Aspiration biopsy findings in amyloid tumor of the cervical vertebra. A case report.

BACKGROUND: The differential diagnosis of destructive lytic lesions of the spine includes amyloid tumors. The diagnosis of amyloid tumor with fine needle aspiration biopsy (FNA) is challenging. Previous reports of FNA of osseous amyloid tumors have detailed the cytologic appearance of amyloid along with lymphocytes, plasma cells and histiocytes, occasionally multinucleate or forming granulomatous lesions. CASE: An 84-year-old man presented with neck pain. Radiologic studies showed a destructive, lytic lesion of C-6, with a large, soft tissue mass. FNA yielded many acellular smears containing abundant amyloid that was confirmed with special stains of corresponding tissue cores and subsequent surgical biopsies. CONCLUSION: Osseous amyloid tumors are destructive, lytic lesions that mimic other processes. Amyloid can be distinguished from other substances in FNA samples and amyloid tumor identified, even when amyloid is present without typical cellular components.

Does APO epsilon4 correlate with MRI changes in Alzheimer's disease?

OBJECTIVE: To assess the relation between APO E genotype and MRI white matter changes in Alzheimer's disease. The APO epsilon4 allele is correlated with amyloid angiopathy and other neuropathologies in Alzheimer's disease and could be associated with white matter changes. If so, there should be a dose effect. METHODS: 104 patients with probable Alzheimer's disease (NINCDS-ADRDA criteria) in this Alzheimer's Disease Research Centre were studied. Patients received MRI and APO E genotyping by standardised protocols. Axial MRI was scored (modified Schelten's scale) for the presence and degree of white matter changes and atrophy in several regions by a neuroradiologist blinded to genotype. Total white matter and total atrophy scores were also generated. Data analysis included Pearson's correlation for regional and total imaging scores and analysis of variance (ANOVA) (or Kruskal-Wallis) and chi(2) for demographic and disease related variables. RESULTS: 30 patients had no epsilon4, 53 patients were heterozygous, and 21 patients were homozygous. The three groups did not differ in sex distribution, age of onset, age at MRI, MMSE, clinical dementia rating, or modified Hachinski ischaemia scores. There were no significant correlations between total or regional white matter scores and APO E genotype (Pearson correlation). CONCLUSIONS: No correlation between total or regional white matter scores and APO E genotype was found. The pathogenesis of white matter changes in Alzheimer's disease may be independent of APO E genotype.

MRI appearances of an ectopic pituitary adenoma: case report and review of the literature.

MR images of an ectopic pituitary adenoma have been published in only a single case, a suprasellar mass. We present a patient with Cushing's disease in whom MRI revealed a pituitary adenoma within the sphenoid sinus. Radiologic characteristics of ectopic pituitary adenomas are reviewed, with emphasis on MRI, which demonstrates a soft tissue mass, isointense with gray matter on T1-weighted images, which enhances in a heterogeneous manner.

Synovial cysts of the lumbar spine: CT evaluation.

Seven cases of surgically proven intraspinal synovial cysts are reported. Computed tomographic (CT) scans demonstrated a series of low-density masses adjacent to the facet joints; in three cases, a dense rim indicated a calcified wall on the cyst; in one, the wall was partially calcified; and in three the mass appeared to be filled with gas. In all of these cases, there was severe degenerative facet disease at the same level as the synovial cyst. In six patients, the cysts were unilateral, while one was bilateral; seven cysts were located at the level of L4-L5, and one at L3-L4. We conclude from this study that the intraspinal synovial cyst can be identified reliably by the CT scan.

Thoracic chordoma with unusual radiographic features.

A case of chordoma involving the thoracic spine (T12) is reported. The plain film findings included lytic obstruction and partial collapse of a single vertebral body. Noncontrast CT and CT following Metrizamide myelography revealed vertebral body destruction with paravertebral and intraspinal soft tissue masses. Unusual findings in the case included a photon deficient area on nuclear medicine corresponding to the lesion and normal vascularity on spinal angiography. We know of no previous report describing chordoma as a "cold" defect on bone scanning.

CT features of early Listeria monocytogenes cerebritis.

Listeria monocytogenes is a relatively uncommon pathogen affecting infants or adults with predisposing conditions, such as cirrhosis, diabetes mellitus, autoimmune disease, renal transplants, and solid and lymphoreticular malignancies. Cerebral parenchymal involvement is rare and consists of focal cerebritis, which may progress to abscess formation. This article presents three cases of early Listeria monocytogenes cerebritis, two of which demonstrated ill-defined superficial areas of low attenuation with curvilinear gyral enhancement and one of which demonstrated a deep, low-attenuation lesion with faint surrounding enhancement. Although these findings are nonspecific, their early recognition in the proper clinical setting may help institute early antibiotic therapy, which appears to be successful without surgical intervention.

CT diagnosis of delayed cerebral air embolism following intraaortic balloon pump catheter insertion.

Air embolism to the brain occurred several days after insertion of an intraaortic balloon pump. CT demonstrated diffuse hemispheric edema along with two small collections of air in the cerebral hemispheres. Early diagnosis of air embolism to the brain allows early institution of proper therapy in this life-threatening condition.

Balloon occlusion of a recurrent carotid-cavernous fistula previously treated by carotid ligations.

A carotid-cavernous fistula recurred 16 years after a Hamby procedure. The recurrence was manifested by subarachnoid hemorrhage originating from dilated draining pial veins. The fistula was closed with a balloon catheter introduced through a patent remnant of the cervical carotid artery. Patients who have previously undergone Hamby trapping and embolization should be reassessed for an occult fistula that could predispose them to intracranial bleeding.

Statistical assessment of perceptual CT scan ratings in patients with Alzheimer type dementia.

Three neuroradiologists perceptually evaluated CT of 24 patients with Alzheimer type dementia and 22 normal control subjects and made a dichotomous judgment for each case (i.e., normal control or Alzheimer type dementia). The mean percentage of patients correctly classified was 83.3%. The neuroradiologists also completed perceptual ratings on each scan. Thirteen regions were rated for atrophy on a scale of 0-4. Discriminant function analyses of several sets of perceptual atrophy ratings (optimized on an exploratory set and evaluated on a test set) showed that the perceptual ratings of temporal lobe regions produced an average accuracy of 88.57%. In contrast, only 74.26% of the cases were correctly classified when the discriminant functions were based on perceptual ratings of midventricular and supraventricular areas. Linear measures of atrophy correctly classified only 65.20% of the subjects. The results suggest that atrophy ratings of brain regions that show the characteristic macroscopic neuropathological changes of Alzheimer disease may be used by neuroradiologists to reach more accurate diagnostic decisions.

Ependymoma of filum terminale: metrizamide-enhanced CT evaluation.

Two cases of surgically proven myxopapillary ependymomas of filum terminale are reported. In both, myelography and metrizamide-enhanced computed tomographic (CT) scans were performed. An intramedullary tumor in the lower thoracic spine, soft-tissue masses in the neural foramina and enlarged bony spinal canal in the lower thoracic and upper lumbar spine were noted in one case and, in the other, an intradural extramedullary tumor at T12-L1 level. Both patients had normal cranial CT scans, and both presented with similar symptoms--low back pain and weakness and paresthesia of leg or legs for up to 3 years' duration. Myelography and metrizamide-enhanced CT scans were performed in order to evaluate disc disease in one patient and spinal stenosis in the other. Ependymoma was an incidental finding, which was then removed by surgical resection. Pathology confirmed the diagnosis.

Thoracic spinal metastasis from unexpected cerebellar medulloblastoma: the value of MRI.

A 28-year-old male was found on CT metrizamide myelography to have an intradural extramedullary tumor at the T8-T9 level. This was seen to compress the spinal cord, and on surgery it was proven to be medulloblastoma. Cranial CT scans disclosed only mild hydrocephalus and minimal anterior displacement of the inferior fourth ventricle on the right. However, magnetic resonance imaging (MRI) which was performed after the spinal surgery demonstrated an inferior cerebellar vermian tumor.

Computed tomography of aneurysmal bone cyst of the L1 vertebral body.

A 31-year-old woman with an aneurysmal bone cyst of the L1 vertebral body proved by biopsy and studied by plain lumbar spine roentgenography, radionuclide studies, myelography, and CT is presented. The unusual location of involvement of the vertebral body alone and the difficulty in differential diagnosis between aneurysmal bone cyst and benign giant cell tumor are discussed.

Computed tomography of spontaneous acute cervical epidural hematoma.

Cervical spinal epidural hematoma is a rare cause of acute neurologic syndromes including paralysis of various types. Although devastating, it can be successfully treated surgically if recognized early. We report two cases of spontaneous cervical epidural hematoma diagnosed by computed tomography, the first with a plain scan and the second with a scan after intrathecal injection of metrizamide. In both patients the diagnosis was not clinically suspected. Surgery resulted in a dramatic improvement of the neurologic deficit in both cases.