assessment of the function and structure of thyroid gland. MATERIAL AND METHODS: For the research four families were qualified, 7 persons with PS, 12 persons altogether. In all the patients the anamnesis in the form of a questionnaire and laryngological examination were performed. It was followed by pure tone, speech and impedance audiometry and brainstem response testing as well. ENG was also conducted. Patients with hearing loss were subjected to magnetic resonance of temporal bone. For the whole group thyroid hormones levels and iodine organification in the thyroid identified in a test with potassium perchlorate were measured and also USG and scyntography were conducted. RESULTS: In audiological examination in 3 cases deafness, in 2 cases profound hypoacusis and in 2 mild hypoacusis were recognised. In the group in 2 patients the hypoacusis was of a mixed type. In radiological assessment the labirynth showed anatomical anomalies in the form of enlargement of the vestibular aqueduct and the endolyphatic sac, yet in 3 patients the anomalies also concerned the structure of cochlear and semicircular canals. Endocrine examination showed hypothyroidism in 5, its subclinical form in 1, diffuse thyroid goitre in 4 and nodular thyroid goiter in 2 cases. CONCLUSIONS: A complex clinical evaluation: endocrine and audiological, together with radiological diagnostic imaging, supported by molecular studies of SLC26A4 gene, are the procedures, necessary for complete and accurate diagnosis of PS and EVAS.

[The usefulness of fused MRI and SPECT images for the voxel positioning in proton magnetic resonance spectroscopy and planning the biopsy of brain tumors: presentation of the method]. / Przydatnosc obrazów fuzyjnych rezonansu magnetycznego i tomografii emisyjnej pojedynczego fotonu do pozycjonowania obszaru zainteresowania w protonowej spektroskopii rezonansu magnetycznego i planowania biopsji nowotworów mózgu pochodzenia glejowego--prezentacja metody.

BACKGROUND AND PURPOSE: Progress in neurooncology suggests a need to combine information from anatomical-morphological and functional imaging in diagnosis and management. It is not always possible to establish a correct diagnosis using MRI imaging techniques alone, especially in the case of recurrent brain tumors. It is suggested that the results of different imaging techniques should be combined especially in these circumstances. The aim of this study was to evaluate the usefulness of fused post gadolinium MRI and single photon emission tomography (SPECT) images for planning 1H MRS. MATERIALS AND METHODS: 19 patients with a histopathological diagnosis of glial brain neoplasms were examined. SPECT was performed after i.v. administration of iodine-alpha-methyltyrozine (IMT). Fused SPECT and post Gd MR images were obtained on a peripheral console (Linux, PC), using a self developed technique. 1H MRS was performed on a 1.5 T scanner with the single voxel (SVS) technique using STEAM (TE 20 ms, TR 2000 ms) and (PRESS TE 136 TR 2000 ms) sequences. RESULTS: 1H MRS with a volume of interest positioned in the most metabolically active areas on fused images, gave a more accurate diagnosis of tumor type and grade that was clinically relevant in 3 patients. CONCLUSIONS: The authors conclude that planning 1H MRS with the use of fused MRI and SPECT images improves the diagnosis.

Development of a decision support system for diagnosis and grading of brain tumours using in vivo magnetic resonance single voxel spectra.

A computer-based decision support system to assist radiologists in diagnosing and grading brain tumours has been developed by the multi-centre INTERPRET project. Spectra from a database of 1H single-voxel spectra of different types of brain tumours, acquired in vivo from 334 patients at four different centres, are clustered according to their pathology, using automated pattern recognition techniques and the results are presented as a two-dimensional scatterplot using an intuitive graphical user interface (GUI). Formal quality control procedures were performed to standardize the performance of the instruments and check each spectrum, and teams of expert neuroradiologists, neurosurgeons, neurologists and neuropathologists clinically validated each case. The prototype decision support system (DSS) successfully classified 89% of the cases in an independent test set of 91 cases of the most frequent tumour types (meningiomas, low-grade gliomas and high-grade malignant tumours--glioblastomas and metastases). It also helps to resolve diagnostic difficulty in borderline cases. When the prototype was tested by radiologists and other clinicians it was favourably received. Results of the preliminary clinical analysis of the added value of using the DSS for brain tumour diagnosis with MRS showed a small but significant improvement over MRI used alone. In the comparison of individual pathologies, PNETs were significantly better diagnosed with the DSS than with MRI alone.

[Brain metabolism alterations in patients with anorexia nervosa observed in 1H-MRS]. / Protonowa spektroskopia rezonansu magnetycznego (1H-MRS) mózgowia u pacjentek z jadlowstretem psychicznym (anorexia nervosa).

The causes of metabolic brain changes in patients with anorexia nervosa are still not fully explained. The purpose of this study was to use the 1H-MRS method in investigating metabolic changes in the brain of patients with anorexia nervosa. We studied 10 patients for visible alternations in brain metabolism and compared the results to healthy controls. 1H-MRS was acquired by the method of single voxels in white and grey matter. Proton MRS was performed after image guided localization using stimulated echo acquisition mode (STEAM) sequence with a short echo time of 20 ms. For data evaluation we used standard Siemens software and the additional PC. Choosing of the MRS sequences was related with particular interest in metabolites of short time echo: myoinositol and lipids. Besides this we evaluated peaks of: N-acetylaspartate (NAN), creatine (Cr) and choline (Cho). The results show significant differences in the levels of metabolites connected with fatty metabolism. In white matter we observed the reduction of lip-peak. The data was evaluated approximately and presented as lip:Cr. We did not observe any differences in other metabolites. As far as we know similar results had been reported and our study confirmed significant disorders in metabolism of these chemicals in patients with anorexia nervosa.

[Color Doppler imaging of the retrobulbar circulation in non-exudative and exudative age-related macular degeneration]. / Przeplyw krwi w naczyniach oka u chorych na postac sucha i wysiekowa starczego zwyrodnienia plamki (AMD) badany metoda, kolorowej ultrasonografii dopplerowskiej (USG-CD).

PURPOSE: To study ocular perfusion in the ophthalmic artery, central retinal artery, nasal and temporal posterior ciliary : arteries in non-exudative and exudative age-related macular degeneration. MATERIAL AND METHODS: Twenty five subjects with non-exudative age-related macular degeneration were compared to twenty five subjects with exudative age-related macular degeneration and to twenty five age-matched control subjects. Color Doppler imaging measured peak systolic velocity (PSV) and end diastolic velocity (EDV) in the ophthalmic artery, central retinal artery, nasal and temporal posterior ciliary arteries of one eye. The resistivity index (RI) and the pulsatility index (PI) were calculated. RESULTS: There were statistically significant differences between: subjects with non-exudative age-related macular degeneration and subjects with exudative age-related macular degeneration in EDV, RI and PI in the ophthalmic artery and PSV in the temporal posterior ciliary artery, subjects with non-exudative age-related macular degeneration and control subjects in RI in central retinal artery, subjects with non-exudative age-related macular degeneration and control subjects in RI and PI in nasal posterior ciliary artery, subjects with exudative age-related macular degeneration and control subjects in PI in nasal posterior ciliary artery. CONCLUSIONS: The study results showed reduced ocular blood flow in patients with non-exudative age-related macular degeneration compared to patients with exudative age-related macular degeneration and to control subjects. The higher RI in central retinal artery in non-exudative age-related macular degeneration compared to control subjects, suggest there may be a more generalized perfusion abnormality beyond the choroid.

Recurrent cerebral gliomas in MRI and Iodine-123[corrected]-alpha-methyl-tyrosine SPECT: the use of digitally fused images.

BACKGROUND: Early detection and site location of recurrent cerebral glioma helps design optimum therapeutic regimen, which contributes to prolonged survival time of the patients. However, diagnosing the neoplastic growth at the post-resection site is a difficult process. The diagnostic modality to provide the most extensive morphological data is dynamic MR tomography. On the other hand, the tumour-related metabolic changes can be best diagnosed using the PET and SPECT techniques of nuclear medicine that employ radiolabelled amino acid 131 I-alpha-metyl-tyrosine (IMT) as the tracer. Thus, for comprehensive diagnostics of brain tumours, it is most effective to combine both the modalities and evaluate the fused images. The aim of the present study was to verify the usefulness of the calculated algorithm for a digital fusion of RM/SPECT images for the assessment of post-resection site of cerebral gliomas. MATERIAL AND METHODS: The findings of MR and SPECT imaging for 21 patients who had surgery for cerebral glioma were subject to assessment. Diagnosis was based on histopathology results (8 cases of anaplastic astrocytoma and 13 cases of multiform glioblastoma). The site and size of the contrast enhancement areas from MR was compared with the hot focus location from SPECT. RESULTS: The study confirmed the feasibility of digital fusion of images yielded by SPECT and MR. The fused images reflect the non-homogeneity of the post-resection site of cerebral gliomas. Contrast enhancement areas only partially overlapped with the hot foci which, furthermore, were found to be substantially smaller. CONCLUSIONS: The consistency of tumour locations detected with MR and SPECT was higher for tumours of the anaplastic astrocytoma type than for multiform glioblastomas (higher polymorphism of pathological changes).

[Possibilities in the differential diagnosis of brain neoplasms using the long and short time sequences of proton magnetic resonance spectroscopy]. / Mozliwosci róznicowania nowotworów mózgu przy równoczesnym stosowaniu sekwencji z dlugim i krótkim czasem echa w protonowej spektroskopii rezonansu magnetycznego.

UNLABELLED: Currently to perform proton magnetic resonance spectroscopy (1H MRS) with single voxel spectroscopy (SVS) technique long and/or short echo time sequences are used in order to provide complementary information. PURPOSE: The aim of the study was to compare the usefulness of STEAM (time echo, TE, 20 ms) and PRESS (TE 136 ms) sequences in the evaluation of brain neoplasms. MATERIALS AND METHOD: 15 healthy volunteers and 19 patients with brain tumors were examined using 1, 5 T MR scanner. MRI was performed with a standard protocol for brain neoplasms. 1H MRS with the SVS technique was performed after magnetic resonance imaging (MRI) using STEAM 20 and PRESS 136 sequences (voxel size 1 to 8 cc). RESULTS: In the STEAM sequence besides basic metabolites visible in PRESS as N-acetylaspartate, choline and creatine peaks of myoinositol and glutamate were visualized. Data obtained with short TE sequences in conjunction with long TE data were useful and in 5 cases necessary to identify the tumor type. These results were confirmed by pathology. CONCLUSIONS: The use of short TE sequences enables to visualize metabolites important for the diagnosis and differentiation of the tumor type. The combined information drawn out from both long and short TE spectra is also important.

The use of proton MRS in the differential diagnosis of brain tumors and tumor-like processes.

BACKGROUND: Progress in the treatment of brain neoplasms requires accurate identification of tumor type and grade, before a proper treatment plan can be implemented. The aim of our study was to investigate the use of proton magnetic resonance spectroscopy in the differential diagnosis of neoplastic brain tumors and tumor-like processes. MATERIAL/METHODS: 29 patients with ambiguous CT images of brain mass lesions were examined by MRI. 1H MRS was applied in this group as the primary option to improve differential diagnosis. In each case a routine MRI was taken in three orthogonal planes before and after i.v. administration of Gd-DTPA. 1H MRS was performed at 1.5 T using the PRESS (TE 136 ms) and STEAM (TE 20 ms) single voxel spectroscopy techniques. MRS was performed after i.v. administration of Gd-DTPA. The lesion types according to spectral patterns were compared to postoperative pathology or biopsy results. RESULTS: MRS-based diagnosis was consistent with pathology results in all cases of astrocytoma, glioblastoma and meningioma. In two cases distinguishing brain metastases from glioblastomas was difficult because of contamination of the voxel with brain tissue. Three cases of anaplastic oligodendrogliomas were misclassified as glioblastomas. In two cases MR spectra indicating an inflammatory-demyelinating process correlated with biopsy results and clinical course. CONCLUSIONS: 1HMRS proved to be a useful tool in establishing tumor type and differentiating between neoplastic and large inflammatory tumor-like lesions.

[Massive choroidal hemorrhage as a late trabeculectomy complication ]. / Masywny krwotok podnaczyniówkowy jako pózne powiklanie trabekulektomii.

The purpose of this paper was to present the case of an unusual late complication of filtering glaucoma surgery. A massive choroidal hemorrhage occurred 5 years after trabeculectomy and extracapsular cataract extraction. The diagnosis was confirmed by MRI examination. Improvement in choroidal status and in visual acuity (from hand motions to 6/12 with aphakic correction of 12 diopters) was observed during three weeks of medication. The retina and the choroid remained attached during two years of observation.