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1.
AJNR Am J Neuroradiol ; 40(8): 1257-1264, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31320462

RESUMO

BACKGROUND AND PURPOSE: Intrathecal contrast-enhanced glymphatic MR imaging has shown promise in assessing glymphatic function in patients with dementia. The purpose of this study was to determine the safety profile and feasibility of this new MR imaging technique. MATERIALS AND METHODS: A prospective safety and feasibility study was performed in 100 consecutive patients (58 women and 42 men, 51 ± 19 years of age) undergoing glymphatic MR imaging from September 2015 to August 2018. Short- and long-term serious and nonserious adverse events were registered clinically and by interview after intrathecal administration of 0.5 mL of gadobutrol (1.0 mmol/mL) along with 3 mL of iodixanol (270 mg I/mL). Adverse events are presented as numbers and percentages. RESULTS: One serious adverse event (anaphylaxis) occurred in a patient with known allergy to iodine-containing contrast agents (1%). The main nonserious adverse events during the first 1-3 days after contrast injection included severe headache (28%) and severe nausea (34%), though the frequency depended heavily on the diagnosis. After 4 weeks, adverse events had resolved. CONCLUSIONS: Intrathecal administration of gadobutrol in conjunction with iodixanol for glymphatic MR imaging is safe and feasible. We cannot conclude whether short-duration symptoms such as headache and nausea were caused by gadobutrol, iodixanol, the lumbar puncture, or the diagnosis. The safety profile closely resembles that of iodixanol alone.


Assuntos
Encéfalo/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Sistema Glinfático/diagnóstico por imagem , Neuroimagem/métodos , Compostos Organometálicos/administração & dosagem , Adulto , Idoso , Meios de Contraste/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Injeções Espinhais , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/efeitos adversos , Estudos Prospectivos , Ácidos Tri-Iodobenzoicos/administração & dosagem
2.
Skull Base ; 18(1): 59-66, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18592017

RESUMO

OBJECTIVE AND IMPORTANCE: Malignant granular cell tumors (MGCTs) are extremely rare, high-grade sarcomas of Schwann cell origin. They often metastasize and are associated with short survival. We describe a patient with a large MGCT arising from the suboccipital nerve that eroded the posterior skull base, invaded the perifocal neck muscles, demonstrated perineural extension, and metastasized to regional lymph nodes. CLINICAL PRESENTATION: A 60-year-old woman with several years' history of neck pain noticed a right-sided suboccipital swelling 4 months prior to seeking medical attention. Magnetic resonance imaging (MRI) showed a 5-cm bone-eroding suboccipital tumor and a second tumor, anterocaudal to this, 4 cm in diameter. INTERVENTION: The patient underwent surgery. A 4-cm multinodular tumor was removed, freeing it from the internal jugular vein. A 5-cm suboccipital tumor infiltrated the trapezius, semispinalis capitis, and longissimus capitis muscles. The major and minor rectus capitis muscles were completely engulfed by tumor and their attachments to the occipital bone completely eroded. The oblique capitis muscle was infiltrated at its attachment to the C1 transverse process. These muscles were resected with a free margin to remove all tumor tissue. We then removed tumor encasing the right vertebral artery, the medial mastoid process up to the transverse sinus and anteriorly to the stylomastoid foramen, and lastly, the posterior third of the occipital condyle, achieving a gross total removal and no visible residual on postoperative contrast-enhanced MRI. CONCLUSION: This case represents the first report of resected primary MGCT involving the posterior fossa and arising from the suboccipital nerve.

3.
AJNR Am J Neuroradiol ; 29(9): 1664-70, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18583405

RESUMO

BACKGROUND AND PURPOSE: Inclusion of oligodendroglial tumors may confound the utility of MR based glioma grading. Our aim was, first, to assess retrospectively whether a histogram-analysis method of MR perfusion images may both grade gliomas and differentiate between low-grade oligodendroglial tumors with or without loss of heterozygosity (LOH) on 1p/19q and, second, to assess retrospectively whether low-grade oligodendroglial subtypes can be identified in a population of patients with high-grade and low-grade astrocytic and oligodendroglial tumors. MATERIALS AND METHODS: Fifty-two patients (23 women, 29 men; mean age, 52 years; range, 19-78 years) with histologically confirmed gliomas were imaged by using dynamic susceptibility contrast MR imaging at 1.5T. Relative cerebral blood volume (rCBV) maps were created, and 4 neuroradiologists defined the glioma volumes independently. Averaged over the 4 observers, a histogram-analysis method was used to assess the normalized histogram peak height of the glioma rCBV distributions. RESULTS: Of the 52 patients, 22 had oligodendroglial tumors. The histogram method was able to differentiate high-grade gliomas (HGGs) from low-grade gliomas (LGGs) (Mann-Whitney U test, P < .001) and to identify low-grade oligodendroglial subtypes (P = .009). The corresponding intraclass correlation coefficients were 0.902 and 0.801, respectively. The sensitivity and specificity in terms of differentiating low-grade oligodendroglial tumors without LOH on 1p/19q from the other tumors was 100% (6/6) and 91% (42/46), respectively. CONCLUSION: With histology as a reference, our results suggest that histogram analysis of MR imaging-derived rCBV maps can differentiate HGGs from LGGs as well as low-grade oligodendroglial subtypes with high interobserver agreement. Also, the method was able to identify low-grade oligodendroglial tumors without LOH on 1p/19q in a population of patients with astrocytic and oligodendroglial tumors.


Assuntos
Volume Sanguíneo/fisiologia , Neoplasias Encefálicas/irrigação sanguínea , Glioma/irrigação sanguínea , Processamento de Imagem Assistida por Computador/métodos , Angiografia por Ressonância Magnética/métodos , Oligodendroglioma/irrigação sanguínea , Adulto , Idoso , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patologia , Diagnóstico Diferencial , Feminino , Glioma/diagnóstico , Glioma/patologia , Humanos , Perda de Heterozigosidade , Masculino , Pessoa de Meia-Idade , Oligodendroglioma/diagnóstico , Oligodendroglioma/genética , Oligodendroglioma/patologia , Reação em Cadeia da Polimerase , Prognóstico , Sensibilidade e Especificidade
4.
Tidsskr Nor Laegeforen ; 121(2): 168-70, 2001 Jan 20.
Artigo em Norueguês | MEDLINE | ID: mdl-11475192

RESUMO

BACKGROUND: Pneumocephalus is a rare complication of sinus surgery. The complications of sinus surgery are often classified as minor or major. Minor complications are seen as adhesions, scarring, bleeding, development of subcutaneous emphysema, penetration of the orbit without herniation and eyelid ecchymosis. The incidence of major complications is 0 to 3% and include haemorrhage, retrobulbar haematoma, injury to the optic nerve, CSF leaks, meningitis, intracranial penetration with development of tension pneumocephalus, and death. MATERIAL AND METHODS: We present a case of pneumocephalus after endonasal ethmoidectomy. The literature is reviewed. RESULTS: The patient had clinical findings consistent with non-tension pneumocephalus. Development of tension pneumocephalus is a distinct possibility and it is necessary to monitor these patients closely. INTERPRETATION: In order to reduce the risk of injury to the anterior skull base it is important to eliminate certain normal anatomic variations and to assess the individual anatomy thoroughly. This can be done with preoperative nasal endoscopy and CT imaging. This applies even more to patients who have previously undergone sinus surgery.


Assuntos
Seio Etmoidal/cirurgia , Pneumocefalia/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Seio Etmoidal/anatomia & histologia , Seio Etmoidal/diagnóstico por imagem , Humanos , Masculino , Ilustração Médica , Obstrução Nasal/cirurgia , Pneumocefalia/diagnóstico , Pneumocefalia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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