Gerhard Schroth

Computed Tomography and Magnetic Resonance Tomography of Intracranial Tumors

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The Rett syndrome: Magnetic resonance imaging and clinical findings in four girls

The clinical and laboratory findings in 4 girls with the Rett syndrome are presented. The MRI results at different disease stages with detailed descriptions of the techniques applied-including quantification of T1 and T2 relaxation times in the brain-are reported. There were no pathological signal intensities in T1- or T2-weighted images. Thus, MRI does not provide any significant additional help in the diagnosis of the Rett syndrome. However, it does indicate that disturbances of myelinization or the brain water content are not probable etiologies in this syndrome.

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.

CT and MR Imaging of Orbital Lesions

In the past, the diagnosis of orbital lesions manifested clinically by unilateral or bilateral proptosis and/or impaired ocular motility has relied on conventional skull films and orbital radiographs, sonography, fluorescein angiography, internal and external carotid angiography, and ophthalmic venography. The introduction of CT, however, has greatly reduced the importance of invasive diagnostic procedures (Wende et al. 1977).

Classification of Brain Tumors

In 1914, L. Bruns stated in Krause’s General Surgery of Brain Disorders that brain tumors include all neoplasias growing within the cranium and that they comprise three groups: (1) true tumors, (2) infectious granulomas, and (3) parasites. Current usage is more precise and is limited to the first of Bruns’ categories. Even so, brain tumors constitute a large and very heterogeneous group. A taxonomic approach to classification is necessary if we are to make sense of an initially disorganized set of observations, compare the findings of different observers, and attempt a prognostic evaluation.

Computertomographie und Kernspintomographie bei nicht tumorbedingten raumfordernden intrakraniellen Prozessen

Zahlreiche, nicht tumorbedingte raumfordernde Prozesse fuhren zu tumorahnlichen oder -identischen Darstellungen in der computertomographischen und kernspintomographischen Bildgebung. Die artspezifische Diagnose ist in vielen Fallen allein aus der Bildinterpretation nicht zu stellen. Selbst wenn die Anamnese und klinischen Befunde zur Urteilsfindung herangezogen werden, konnen Fehlinterpretationen unterlaufen. Gerade im Hinblick auf eine zielsichere Indikationsstellung fur einen neurochirurgischen Eingriff und die Wahl des chirurgischen Vorgehens ist aber eine moglichst exakte praoperative Artdiagnose erforderlich. Im Einzelfall mus also das gesamte Repertoire der Neuroradiologie ausgeschopft werden, um im Zusammenhang mit dem klinischen Krankheitsbild den pathologischen Befund richtig einordnen und die entsprechenden therapeutischen Konsequenzen ziehen zu konnen.