Ekkehard Kazner

Computer assisted tomography in primary malignant lymphomas of the brain.

Computer assisted tomography (CAT) data from 10 patients with histologically verified primary malignant lymphomas of the brain are reported. Studies both prior to and after contrast medium administration were done on nine patients. In all these patients, tumor nodules presented with slightly increased density in the precontrast scan and considerable contrast enhancement. The appearance of malignant lymphomas in the CAT scan may be similar to that of meningiomas. Pituitary adenoma, medulloblastoma, and metastasis of malignant melanoma may not be ruled out in a particular case from the CAT picture alone. Blurred margin of the tumor after contrast enhancement was found in half the patients. Diffusely growing malignant lymphomas produce low density areas in the CAT scan without contrast medium uptake.

Computed Tomography in Head Injuries

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Sensitivity of Computed Tomography and Serial Scintigraphy in Cerebrovascular Disease

Computed tomography and serial scintigraphy with 99mTc-pertechnetate (radionuclide angiography and early and late static imaging) were compared in 214 patients with cerebrovascular disease. CT correctly identified 151 (95.0%) of 159 patients with completed ischemic stroke but was positive in only 11 (25%) of 44 patients with asymptomatic stenosis, transient ischemic attacks (TIA), or prolonged reversible ischemic neurological deficit (PRIND). Scintigraphy was positive in 93.1% of patients with completed stroke. CT detected 175 territories of vascular supply involved, scintigraphy 164. In patients with asymptomatic stenosis, TIA, or PRIND, scintigraphy was correct in 77.3% of cases. The combined evaluation offered a sensitivity of 97.5% in patients with completed stroke and 86.4% in those with asymptomatic stenosis, TIA, or PRIND. The rate of true-positive scintigraphic findings in patients with completed stroke did not change as the interval between ictus and study increased. In patients with intracerebral hematoma, CT was far more specific than scintigraphy. If cerebrovascular disease is suspected, radionuclide angiography should be performed first.

Computed Tomography and Magnetic Resonance Tomography of Intracranial Tumors

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Classification of Intracranial Tumors

L. Bruns (1914) stated in Krause’s “General Neurosurgery” that brain tumors included all neoplasms growing within the cranial cavity and that these might be divided into three groups: (1) genuine tumors, (2) granulomatous lesions, and (3) parasites. Current use of the term “brain tumor” is more precise and limited to the first of L. Bruns’ categories. Even so, brain tumors represent a large and inhomoge-neous group. The comparison and evaluation of such a diverse set of observations is only possible after making a systematic classification of pertinent data.

Impact of CT and MR on the Diagnostic Evaluation of Neurologic and Neurosurgical Diseases

Today CT and MR are considered to be the most important and most reliable methods for the diagnosis of brain tumors. The sensitivity of these modalities in the detection of intracranial tumors approaches 100%. The extraordinary value of both methods is based not only on this high detection rate but also on their ability to localize tumors in relation to vital centers, assess their mass effect, and establish the tissue type of the lesion (= specificity).

Technique of CT and MR Examinations

The three original groups participating in our study used the EMI Mark I scanner from 1975 to the middle of 1977 and the EMI CT 1010 scanner after mid-1977. The Siemens Somatom DR has been used in Augsburg and Berlin since 1983, and the Philips Tomoscan CT 350 in Mainz since mid-1986.

CT and MR Imaging of Lesions of Skull Base and Cranial Vault

The importance of CT in examinations of the skull base, including its role in the planning of operative or radiation therapy, has long been recognized (Liliequist and Forsell 1976; Bradac et al. 1977 a, b; 1978 a, b; Hammerschlag et al. 1977; Caille et al. 1977; Lohkamp et al. 1977; Huk and Schiefer 1978; Becker et al. 1978; Weinstein et al. 1978). In the present chapter we shall review the capabilities and limitations of this modality in the diagnosis of diseases involving the bony skull base and cranial vault. A more detailed discussion of specific tumor types may be found under the appropriate headings elsewhere in the book.

CT and MR Imaging of Brain Tumors

Our clinical population numbered 8516 patients with primary and metastatic brain tumors who underwent evaluation by computed tomography at the neurosurgical and neuroradiologic departments of the Berlin, Mainz, and Munich centers from 1975 to 1986 and at the Neurosurgical Department of Augsburg Central Hospital from 1983 to 1986. Table 5 lists all the tumors having an incidence greater than 1% in the total population; 98% of the lesions were confirmed histologically (open surgery, stereotactic biopsy, autopsy). “Rare” intracranial tumors having an incidence no greater than 1% are listed in Table 6. The frequencies of the individual tumor types correlate well with the statistical data reported by Cushing (1932), Olivecrona (1967), and Zulch (1986) for large clinical series.

CT and MR Imaging of Non-neoplastic Intracranial Masses

Many intracranial mass lesions of non-neoplastic origin present CT and MR features similar or identical to those of true neoplasms. In many cases a definitive diagnosis cannot be made from imaging findings alone, and misinterpretation is possible even when the history and clinical findings are considered. Yet an accurate preoperative diagnosis is an essential prerequisite for selecting candidates for a neurosurgical operation and planning the procedure. In some cases the full range of neuroradiologic techniques may have to be applied and evaluated in the context of clinical findings before the physician can accurately classify the disease and draw appropriate therapeutic conclusions.