Neuroradiology 0028-3940

Ruscalleda, Jordi

doi: 10.1007/s002340100683pmid: N/A

Gahn, G.; von Kummer, R.

doi: 10.1007/s002340100613pmid: 11594418

Ultrasound is widely used for assessment of neurovascular disease, mainly during the subacute or chronic phases of cerebral ischaemia. The availability of aggressive and potentially harmful treatments for acute ischaemic stroke demands fast, and noninvasive examination of the intracranial vasculature. Current ultrasound techniques have the potential to provide essential information about the intracranial arteries in acute stroke. Application of echo-enhancing agents promises to effectively extend current techniques. The clinical significance of sonography in acute stroke needs to be evaluated prospectively and compared with other radiological techniques.

Tourbah, A.; Stievenart, J. L.; Abanou, A.; Fontaine, B.; Cabanis, E. A.; Lyon-Caen, O.

doi: 10.1007/s002340100547pmid: 11594419

MRI is the most powerful imaging technique in managing patients with suspected or confirmed multiple sclerosis (MS). However, conventional MRI variables show nonspecific abnormalities weakly correlated with clinical progression of the disease. New techniques, now routinely available, offer better characterisation of the pathophysiology. We combined conventional MRI, including lesion load, contrast enhancement and “black holes” with magnetisation transfer and diffusion-weighted imaging and localised proton MR spectroscopy (MRS) to study their relationship with disability, course and duration of MS. The variables that were the most significantly linked to the course of the disease (relapsing remitting versus secondary progressive) were lesion load, mean overall magnetisation transfer ratio and apparent diffusion coefficient (MGADC), the percentage of ADC in (PADCIMD), and out of (PADCOMD) modal distribution, and the ratio N-acetylaspartate and creatine-containing compounds on MRS of the centrum semiovale. MGADC and PADCIMD were the independent factors most related to disability and duration of disease. Combining MRI techniques is clinically relevant and feasible for studies of MS and may be applied to other diseases of the central nervous system.

Vikhoff-Baaz, B.; Malmgren, K.; Jönsson, L.; Starck, G.; Ljungberg, M.; Forssell-Aronsson, E.; Uvebrant, P.; Ekholm, S.

doi: 10.1007/s002340100560pmid: 11594420

We carried out spectroscopic imaging (MRSI) on nine consecutive patients with temporal lobe epilepsy being assessed for epilepsy surgery, and nine neurologically healthy, age-matched volunteers. A volume of interest (VOI) was angled along the temporal horns on axial and sagittal images, and symmetrically over the temporal lobes on coronal images. Images showing the concentrations of N-acetylaspartate (NAA) and of choline-containing compounds plus creatine and phosphocreatine (Cho + Cr) were used for lateralisation. We compared assessment by visual inspection and by signal analysis from regions of interest (ROI) in different positions, where side-to-side differences in NAA/(Cho + Cr) ratio were used for lateralisation. The NAA/(Cho + Cr) ratio from the different ROI was also compared with that in the brain stem to assess if the latter could be used as an internal reference, e. g., for identification of bilateral changes. The metabolite concentration images were found useful for lateralisation of temporal lobe abnormalities related to epilepsy. Visual analysis can, with high accuracy, be used routinely. ROI analysis is useful for quantifying changes, giving more quantitative information about spatial distribution and the degree of signal loss. There was a large variation in NAA/(Cho + Cr) values in both patients and volunteers. The brain stem may be used as a reference for identification of bilateral changes.

Johnson, D.; Coley, S. J.; Kyrion, J.; Taylor, W. J.

doi: 10.1007/s002340000512pmid: 11594421

Biplane digital imaging systems are favoured in neurointerventional practice since they are believed to contribute to safer, quicker and more efficacious procedures. Our aim was to establish if such equipment exposes patients to the same level of ionising radiation as monoplane systems. We reviewed monoplane and biplane fluoroscopy screening times and dose-area products (DAP) for 267 diagnostic cerebral angiograms and 56 neurointerventional cases. Significantly lower DAP for the latter were recorded on the biplane equipment, demonstrating an important reduction in patient exposure to radiation. There were no significant differences between the two systems for diagnostic cerebral angiography.

Nomura, M.; Kida, S.; Uchiyama, N.; Sanada, J.; Yoshikawa, J.; Yamashima, T.; Yamashita, J.; Matsui, O.

doi: 10.1007/s002340100562pmid: 11594422

Our aim was to investigate the usefulness of helical CT during selective angiography (CT arteriography) in pretreatment assessment of unruptured intracranial aneurysms. We studied 47 unruptured aneurysms in 34 prospectively recruited patients for whom endovascular embolisation was initially considered. As pretreatment assessment, we performed rotational digital subtraction angiography (DSA) followed by CT arteriography. The findings on axial source images (axial images) and reconstructed three-dimensional CT angiography (3D-CTA) of CT arteriography were compared to those of rotational DSA, with particular attention to the neck of the aneurysm and arterial branches adjacent to it. Information provided by CT arteriography was more useful than that of rotational DSA as regards the neck in 25 (53 %) of 47 cases and as regards branches in 18 (49 %) of 37 aneurysms. On axial images, small arteries such as the anterior choroidal artery were seen in some cases. CT arteriography can provide valuable additional information about unruptured aneurysms, which cannot be obtained by rotational DSA alone. This technique is useful for obtaining anatomical information about aneurysm anatomy and for deciding the therapeutic strategy.

Bendszus, M.; Beck, A.; Koltzenburg, M.; Vince, G. H.; Brechtelsbauer, D.; Littan, T.; Urbach, H.; Solymosi, L.

doi: 10.1007/s002340100572pmid: 11594423

In previous studies the origin of the majority of isolated sixth nerve palsies was not clear or was ascribed to vascular disease. Our purpose was determine how frequently a causative lesion was demonstrated on MRI in patients with an acute unilateral sixth nerve palsy. We performed a prospective study of 43 patients using a standardised protocol. In 27 patients (63 %) a lesion was identified on the initial MRI relevant to the sixth nerve palsy; 21 (49 %) were found to have a tumour or tumour-like lesion; the frequency of presumed vasculopathy in this group was 15 %. There were 16 patients (37 %) with an initially normal MRI, of whom 10 (62 %) had a history of vasculopathy, a significantly different proportion from the group of patients with a visible causative lesion. MRI after 3–6 months was normal in all patients with a normal initial MRI. We suggest that MRI should routinely be performed in patients presenting with an acute sixth nerve palsy, even those with evidence of a vasculopathy. If the symptoms regress spontaneously and there is a history of vasculopathy, follow-up MRI is not necessary.

Poon, M. A.; Stuckey, S.; Storey, E.

doi: 10.1007/s002340100587pmid: 11594424

We report a 51-year-old woman with the Brownell-Oppenheimer (cerebellar) variant of Creutzfeldt-Jakob disease (CJD). She had the typical findings of bilateral basal ganglion changes on MRI, as well as changes in the cerebellum and hippocampus. This case adds further information to the known imaging characteristics of CJD.

Buxton, N.; Davis, G.; Robertson, I. J. A.; Jaspan, T.; Lenthall, R. K.; Cooper, A. D.; Robson, K.

doi: 10.1007/s002340100568pmid: 11594425

We report a patient presenting with hydrocephalus secondary to a posterior third ventricular plasma-cell lesion which exhibited delayed transudation of contrast medium into the adjacent aqueduct and fourth ventricle.

Sumida, M.; Arita, K.; Migita, K.; Tominaga, A.; Iida, K.; Kurisu, K.

doi: 10.1007/s002340100559pmid: 11594426

We reviewed the clinical, radiological and surgical findings in patients with both pituitary adenoma and Rathke's cleft cyst. We retrospectively selected patients with both lesions from the 374 patients in whom a sellar/juxtasellar lesion was detected on MRI at 1.5 tesla. All patients received intravenous contrast medium. Concomitant pituitary adenoma and Rathke's cleft cyst were found in eight patients (2.1 %). The frequency of the combination was 3.5 % of pituitary adenomas and 11 % of Rathke's cleft cysts. Symptoms were always due to the adenoma, secreting adrenocorticotrophin in two patients and growth hormone in six. The adenoma was larger in five patients, and the cyst in three. The cysts gave variable signal. The adenoma was adjacent to the cyst in seven patients, and enclosed it in the other patient. As a result of experience with MRI, concomitant pituitary adenoma and Rathke's cleft cyst are now known not to be as rare as thought previously. When a nonenhancing cyst-like structure is demonstrated in a patient with pituitary adenoma, the possibility of a coexisting Rathke's cleft cyst should be considered.