J. Funes

Restricted diffusion in a ring-enhancing mucoid metastasis with histological confirmation: case report.

We present a case of restricted diffusion in a ring-enhancing cerebellar metastasis in a 58-year-old man. Diffusion imaging showed restriction with low apparent diffusion coefficient values within the cavity. Diagnosis of abscess was suggested based on radiological findings. A suspicious lung nodule was found in the systemic evaluation, and histological examination of the brain lesion confirmed metastatic adenocarcinoma with mucoid content confirmed by further specific pathological tests. We discuss the reason of diffusion findings and the importance of the correct interpretation of this technique in a clinical situation. Our case confirms previous hypothesis about restricted diffusion related to mucoid content in metastasis.

Structural sex differences at disease onset in multiple sclerosis patients.

Background Male sex is associated with worsening disability and a more rapid progression of multiple sclerosis (MS). This study analysed structural sex differences in magnetic resonance images of the brain, comparing women whose disease started before and after the menopause with a control group of men. Methods This was a case control study in which female patients whose MS started before (Group 1) and after (Group 2) the menopause were included. The control group was matched by age, disease duration, Expanded Disability Status Scale and disease-modifying treatment. Patients were analysed according to demographic and clinical variables, as well as in terms of radiological measurements at disease onset and during the first 12 months of follow-up. These measurements included normalised total brain volume (NTBV), normalised cortical volume (NCV), normalised white matter volume, left and right hippocampus, the thalamus, brain stem volume, lesion load and percentage brain volume change. A linear regression model was used to analyse the data. Results A total of 97 patients were included: 53 in Group 1 (27 females) and 44 in Group 2 (22 females). In Group 1, we observed a reduction in brain volume in males compared with females at disease onset in NTBV (p = 0.01), NCV (p = 0.001) and brain stem volume (p = 0.01). We did not observe differences in Group 2 at disease onset in the brain volumes analysed. Conclusion We observed structural sex differences in brain volume at disease onset in the pre-menopausal group. However, no structural differences were observed at disease onset between the sexes after the menopause had started.

Diferencias en la tasa de atrofia global y regional y del volumen lesional entre género en esclerosis múltiple

INTRODUCTION Previous studies showed gender-associated clinical and MRI differences in multiple sclerosis (MS) evolution. However, only few studies were done with non conventional MRI techniques and no one was done in a South American MS population. The aim of this study was to investigate gender differences according to nonconventional MRI measures in patients with MS from Buenos Aires, Argentina. METHODS Relapsing-remitting MS patients (RRMS) with at least 6 years of follow up and an MRI at onset and at 6 years were included. Patients were assessed using nonconventional MRI measures: total brain volume (TBV), neocortical grey brain volume (GBV), white brain volume (WBV), lesion load (LL), % of brain volume change between onset and year 6 (% BVC) and regional brain volume change. Gender-related MRI differences were investigated using general linear model analysis. RESULTS The 45 patients were included (25 female). Mean follow up time was 7.3 ± 0.2 years. No differences in age, EDSS at onset, DMD treatment, TBV, GBV, WBV neither LL were found between gender at baseline. Six years later, males showed a decrease in TBV (P=.002) and GBV (P ≤ 0.001) and an increase in LL (P=.02) and % BVC (P<.001) vs. females. Female patients showed a decrease in the volume of frontal subcortical region. DISCUSSION This is the first study showing differences in brain volume changes between gender in MS patients from South America. Future studies will confirm our initial findings.

Thalamus volume change and cognitive impairment in early relapsing–remitting multiple sclerosis patients

Aims The objective of the study was to assess whether changes in the volume of the thalamus during the onset of multiple sclerosis predict cognitive impairment after accounting for the effects of brain volume loss. Methods A prospective study included patients with relapsing–remitting multiple sclerosis less than 3 years after disease onset (defined as the first demyelinating symptom), Expanded Disability Status Scale of 3 or less, no history of cognitive impairment and at least 2 years of follow-up. Patients were clinically followed up with annual brain magnetic resonance imaging and neuropsychological evaluations for 2 years. Measures of memory, information processing speed and executive function were evaluated at baseline and follow-up with a comprehensive neuropsychological test battery. After 2 years, the patients were classified into two groups, one with and the other without cognitive impairment. Brain dual-echo, high-resolution three-dimensional T1-weighted magnetic resonance imaging scans were acquired at baseline and every 12 months for 2 years. Between-group differences in thalamus volume, total and neocortical grey matter and white matter volumes were assessed using FIRST, SIENA, SIENAXr, FIRST software (logistic regression analysis P < 0.05 significant). Results Sixty-one patients, mean age 38.4 years, 35 (57%) women were included. At 2 years of follow-up, 17 (28%) had cognitive impairment. Cognitive impairment patients exhibited significantly slower information processing speed and attentional deficits compared with patients without cognitive impairment (P < 0.001 and P = 0.02, respectively). In the cognitive impairment group a significant reduction in the percentage of thalamus volume (P < 0.001) was observed compared with the group without cognitive impairment. Conclusion We observed a significant decrease in thalamus volume in multiple sclerosis-related cognitive impairment.

Clasificación y caracterización epidemiológica de las fracturas orbitarias diagnosticadas mediante tomografía computada

Purpose. To characterize the cases of orbital fractures diag-nosed by computed tomography (CT) during a time periodof one year at our Radiology Department.Ma...

Cervical chordoma with moderate bone impairment in a child. Answer to October e-quid

A 4-year-old boy, without personal antecedents, born at term after a normal pregnancy, presented progressive right hemiparesis over one month. He was referred for a brain and medulla MRI (Fig. 1), completed by a CT scan (Fig. 2). The diffusion sequence was negative. ଝ Here is the answer to the case previously published in the n o 10/2012. As a reminder we publish again the entire case with the response following.

NR-WS-38 Lymphomes cerebraux : Interet de la spectroscopie par resonance magnetique

Objectifs Montrer l’apport de la Spectroscopie par Resonance Magnetique (SRM) dans le prise en charge des lymphomes cerebraux. Mettre en relief l’importance de cette technique pour aider a etablir le diagnostic de cette pathologie, qui oblige le chirurgien a modifier la strategie chirurgicale et choisir la biopsie cerebrale. Materiels et methodes Nous presentons 6 cas evalues dans notre hopital avec SRM. Les patients presentaient des cephalees et d’autres symptomes cliniques non specifiques, en fonction de la topographie de la tumeur. L’IRM n’a pas ete concluante. L’une des tumeurs etait un lymphome systemique-non diagnostiquee jusque la-avec une localisation cerebrale, et les autres etaient des lymphomes cerebraux primitifs. Resultats Sur la SRM, les metabolites suivants ont ete constates : les pics de choline et de lipides etaient les plus importants. Le pic de lipides a ete identifie comme le metabolite dominant dans certains des cas, en particulier dans les sequences a TE court (30). Aucune difference de metabolites n’a ete constatee entre les formes primaires et la forme systemique de cette maladie. Conclusion Les lymphomes du systeme nerveux sont des tumeurs cerebraux avec un large eventail de manifestations radiologiques qui les rendent difficiles a caracteriser avec les seules donnees de l’IRM conventionnelle. La SRM peut devenir utile en demontrant la presence des pics de choline et de lipides. Ce dernier pic sur une tumeur autrement solide et profonde, renforce le diagnostic presomptif de lymphome et doit alerter le chirurgien a changer la strategie therapeutique.

Lymphomes cerebraux : interet de la spectroscopie par resonance magnetique

Objectifs Montrer l’apport de la Spectroscopie par Resonance Magnetique (SRM) dans la prise en charge des lymphomes cerebraux. Mettre en relief l’importance de cette technique pour aider a etablir le diagnostic de cette pathologie, qui oblige le chirurgien a modifier la strategie chirurgicale et choisir la biopsie cerebrale. Materiels et methodes Nous presentons 6 cas evalues dans notre hopital avec SRM. Les patients presentaient des cephalees et d’autres symptomes cliniques non specifiques, en fonction de la topographie de la tumeur. L’IRM n’a pas ete concluante. L’une des tumeurs etait un lymphome systemique-non diagnostiquee jusque la-avec une localisation cerebrale, et les autres etaient des lymphomes cerebraux primitifs. Resultats Sur la SRM, les metabolites suivants ont ete constates : les pics de choline et de lipides etaient les plus importants. Le pic de lipides a ete identifie comme le metabolite dominant dans certains des cas, en particulier dans les sequences a TE court (30). Aucune difference de metabolites n’a ete constatee entre les formes primaires et la forme systemique de cette maladie. Conclusion Les lymphomes du systeme nerveux sont des tumeurs cerebraux avec un large eventail de manifestations radiologiques qui les rendent difficiles a caracteriser avec les seules donnees de l’IRM conventionnelle. La SRM peut devenir utile en demontrant la presence des pics de choline et de lipides. Ce dernier pic, sur une tumeur autrement solide et profonde, renforce le diagnostic presume de lymphome et doit alerter le chirurgien a changer la strategie therapeutique.

NR14 Les lesions thalamiques bilaterales : notre experience

Objectifs Decrire les differentes etiologies qui peuvent atteindre les deux thalamus simultanement. Montrer des exemples de notre experience. Materiels et methodes On a revu retrospectivement des patients avec affection des thalamus de differentes etiologies, et on a evalue leur caracteristiques en imagerie. Ils ont eu un scanner et/ou une IRM. Resultats Plusieurs maladies peuvent atteindre les thalamus au meme temps. Les lesions ischemiques qui siegent chez les patients portant une variante vasculaire appelee « artere de Percheron » ; les thromboses veineuses profondes, les tumeurs comme les gliomes infiltrants et les lymphomes ; les maladies demyelinisantes, infectieuses et metaboliques. Conclusion L’affection bilaterale et simultanee des deux thalamus n’est pas une frequente, seulement dans certaines maladies.

Hypertension intracranienne benigne : apport de l’IRM

Objectifs Remarquer les donnees subtiles de l’imagerie par IRM dans le diagnostic de l’hypertension intracrânienne benigne ou pseudotumor cerebri. Materiels et methodes On a evalue des patients sans et avec diagnostic clinique de cette pathologie (criteres de Dandy) et on a cherche l’incidence des images caracteristiques deja decrites, mais peu connues par les radiologues generaux. Resultats On a trouve les signes radiologiques suivants : aplatissement de la sclerotique posterieure, distension de l’espace sousarachnoidien peri-optique, tortuosite verticale des nerfs optiques, selle turcique vide, ventricules petits ou normaux. Conclusion La pression intra-crânienne elevee produit une variete de signes en resonance magnetique qui peut aider a etablir le diagnostic de pseudotumor cerebri. Les donnees radiologiques sont peu connues et assez subtiles. Il faut les connaitre et les chercher pour les retrouver dans les examens d’IRM.