First-line therapy with temozolomide induces regression of primary CNS lymphoma.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
W Küker
Publications and source records attributed to W Küker.
Primary CNS lymphoma in the spinal cord: clinical manifestations may precede MRI detectability.
We report a 36-year-old woman whose first MRI after developing symptoms of cervical nerve root irritation was normal. Eight months later, after progression to tetraparesis and demonstration of an extensive contrast-enhancing intramedullary lesion giving high signal on T2-weighted images, the diagnosis of lymphoblastic non-Hodgkin's lymphoma was made by biopsy. The lesion responded for a short time to corticosteroid medication, but later rapidly extended to the epidural soft tissues, probably due to a cerebrospinal fluid fistula. Despite radio-and chemotherapy, the patient survived only 7 months from histological diagnosis and 15 months from the onset of symptoms.
Adult↗
Myelopathy in primary Sjögren's syndrome: diagnostic and therapeutic aspects.
We report a patient with a myelopathy in primary Sjögren's syndrome, proven by salivary gland biopsy and specific antibodies. Under steroid medication, the patient had a remitting and relapsing clinical course. The severity of clinical symptoms correlated with a transient contrast uptake in spinal magnetic resonance imaging. Under a treatment with azathioprine and prednisone the patient has suffered no relapse within the last 20 months. Although this is only a case report, the combination of azathioprine and prednisone may be a valuable medication in chronic cases of Sjögren's syndrome with neurologic symptoms.
Aged↗
MRI features of primary, secondary and metastatic medulloblastoma.
Medulloblastoma is the most frequent paediatric malignant brain tumour. The purpose of this study was to define imaging characteristics and contrast uptake patterns of primary and recurrent medulloblastoma using MRI. The MRI examinations of 17 histologically proven cases of medulloblastoma diagnosed in our institution (13 males and 4 females; mean age 13 years, 7 months) were reviewed in retrospect. Only patients with pre-treatment and follow-up examinations including T2-weighted images (fluid-attenuated inversion recovery or turbo spin echo) and T1-weighted images after contrast injection (0.1 mmol/kg Gd-DTPA) were included in this study. Whereas 6 of 7 tumours ( n=17) were hyperintense on T2-weighted images, contrast enhancement was detected in 13 patients. Fifteen tumours occurred in the cerebellar vermis, two were located in the cerebellar hemispheres. Mean size at the time of presentation was 30.1 mm. All patients presented with some extent of an occlusive hydrocephalus. Local recurrent tumour or metastases were seen in 6 patients (3 months to 7 years, mean age 2.5 years). Whereas the T2 signal intensity of recurrent tumour or subarachnoidal metastases resembled the primary neoplasms, the contrast uptake tended to be less pronounced ( n=3) or was completely absent ( n=2); thus, suggestive signs of primary medulloblastoma are location in the vermis, hyperintensity on T2-weighted images and hydrocephalus. The amount of contrast enhancement is variable and nonspecific. Secondary medulloblastoma manifestation is characterized by T2 hyperintensity but not by contrast uptake.
Adolescent↗
MRI features of primary central nervous system lymphomas at presentation.
Pretreatment MRI examinations of 40 immunologically competent patients with primary CNS lymphoma (PCNSL) were evaluated (24 men, 16 women, median age 63 years). Seventy lesions were found (mean size: 19.9 mm). The number of lesions ranged from one (n = 25) to six (n = 1). The most frequent locations were the cerebral hemispheres (n = 22), the corpus callosum (n = 11), and the basal ganglia (n = 11). Cerebellar manifestations were found in 10 patients. Ocular (n = 2) and medullary cord (n = 1) manifestations were rare. Contrast enhancement was encountered in all lesions. Although 39 patients had lesions adjacent to the CSF space, leptomeningeal spread was only present in five patients. Necrosis was seen in two lesions only. Edema was extensive in 24 patients, moderate in 11 patients, and absent in five patients. Contrast-enhancing lesions in contact with the subarachnoid space and without necrosis are characteristic of PCNSL.
Adult↗
Preirradiation gemcitabine chemotherapy for newly diagnosed glioblastoma. A phase II study.
BACKGROUND: The median survival for patients with glioblastoma is reported to be 12 months. To improve the outcome for glioblastoma patients, the authors evaluated the therapeutic efficacy of preirradiation gemcitabine chemotherapy followed by standard radiotherapy. METHODS: Twenty-one patients with newly diagnosed glioblastoma were enrolled in a prospective unicenter trial of preirradiation gemcitabine chemotherapy. Chemotherapy included up to 4 monthly cycles of intravenous gemcitabine (Day 1, Day 8, and Day 15; 1000 mg/m2). Involved field radiotherapy was given after chemotherapy or earlier in the case of disease progression or gemcitabine intolerance. RESULTS: With gemcitabine chemotherapy alone, there was a median progression free survival of 11 weeks and a progression free survival rate at 4 months of 24%. In 18 of 21 patients who subsequently received a full course of radiotherapy, the median progression free survival from the time of diagnosis was 8 months and the progression free survival rate at 12 months was 17% (3 of 18 patients). The median overall survival was 11 months. There was no specific treatment-related neurotoxicity reported. Neither age nor extent of residual postoperative tumor predicted the duration of progression free survival in patients treated with gemcitabine chemotherapy alone or in those treated with gemcitabine plus radiotherapy. CONCLUSIONS: Gemcitabine followed by radiotherapy is a safe regimen for patients with newly diagnosed glioblastoma but the gemcitabine schedule used in the current study did not appear to confer any survival advantage compared with standard involved field radiotherapy alone.
Adult↗
[Bithalamic infarcts as the etiology of acute stupor. Early diagnosis with diffusion-weighted MRI].
Fast diagnostic evaluation of somnolent or unconscious patients is a demanding task for neurologists. Apart from postictal, metabolic, and toxic causes, vascular syndromes must be rapidly identified in order to initiate a specific fibrinolytic therapy. Given its high mortality if not treated in time, this dictum holds especially true for basilar artery occlusion. However, certain ischemic lesions in the vascular territory of the basilar artery without occlusion of the basilar artery itself can also result in somnolence, sopor, or even unconsciousness. Here we report early imaging signs of bithalamic infarctions as the cause of acute sopor using diffusion-weighted (DW)-MRI, which reliably identifies acute bithalamic infarctions as a possible cause of acute consciousness disturbance, even with noncooperative patients.
Acute Disease↗
Ultrasonography and contrast-enhanced MRA in ICA-stenosis: is conventional angiography obsolete?
BACKGROUND: The standard techniques for the screening and staging of internal carotid artery (ICA) stenosis are Doppler (continuous wave) and Duplex sonography. For the imaging of ICA occlusive disease, magnetic resonance angiography (MRA) is replacing digital subtraction angiography (DSA). The purpose of this observational study was to assess whether contrast enhanced MRA (CE-MRA) combined with ultrasound provided sufficient information for the planning of surgical treatment. METHODS: CE-MRA was performed in 195 patients (mean age 67.5 years) with sonographic evidence of severe ICA stenosis. The MRA examination protocol contained a heavily T1-weighted contrast bolus enhanced 3D-gradient echo sequence. The degree of stenosis was estimated retrospectively by two experienced neuroradiologists who were blinded to the sonographic findings. RESULTS: The consistency of MRA and ultrasound was sufficient to plan thrombendarterectomy in 182/195 patients. The estimations of the degree of stenosis were congruent between MRA and ultrasound in 91% of 197 vessels with high-degree carotid artery stenosis. CE-MRA evaluation had a high interobserver agreement. In 3 cases ultrasound examination diagnosed a filiform ICA stenosis which was not visible with MRA. In all these cases, DSA and the intraoperative findings revealed very short (1-2 mm), high-grade, excentric stenosis. CE-MRA correctly detected patency in 5 patients with high-grade and low-flow carotid artery stenosis, which had been regarded as occluded by ultrasound. Conversely with, in CE-MRA two occluded vessels were falsely considered as open. CONCLUSION: The combination of sonography and CE-MRA is a powerful tool for the non-invasive presurgical evaluation of the carotid arteries. DSA should be reserved for selected cases.
Aged↗
The role of intraoperative magnetic resonance imaging for the detection of hemorrhagic complications during surgery for intracerebral lesions an experimental approach.
BACKGROUND: Intraoperative magnetic resonance imaging (MRI) for guided biopsy or microsurgical resection of intracranial lesions is gaining broader acceptance. It is not known whether intraoperative MRI has the potential to detect hemorrhagic complications of these surgical procedures, because scientific research has so far focussed on the signal characteristics of less acute clots. It is the objective of this experimental study to investigate whether MRI can visualise intracerebral blood within minutes after its occurrence. METHODS: In 26 pigs, a frontal hematoma was produced by injecting autologous blood. Twenty pigs underwent MRI 30 minutes after injection, and 6 pigs within the first 10 minutes. MRI scans were performed on a 1.5T system. T1-weighted spin echo (SE), T2-weighted turbo spin echo (TSE), T2-weighted fluid attenuated inversion recovery (FLAIR), and T2-weighted gradient echo (GE) images were acquired. Depending on the differences of the signal intensities of the hematoma and the surrounding brain, the detectability of the hematoma was rated as good, fair, or poor. RESULTS: None of the induced hematomas were rated to be clearly visible on T1-weighted sequences. Six of the 26 hematomas (23%) were easily detectable on FLAIR sequences, 18 hematomas (69%) on T2-weighted TSE sequences, and 23 hematomas (88%) on the T2-weighted GE sequences. CONCLUSION: Extravasated blood can be identified with a high reliability within minutes after its occurrence on MRI provided that T2-weighted GE sequences are used for imaging. In conclusion, intraoperative MRI is not only of value for guidance of neurosurgical procedures, but also for immediate detection of hemorrhagic complications.
Animals↗
Proton MR spectroscopy reveals lactate in infantile neuroaxonal dystrophy (INAD).
Changes of cerebral metabolites detected by proton MR spectroscopy in two cases of infantile neuroaxonal dystrophy are described. A 6 11/12-year-old boy and a girl (aged 4 1/12 years at the first and 5 2/12 years at the second examination) with infantile neuroaxonal dystrophy were investigated by magnetic resonance imaging and spectroscopy of the basal ganglia. The signal intensity of the cerebellar cortex was increased on T2-weighted, proton density, and fluid attenuated inversion recovery images. The long echo time (135 ms) spectra revealed the presence of lactate in the basal ganglia of both cases in all investigations. The N-acetylaspartate/creatine ratio was reduced in Case 1 and in the second investigation of Case 2. The choline/creatine ratio was always increased. As the diagnosis of infantile neuroaxonal dystrophy is made by a synopsis of various clinical, neuropathological, neurophysiological, and neuroradiological data, the presence of lactate in the basal ganglia spectra may help to narrow down the diagnosis and can support the decision to perform more invasive diagnostic procedures (such as biopsies of skin, conjunctiva or even of the brain).
Aspartic Acid↗
[Contrast enhanced MR-angiography (CE-MRA): do contrast media with higher T1 relaxation improve imaging of carotid stenoses?].
PURPOSE: CE-MRA is a powerful tool for the non-invasive evaluation of carotid artery occlusive disease. However, due to certain drawbacks, it has not completely replaced DSA. The purpose of this study was to evaluate if Gd-BOPTA, a contrast agent with high T1 relaxivity, can increase the diagnostic accuracy of CE-MRA. MATERIAL AND METHODS: The CE-MRA examinations of 54 consecutive patients were evaluated by two experienced radiologists, independently. The examinations of 27 patients were contrasted either with 20 ml Gd-BOPTA or with 20 ml Gd-DTPA. The reviewers were blinded to the contrast agent chosen and to the ultrasound results. They rated the overall image quality and the degree of the ICA stenoses. RESULTS: For the estimation of the degree of the ICA stenoses there was a high interrater validity. In comparison to the ultrasound findings, 6 of 50 high-degree stenoses were underestimated as moderate stenoses. In one of seven sonographically occluded vessels, MRA revealed residual patency in the vessel lumen. It was not possible to identify the contrast agent that was taken for a study. Subjective estimation of the image quality (arterial contrast of the ICA, contrast of the other vessels, and general impression) did not significantly change with the contrast agent employed. CONCLUSION: The diagnostic accuracy of CE-MRA for the evaluation of internal carotid artery stenoses is not improved by Gd-BOPTA if identical volumina of contrast media are applied. The potential of this contrast agent can be the reduction of the amount of contrast without loss of diagnostic information. Further studies are necessary.
Aged↗
Unilateral thalamic edema in internal cerebral venous thrombosis: is it mostly left?
Thrombotic occlusion of the internal cerebral veins is a particularly dangerous form of cerebral venous thrombosis (CVT) as it causes venous infarction of the thalami. Because both thalami drain into the vein of Galen and straight sinus, bilateral thalamic involvement is frequently encountered in internal CVT. However, unilateral thalamic edema may also occur, even if all internal cerebral veins are occluded. This suggests collateral venous drainage of the thalami, which is commonly insufficient in internal CVT. Patients with unilateral congestion of the thalamus, including 3 patients reported here, had mostly left-sided involvement, indicating that right-sided unilateral thalamic involvement in CVT may be clinically silent.
Adult↗
Spontaneous occlusion of a cerebral arteriovenous malformation: angiography and MR imaging follow-up and review of the literature.
We present the angiographic and MR imaging course of a 62-year-old man with a right parietal high-flow arteriovenous malformation (AVM), which was diagnosed because of seizures. A spontaneous, complete, and asymptomatic occlusion of the AVM was confirmed by a second angiography 3 months later. The possible mechanisms leading to the occlusion are discussed, and a brief review of the literature is given.
Angiography, Digital Subtraction↗
PCV salvage chemotherapy for recurrent primary CNS lymphoma.
Explore the source record for details and available documents.
Aged↗
Is the head position during preoperative image data acquisition essential for the accuracy of navigated brain tumor surgery?
OBJECTIVE: To analyze the influence of head positioning during preoperative image data acquisition on intraoperative accuracy of modern neuronavigation systems. MATERIAL AND METHODS: All measurements were performed preoperatively before opening the head. In 24 patients, preoperative MR image data acquisition was performed twice on a 0.5 T scanner using a contrast-enhanced T1-weighted sequence; first in the neutral head position, and thereafter in the surgical head position for pterional craniotomy. For both data sets, the Sylvian fissure, the central sulcus, and the superior and inferior temporal sulci were depicted on the patient's scalp using the frameless neuronavigation system EasyGuide Neurotrade mark. At the beginning of surgery, with the head fixed in a Mayfield clamp and an articulated instrument holder being used for fixation of the navigation system's pointer, the distances of 10 correlating points of the sulci for the two data sets were measured. To evaluate the accuracy of the navigation system in this experimental set-up, a phantom study was also performed. RESULTS: The phantom study revealed a mean inaccuracy of 1.6 mm (range 0.1-2.3 mm, standard deviation 0.6 mm). The patient study revealed a mean inaccuracy of 1.8 mm (range 0.4-2.8 mm, standard deviation 0.5 mm). CONCLUSIONS: The data suggest that the positioning of the patient's head during preoperative imaging plays no relevant role in intraoperative accuracy of neuronavigation. However, further studies and a larger number of patients with various pathologies in different regions of the brain are necessary to obtain a better understanding of the problem of brain shift in neuronavigation due to patient positioning alone, and to avoid procedure-related operative morbidity.
Adult↗
[Raeder- and Collet-Siccard-Syndrome. Acute pareses of cranial nerves symptomatic of a dissection of internal carotid artery].
Acute cerebral nerve paresis can be caused in many different ways. One of the more rare causes of paresis of one or more neural pathways is dissection of the internal carotid artery. Early diagnosis is important, even with atypical symptoms, since prompt anticoagulative therapy can hinder stroke from embolism due to the dissection. We report on two patients with Raeder's syndrome and Collet-Sicard syndrome resulting from dissection of the internal carotid artery. Besides the cranial and caudal nerves involved in our study, loss of function has also been reported with the sixth to eighth cranial nerves, so that any painful, sudden cranial nerve deficiency can indicate possible carotid dissection.
Acute Disease↗
Classification of acquired lesions of the corpus callosum with MRI.
MRI has facilitated diagnostic assessment of the corpus callosum. Diagnostic classification of solitary or multiple lesions of the corpus callosum has not attracted much attention, although signal abnormalities are not uncommon. Our aim was to identify characteristic imaging features of lesions frequently encountered in practice. We reviewed the case histories of 59 patients with lesions shown on MRI. The nature of the lesions was based on clinical features and/or long term follow-up (ischaemic 20, Virchow-Robin spaces 3, diffuse axonal injury 7, multiple sclerosis 11, hydrocephalus 5, acute disseminated encephalomyelitis 5, Marchiafava-Bignami disease 4, lymphoma 2, glioblastoma hamartoma each 1). The location in the sagittal plane, the relationship to the borders of the corpus callosum and midline and the size were documented. The 20 ischaemic lesions were asymmetrical but adjacent to the midline; the latter was involved in new or large lesions. Diffuse axonal injury commonly resulted in large lesions, which tended to be asymmetrical; the midline and borders of the corpus callosum were always involved. Lesions in MS were small, at the lower border of the corpus callosum next to the septum pellucidum, and crossed the midline asymmetrically. Acute disseminated encephalomyelitis and the other perivenous inflammatory diseases caused relatively large, asymmetrical lesions. Hydrocephalus resulted in lesions of the upper part of the corpus callosum, and mostly in its posterior two thirds; they were found in the midline. Lesions in Marchiafava-Bignami disease were large, often symmetrically in the midline in the splenium and did not reach the edge of the corpus callosum.
Adolescent↗
Presumed capillary telangiectasia of the pons: MRI and follow-up.
Capillary telangiectasia is a vascular abnormality primarily of the brainstem. The clinical relevance is unclear as is the association with clearly pathologic findings such as cavernous haemangioma. We report on four cases with capillary telangiectasia proven by follow-up and describe the imaging characteristics. T2 abnormality was only observed in half of the patients as was the presence of a discernable collecting vein. Whereas two cases were incidental findings in neurologically normal persons and one had symptoms clearly attributable to lacunar stroke, one patient may have had symptoms due to the vascular abnormality in the pons.
Adult↗