Benjamin Kaufman

Metastatic lesions in the sella turcica and pituitary gland

The sella turcica with adjacent osseous tissues was examined histologically in 60 cases of carcinoma which came to postmortem examination in the course of one year. Forty‐nine of the specimens were also examined by roentgenography. Sixteen contained metastatic lesions, 9 of which originated from the breast. Statistical analysis showed that the incidence of sellar metastases was significantly higher for carcinoma of the breast than for all other neoplasms. Involvement of the sella was positively correlated with other skeletal metastases. X‐ray examination was found to be a relatively insensitive method for detecting metastatic lesions in the sella.

MR imaging of pediatric cerebral abnormalities

Surgicalne hundred sixteen magnetic resonance (MR) imaging studies from 105 pediatric patients with a variety of cerebral abnormalities were reviewed to determine the diagnostic efficacy of MR in the pediatric population. All subjects tolerated the MR procedure well, although sedation was necessary for younger children. Compared with CT, MR proved to be advantageous in detection and characterization of the pathology in 23 of 105 patients, especially when the abnormality was located along the base of the brain and midline, or when it involved primarily the white matter. Intracranial calcification was the one abnormality not detected with MR although dense calcifications could be seen as areas of low signal intensity. Some characteristics of various pathological entities were compared in an attempt to differentiate among abnormalities in the same anatomical location: craniopharyngioma from optic chiasm and hypothalamic glioma, cystic glioma from arachnoid cyst, and chronic subdural hematoma from subdural hygroma. The lack of ionizing radiation in MR is of particular interest in pediatric neuroradiology since radiation is of special concern in the young age group.

Ophthalmoplegia, Ataxia and Hyporeflexia (Fisher’s Syndrome)

This report concerns a patient with ophthalmoplegia, ataxia and hyporeflexia (Fisher’s syndrome) with a lesion in the midbrain tegmentum demonstrated by computerized-tomography (CT) scanning. Spontane

Diagnosis of sacral perineural cysts by nuclear magnetic resonance

A case of sacral perineural ( Tarlov ) cyst is presented. The diagnostic advantages of nuclear magnetic resonance imaging in this uncommon entity are illustrated and explained.

The use of systematic desensitization to overcome resistance to magnetic resonance imaging (MRI) scanning

The use of behavioral techniques with radiologic procedures has received surprisingly little attention in the behavioral literature. The current paper describes the successful use of systematic desensitization to enable a woman to complete a magnetic resonance imaging (MRI) scan. Suggestions for when behavior therapy may be useful to radiologists are also given.

Large Pituitary Gland Adenomas Evaluated with Magnetic Resonance Imaging

Magnetic resonance imaging (MRI), computed tomographic (CT) scanning, and angiography or digital subtraction angiography (DSA) were used preoperatively to evaluate 16 surgically proven cases of sellar tumor with extrasellar extension. There were 15 pituitary tumors and 1 schwannoma. The capabilities of MRI in evaluating these tumors were compared with CT scanning and angiography. Bone destruction and tumor calcification were better detected by CT scanning than by MRI. MRI was as effective as CT scanning in detecting a cyst or variation in tumor consistency. Neither MRI nor CT scanning was capable of distinguishing specific tumor types. In every case, MRI was superior to CT scanning for delineating spatial relationships of the tumor to the 3rd ventricle, the optic apparatus, adjacent brain, and parasellar vasculature. Vessel encasement by tumor was clearly seen on MRI when there was no direct indication of this on other studies. Cavernous sinus invasion was not demonstrated by CT scanning, but was indicated by MRI in 5 cases and was surgically confirmed in 3. MRI can provide more precise spatial information on extrasellar tumor extension. Vascular encasement and cavernous sinus invasion may be determined preoperatively. Treatment expectations and operative approaches can be guided by this information. When MRI is available, it is the test of choice for the preoperative evaluation of patients with suspected large pituitary gland (sellar region) tumors. Contrast-enhanced CT scanning and angiography can be used as supplementary studies to add information inherently unique to these techniques.

MR imaging of the skull base

Fifty-four patients with abnormalities primarily involving the base of the skull were evaluated by magnetic resonance (MR) imaging. The results were compared with information obtained by other radiologic studies, primarily X-ray CT. On MR imaging, better anatomic definition of soft tissues in the deep compartments of the nasopharynx was achieved through the high level of tissue contrast discrimination and lack of bone artifacts. The parapharyngeal fat plane, separating pterygoid from pharyngeal musculatures, was consistently demonstrated. However, the inability of MR to image compact bone proved to be a major drawback where bony detail was required. In general, MR imaging demonstrated 100% sensitivity to abnormalities involving the posterior compartment (clivus and craniovertebral junction) and was least valuable in the evaluation of the anterior compartment (orbits, cribiform plate, and sinuses).

Increased prefrontal sulcal prominence in relatively young patients with unipolar major depression

Although several studies have reported ventricular enlargement and sulcal prominence in mixed samples of patients with affective disorders (unipolar and bipolar subtypes), it is not established if these findings extend to a homogeneous sample of relatively young patients with unipolar major depression ventricular:brain ratio (VBR) and prefrontal sulcal prominence (PSP). In the present study, measures of ventricle-brain ratio (VBR) and prefrontal sulcal prominence (PSP) were compared in patients with affective disorders (n = 24, mean age = 39), medical control subjects (n = 40), patients with schizophrenia (n = 101) on ventricular : brain ratio (VBR) and prefrontal sulcal prominence (PSP). No statistically significant differences were noted in VBR in the three groups. Both patient groups had significantly greater PSP than the medical control subjects but did not differ significantly from each other. The results of the present study extend the finding of prefrontal sulcal prominence, but not ventricular enlargement, to relatively young patients with unipolar depression. Furthermore, the results of the present study suggest that patients with schizophrenia and patients with affective disorders differ only slightly or not at all in brain morphology, at the level of resolution studied.

Mr imaging of brain stem gliomas

Magnetic resonance (MR) and CT examinations of 26 patients with the established or clinically suspected diagnosis of brain stem glioma were reviewed. Eleven tumors were seen on both MR and CT. The entire extent of the abnormality was better outlined on MR, although CT was more advantageous in demonstrating cystic components and calcium deposition. Magnetic resonance and CT depicted focal intratumoral hemorrhage equally. Magnetic resonance was found to be particularly suitable to follow up the progression or regression of the disease. Of particular interest were two patients with evidence of aqueductal obstruction but normal CT appearance of the midbrain; the causative abnormality, believed to be a glioma, was clearly shown by MR imaging. In nine patients the normal appearance was helpful to exclude the possibility of a brain stem glioma. Thus far, results have shown 100% sensitivity (true positive ratio) and specificity (true negative ratio) with MR in the evaluation of brain stem gliomas. It is concluded that MR imaging should be the examination of choice and could be the definitive screening procedure in patients with suspected brain stem glioma.

RECOVERY OF PITUITARY FUNCTION FOLLOWING SURGICAL REMOVAL OF LARGE NONFUNCTIONING PITUITARY ADENOMAS

Pituitary function was evaluated in eleven patients with large nonfunctioning pituitary adenomas before and 3 months after surgical adenomectomy. The longest anteroposterior dimension from the anterior wall to the dorsum of the sella on a lateral skull x‐ray ranged between 22 and 45 mm. All adenomas were confirmed histologically and had negative immunostaining for GH, PRL, ACTH and HCG.