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  • 1
    ISSN: 1573-7373
    Keywords: astrocytoma ; 201thallium SPECT ; MRI ; MR spectroscopy ; chemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose To compare chemotherapy treatment monitoring in astrocytoma by 201thallium single photon emission computed tomography (SPECT) and photon magnetic resonance spectroscopy (1H-MRS) with magnetic resonance imaging (MRI), and to evaluate the influence of morphological tumor changes on cerebral 201thallium uptake and metabolic changes in 1H-MRS. Materials and methods Six patients with highly malignant astrocytomas were followed with quantitative 201thallium SPECT, MRI, and 1H-MRS during chemotherapy. Maximum follow-up included six examinations per patient by either method during 18 months. Criteria were set for: (1) regression (≥ 25% tumor reduction), (2) status quo (〈 25% reduction and 〈 25% increase), and (3) progression of disease (≥ 25% tumor increase). Results were compared with the clinical state of disease. Changes of tumor volume, contrast enhancement, necrosis, hemorrhage and edema on MRI were compared to changes in 201thallium uptake volumes and 1H-MRS metabolite ratios. Results Six patients were followed with a total of twenty-four examinations with 201thallium SPECT, MRI and 1H-MRS, respectively, between February 1997 and October 1998. Five patients developed clinical progression of disease, 4 out of 5 cases showed SPECT progression, 4 out of 5 cases MRI progression, and 1 out of 2 interpretable cases 1H-MRS progression at final assessment before clinical deterioration. During the phase of clinically stable disease; (A) the criterion for regression or status quo was met in 10 out of 13 assessments with SPECT, 11 out of 13 with MRI, and 8 out of 9 interpretable 1H-MRS; (B) the criterion for progression was met in 3 out of 13 with SPECT, 2 out of 13 with MRI, and 1 out of 9 interpretable 1H-MRS. The accuracy of SPECT, MRI, and 1H-MRS in identifying changes of tumor burden concordant with patients' clinical course was 78%, 83%, and 82%, respectively. SPECT regression was associated with MRI decrease of tumor size, contrast enhancement, edema and hemorrhage. SPECT progression was associated with MRI increase of the same parameters and the increase of necrosis. 1H-MRS regression was associated with decrease of edema. 1H-MRS progression was associated with increase of tumor size, hemorrhage, and increase or decrease of contrast enhancement. Conclusions Both 201thallium SPECT and 1H-MRS evaluation showed sensitivity for detection of astrocytoma progression. We did not find a higher accuracy of SPECT or MRS than of MRI in astrocytoma chemotherapy monitoring. Treatment induced MRI changes were associated with 201thallium uptake variations. 1H-MRS was difficult to apply for astrocytoma treatment monitoring. Improvements regarding size of measurement area such as multivoxel MRS and fat suppression pulses appeared desirable, and also the use of functional techniques with superior resolution such as dual isotope SPECT. However, our results suggest that 201thallium SPECT and 1H-MRS can provide additional information to MRI for chemotherapy efficacy evaluation in selected cases.
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 35 (1993), S. 370-374 
    ISSN: 1432-1920
    Keywords: Magnetic resonance imaging ; Extradural tumours ; Spinal metastases
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Ninety-one patients with extradural spinal tumours were examined by magnetic resonance imaging. There were 76 metastases (6 from unknown primary tumours). Seven patients had primary spinal tumours and 8 had multiple myeloma. Sixteen had bulging, diseased vertebral bodies compressing the subarachnoid space and 67 had extradural tumour compressing the spinal cord. Sixty patients had paravertebral involvement. Intraspinal involvement did not correlate with the extent of spinal lesions. All patients had vertebral destruction, with hypointense or combined hypo- and isointense signal relative to bone marrow on T1-weighted images. In most of the 22 patients with T2-weighted images the tumours were isointense or slightly hyperintense. It was usually impossible to differentiate the various tumours on the basis of signal intensity and morphology. However, metastases from carcinoma of the prostate were often more hypointense than other tumours on T1- and T2-weighted images. An inhomogeneous pattern in which diffusely low signal is combined with focal lower signal on T1-weighted images may suggest myeloma. In the 22 patients examined with both T1- and T2-weighted images, T1-weighted images gave the best information in 18; in 3 they were equivalent and in 1 inferior to T2-weighted images; they are therefore recommended for routine imaging of epidural spinal tumours.
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  • 3
    ISSN: 1432-1920
    Keywords: Magnetic resonance imaging ; Spine ; Aortic disease ; Aortic aneurysm ; Aortic dissection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In five patients with clinical suspicion of spinal disease, MRI of the spine revealed unexpected aortic pathology explaining the symptoms. No significant intraspinal pathology was found on MRI. However, in one patient with clinical suspicion of spinal stenosis, an aortic occlusion was detected on MR images of the spine. The lower extremity ischaemia, caused by the occlusion, was responsible for the symptoms. In another patient a paravertebral haematoma from a ruptured aortic aneurysm resulted in spinal nerve compression, thought before MRI to be caused by a spinal tumour. In three patients aortic aneurysm or dissection resulted in spinal cord ischaemia with symptoms mimicking those of compressive spinal disease. Thus, if MRI of the spine does not provide an explanation for the patient's symptoms, examination of the aorta is recommended.
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  • 4
    ISSN: 1432-1920
    Keywords: Spine ; Intervertebral discs ; Surgery ; MRI-Gadolinium
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of this study was to determine MRI findings in patients successfully operated upon for lumbar disc herniation. We investigated 20 patients with a successful outcome after L4-5 or L5-S1 disc operations clinically and with MRI preoperatively, and at 5 days, 6 weeks, and 4 months after surgery. Postoperatively, T1- and T2-weighted images were obtained. At 4 months gadolinium-enhanced images were added. Pronounced intraspinal MRI changes were seen during follow-up. Deformation of the dural sac was seen in 13 patients preoperatively, in 19 at 5 days after operation, in 15 at 6 weeks, and in 12 at 4 months. Nerve root involvement was seen in all cases both preoperatively and at 5 days after operation, in 17 at 6 weeks, and in 15 at 4 months. No correlation between symptoms or the straight leg raising test and the size or nature of the abnormal tissue in the spinal canal postoperatively could be demonstrated. It was concluded that early postoperative MRI after lumbar discectomy must be interpreted carefully, and that oedema and scar formation are probable reasons for difficulties in interpretation.
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 22 (1981), S. 123-127 
    ISSN: 1432-1920
    Keywords: Malignant melanoma ; Cranial computed tomography ; Brain metastases
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Sixty-eight patients with malignant melanoma were examined by CCT and the findings analyzed. Cerebral metastases were detected in 19 patients. Meningiomas were found in three patients, one with neurological symptoms and two without. Typical metastases less than 10 mm in diameter were located superficially in the grey matter, regular, homogenous, hyperdense, with no edema. Extensive peripheral edema was often associated with metastases measuring more than 10 mm. CCT revealed cerebral metastases in 6 (13%) of 46 asymptomatic patients. The metastases measured less than 10 mm in four and less than 20 mm in two of these patients. Scintigraphy was falsly negative in six patients with metastases smaller than 10 mm. Therefore, CCT is the method of choice for screening asymptomatic patients. Angiography may be of value in the differentiation between meningioma and melanoma metastases.
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 24 (1983), S. 213-215 
    ISSN: 1432-1920
    Keywords: Iohexol ; Cranial computed tomography ; Contrast enhancement
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The commonly used contrast medium metrizoate (isopaque Cerebral®) or the new nonionic iohexol were injected intravenously for enhancement of cranial CT in a randomized double blind study. Each group consisted of 105 patients. No serious reactions occurred. Ten patients receiving metrizoate had minor reactions of mainly allergic type, whereas only one patient receiving iohexol reacted. No differences in enhancement efficiency could be observed.
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 26 (1984), S. 33-38 
    ISSN: 1432-1920
    Keywords: Brain lymphoma ; computed tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Correct diagnosis of malignant lymphoma of the brain and differentiation from malignant glioma, metastases, meningeoma and infection is often difficult. With the aim of finding characteristics pointing to the correct diagnosis all CT examinations from 16 patients with primary or secondary lymphoma of the brain were analysed. In 3 of 10 patients with primary lymphoma and 4 of 6 with secondary lymphoma the tumors were multiple. No differences between the CT appearance of primary and secondary lymphoma were found except that secondary lymphomas were generally smaller and more often multiple. The lymphomas were most often well demarcated, had a density equal to or slightly higher than normal brain tissue, were surrounded by no or slight edema and showed a moderate to marked contrast enhancement. The tumors were situated in the basal ganglia, corpus callosum or cerebellum in high frequency and were always in contact with either the ependyma of the ventricles or the superficial subarachnoid space. A tumor with widespread infiltration of the surroundings of the ventricles seen in 6 patients in the material is highly characteristic of lymphoma.
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 35 (1993), S. 221-226 
    ISSN: 1432-1920
    Keywords: MRI ; Acute transverse myelopathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The MRI examinations of seven patients with acute transverse myelopathy (ATM) were analysed. The patients were examined 2–5 times during the course of their disease with short and long TR/TE spin-echo sequences in the sagittal projection. A previous history of autoimmune disorder and/or signs of infection at the onset of ATM were present in all cases. Cerebrospinal fluid analysis showed local synthesis of immunoglobulin in the nervous system in three cases and signs of infectious myelitis in one. During the acute phase four patients had local enlargement of the cord and all had increased signal on long TR/TE sequences. The outcome was grave in the majority of patients and there seemed to be a correlation between the degree of cord enlargement, persistence of increased signal intensity and limited recovery. Atrophy and remaining high signal intensity were noted on late MRI in patients with poor outcome. In one patient with probable anterior spinal artery occlusion, cavitation of the cord was seen.
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  • 9
    ISSN: 1432-1920
    Keywords: Key words Brain ; MRI ; Spine ; MRI ; Gadolinium contrast media
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Gadodiamide injection, a new nonionic, MRI contrast medium, was compared with the ionic agent gadolinium (Gd)-DTPA at 0.1 mmol/kg body weight in a double-blind, randomised trial in 60 patients, 30 receiving each substance, with known or suspected lesions of the central nervous system. The patients were closely questioned about adverse events. In the Gadodiamide injection group, four patients reported six adverse advents, three of which were judged to be related to the contrast medium. In the Gd-DTPA group, two patients each reported one adverse event, both of which had an uncertain relation to the contrast medium. All events were mild and no medical treatment was needed. No significant change in neurological findings, blood pressure, pulse rate or blood parameters were noted in any patient. Both contrast media were effective; no difference in overall efficacy or safety was observed.
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 36 (1994), S. 107-110 
    ISSN: 1432-1920
    Keywords: Neurofibromatosis ; NF2 ; Meningioma, multiple ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The radiological findings in six patients fulfilling the criteria of neurofibromatosis type 2 (NF2) were reviewed. Subtle cutaneous lesions were found in three. All patients had bilateral acoustic schwannomas; two had small acoustic tumours and normal hearing. In these patients the presenting symptoms were caused by multiple intracranial meningiomas and spinal neurofibromas, respectively, whereas the remaining four patients presented with hearing loss. Two patients had other cranial nerve tumours. Three patients had rapidly growing multiple intracranial meningiomas; two had multiple spinal neurofibromas and one a spinal meningioma. NF2 is a rare disease with few cutaneous but frequent, typical radiological findings in the central nervous system. The presenting symptom is most commonly hearing loss due to acoustic schwannomas, although symptoms emanating from other intracranial or tumours are not uncommon. The discovery of multiple meningiomas or multiple spinal neurofibromas without cutaneous lesions should initiate a search for acoustic schwannomas even when the patient has normal hearing.
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