[Differential diagnosis brain neoplasms--brain infarct. Angiographic problems in the differentiation of a cerebro-vascular attack due to an intracranial tumor].
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Currently, patients with brain neoplasms must undergo both computed tomography (CT) and magnetic resonance (MR) imaging to take advantage of CT's density information and MR's soft tissue imaging capabilities. A method has been developed that allows virtual simulation, digitally reconstructed radiographs (DRRs), and 3-D treatment planning of patients with brain neoplasms to be generated using only one T1-weighted MR data set. DRRs of an anthropomorphic RANDO head phantom were generated using MR and CT imaging. The MR based DRRs provided structural information equivalent to CT based DRRs. The spatial linearity of CT and MR image sets was evaluated by measuring the percent distortion and spatial error. There was no statistical difference in spatial linearity or accuracy between the CT and MR image sets. MR and CT based treatment planning were compared using a variety of different treatment accessories, field sizes, photon energies, and gantry positions. Doses at various points throughout the head phantom were used as comparison points between CT based heterogeneous, CT based homogenous, and MR based homogenous treatment planning of the head phantom. Lithium fluoride thermoluminescent dosimeters were used to verify the dosimetric accuracy of MR based treatment planning by taking measurements at these points. For treatment plans with fields that pass through large air cavities, such as the maxillary sinus, homogenous treatment planning produces unacceptable dosimetric error (2%-4%). For treatment plans with fields that pass through the skull, MR homogenous treatment planning can be used with a dosimetric accuracy of +/- 2%.
Of 679 patients with brain neoplasms admitted to either a medical school center or a community hospital during a nine-year period, 24 had been examined by a psychiatrist before definitive diagnosis of brain neoplasm. These 24 cases were studied to evaluate the role of the psychiatrist in the management of the patients before the neoplasm was diagnosed. Such cases pose many subtle problems for psychiatrists. However, ten of the 24 patients either were sent for definitive tests by the psychiatrist with the tentative diagnosis of brain neoplasm or were triaged to other consultants to pursue that diagnosis.
Vascular abnormalities in brain neoplasms are important to tumor biology and therapy. Glucose transporter (GLUT1) expression is a differentiated property of normal cerebral microvessels typically associated with expression of the blood-brain barrier. We investigated the relationship of GLUT1 expression to other vascular characteristics in F98, 9L, and C6 gliomas and Walker 256 carcinomas implanted into adult rat brains. The percentages of microvessels with immunohistochemically detectable GLUT1 were 95.5 +/- 3.9 in F98, 60.9 +/- 3.9 in 9L, 45.4 +/- 5.6 in C6, and 1.2 +/- 0.3 in Walker 256 (mean +/- SEM). The percentage of GLUT1-positive vessels in F98 was not statistically different from that in normal brain. GLUT1 expression was not dependent on restricted permeability as all tumors were highly permeable to Evans blue. GLUT1 expression was unrelated to vascular density, vascular morphology, and parenchymal GFAP expression. The expression of GLUT1, a marker of cerebral endothelial differentiation, is a newly described property of glial tumor vessels that may have diagnostic and prognostic significance.
OBJECTIVE: To determine if serum S-100beta levels are elevated in children with brain neoplasms and if it can be used as a tumor marker for children with brain neoplasms. DESIGN: Prospective cohort study. SETTING: Urban, tertiary care, children's teaching hospital. PATIENTS: 136 healthy children and 27 children with brain neoplasms. METHODS: Serum levels of S-100beta were measured in 136 healthy children to serve as controls and 27 children with brain neoplasms, who underwent biopsy or resection of the mass. Patients were then classified into astrocytoma or non-astrocytoma groups. MEASUREMENTS AND MAIN RESULTS: The median serum S-100beta level for the control group was 0.27 mcg/l (range, 0.06-2.6 mcg/l), and for the brain neoplasm group was 0.2 mcg/l (range, 0.01-2.1 mcg/l), (p = 0.09). There were 13 children with astrocytomas and 14 with non-astrocytomas. The S-100beta levels for the astrocytoma group was 0.25 mcg/l (range, 0.05-1.1 mcg/l) and for the non-astrocytoma group 0.17 mcg/l (range, 0.01-2.1 mcg/l), (p = 0.47). CONCLUSIONS: Serum S-100beta levels are not elevated in children with brain neoplasms compared to healthy children, nor are they elevated in children with astrocytomas compared to non-astrocytomas. The S-100beta protein does not appear to be useful as a serum tumor marker in children with brain neoplasms.
The human brain cathepsin H is shown to be a specific cysteine aminopeptidase with the optimum activity at pH 6.0. Human brain tumours of neuroectodermal (astrocytomas and glioblastomas) and epithelial (meningiomas) origin were used to study the cathepsin H activity in the malignant brain tissue. A significant increase in the aminopeptidase cathepsin H activity was found in malignant human brain tumours as compared to benign tumours and normal brain tissues.
Data collected over the past 8 years on the radiological appearance of common pediatric primary brain neoplasms are presented. An emphasis is placed on the newer radiological imaging modality of magnetic resonance imaging (MRI). Part I of this article emphasized the clinical evaluation of these brain neoplasms. Three hundred eighty-five children with known brain neoplasms ranging in age from newborn to 18 years were evaluated with one or all of the following radiological modalities: MRI, computed tomography (CT), water-soluble myelography (WSM), WSM with CT, and angiography. Contrast-enhanced MRI and CT scans both were accurate in delineating these brain neoplasms although MRI provided better resolution and delineation than CT. Angiography provided information on the vascularity of the neoplasms and their relationship to prominent arterial and venous structures. Water-soluble myelography with CT and gadolinium-enhanced MRI of the spine were equally accurate in demonstrating metastatic spread to the spinal canal and spinal cord. Magnetic resonance imaging with gadolinium was more accurate than CT with contrast in demonstrating recurrent or residual neoplasm at the operative site and metastatic spread to the brain. Magnetic resonance imaging with gadolinium is the best radiological modality to fully evaluate pediatric brain neoplasms.
Giant intracranial aneurysms (GIA) may simulate brain neoplasms on computed tomography (CT) scans. We present three cases in which a GIA was mistakenly diagnosed as a brain neoplasm on the basis of CT findings. The correct diagnosis was made in each case by cerebral angiography. The possibility of GIA must be considered when a nonenhanced CT study shows a well circumscribed mass without edema at the base of the brain and contrast infusion reveals homogeneous or inhomogeneous enhancement.
Diagnostics of brain tumours still remains a serious problem in neurologist's career. Difficulties in proper diagnosing refer mainly to endocranial tumours with atypical clinical course. Frequency of brain tumours' vascular manifestation is assessed as 1-4%, and in most cases it is the kind of manifestation which corresponds with intracerebral bleedings and more seldom with ischaemic strokes. Reports on brain tumours with developments similar to transient brain ischaemia (1, 2, 3, 4) are published occasionally. In Neurology Clinic of the Medical Academy in Lublin, we conducted observation of two patients with brain tumours (one metastatic and the other one-primary), where the former as well as the latter case were treated as cerebral circulation failures at their initial stage. Application of typical vasoactive treatment brought about temporary regression of symptoms.
The aim of the study was to evaluate the concentration of glutathione (GSH), ascorbic acid (Vit C), and thiobarbiturate acid reacting components (MDA) in brain neoplasms in specimens from normal brain tissue. The group of 72 individuals treated surgically for brain neoplasm in Department of Neurosurgery Medical Academy of Białystok (Poland) in the period from 1996 to 1999 was included into the study. The GSH concentration was estimated with GSH-400 method, ascorbic acid by the use of Kyaw method, and MDA by Salaris and Babs method. The statistical analysis revealed diminished concentration of GSH and Vit. C (p < 0.001), and analogous increase of MDA concentration (p < 0.001) in the investigated specimens compared to the mentioned above substances concentration in the specimens obtained from normal brain tissue.
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Results of the clinical experience gained since 1986 in the treatment planning of patients with brain neoplasms through integration of magnetic resonance imaging (MRI) into computerized tomography (CT)-based, three-dimensional treatment planning are presented. Data from MRI can now be fully registered with CT data using appropriate three-dimensional coordinate transformations allowing: (a) display of MRI defined structures on CT images; (b) treatment planning of composite CT-MRI volumes; (c) dose display on either CT or MRI images. Treatment planning with non-coplanar beam arrangements is also facilitated by MRI because of direct acquisition of information in multiple, orthogonal planes. The advantages of this integration of information are especially evident in certain situations, for example, low grade astrocytomas with indistinct CT margins, tumors with margins obscured by bone artifact on CT scan. Target definitions have repeatedly been altered based on MRI detected abnormalities not visualized on CT scans. Regions of gadolinium enhancement on MRI T1-weighted scans can be compared to the contrast-enhancing CT tumor volumes, while abnormalities detected on MRI T2-weighted scans are the counterpart of CT-defined edema. Generally, MRI markedly increased the apparent macroscopic tumor volume from that seen on contrast-CT alone. However, CT tumor information was also necessary as it defined abnormalities not always perceptible with MRI (on average, 19% of composite CT-MRI volume seen on CT only). In all, the integration of MRI data with CT information has been found to be practical, and often necessary, for the three-dimensional treatment of brain neoplasms.
BACKGROUND AND OBJECTIVES: Brain tumours responsible for longstanding partial epilepsy are characterised by a high prevalence of dysembryoplastic neuroepithelial tumour (DNT), whose natural evolution is much more benign than that of gliomas. The preoperative diagnosis of DNT, which is not yet feasible on the basis of available clinical and imaging data, would help optimise the therapeutic strategy for this type of tumour. This study tested whether [(11)C]-methionine positron emission tomography (MET-PET) could help to distinguish DNTs from other epileptogenic brain tumours. METHODS: Prospective study of 27 patients with partial epilepsy of at least six months duration related to a non-rapidly progressing brain tumour on magnetic resonance imaging (MRI). A structured visual analysis, which distinguished between normal, moderately abnormal, or markedly abnormal tumour methionine uptake, as well as various regions of interest and semiquantitative measurements were conducted. RESULTS: Pathological results showed 11 DNTs (41%), 5 gangliogliomas (18%), and 11 gliomas (41%). MET-PET visual findings significantly differed between the various tumour types (p<0.0002), regardless of gadolinium enhancement on MRI, and were confirmed by semiquantitative analysis (p<0.001 for all calculated ratios). All gliomas and gangliogliomas were associated with moderately or markedly increased tumour methionine uptake, whereas 7/11 DNTs had a normal methionine uptake, including all six located in the mesiotemporal structures. No DNT presented with a marked MET-PET abnormality. CONCLUSION: Normal MET-PET findings in patient with an epileptogenic and non-rapidly progressing brain tumour are suggestive of DNT, whereas a markedly increased tumour methionine uptake makes this diagnosis unlikely.
Currently, the literature lacks a solid body of research on decision and cost-effectiveness analysis of imaging strategies for adults and children suspected of having a brain neoplasm. This article describes the epidemiology and clinical presentation of brain neoplasms, reviews current diagnostic strategies, highlights gaps in the literature on decision and cost-effectiveness analysis, and suggests directions for future research.
The purpose of this article is to discuss the current imaging approaches and new techniques that have been developed in the examination and management of the patient with a brain neoplasm. These approaches and techniques include 1) functional imaging, perfusion, diffusion, localization of task activation, and dynamic circulatory changes; 2) three-dimensional imaging and techniques for tissue segmentation, surgical planning, and treatment planning; 3) positron emission tomography and single photon emission computed tomography, brain tumor diagnosis, and separation of brain tumor from radiation necrosis; 4) in vivo magnetic resonance spectroscopy, brain tumor differentiation and grading, and evaluation of the effects of therapy; and 5) future directions in the evaluation of brain neoplasms.
Ten dogs with primary (n = 8) and metastatic (n = 2) brain tumours were studied in an attempt to evaluate the diagnostic sensitivity of computed tomography (CT) or magnetic resonance imaging (MRI). Of the clinical signs noticed, seizures (seven of 10), behavioural abnormalities and cognition dysfunction (seven of 10), compulsive walking and circling (six of 10), sensorimotor (five of 10) and neuro-opthalmological (two of 10) dysfunction were the most common. In all 10 animals that finally died of the disease or were killed, the histopathological diagnosis that followed necropsy was taken as a golden standard in the CT or MRI prediction of the histological type of brain neoplasms. In every instance, tumour detection, morphology and histological differentiation were possible with the aid of either CT (seven of 10) or MRI (three of 10) imaging especially after contrast enhancement. Only one CT-evaluated dog, diagnosed as meningioma, was found to be astrocytoma on histopathology. Interestingly, a rare case of cerebellar medulloblastoma was correctly identified in MRI scans.