Solomon Batnitzky

Three-dimensional computer reconstructions of brain lesions from surface contours provided by computed tomography: a prospectus

We present a prospectus on the use of computer graphics for the three-dimensional reconstruction and visualization of brain lesions from computed tomographic head examinations, including an algorithm that utilizes surface contour information to reconstruct and display three-dimensional anatomical sites. We provide examples of the use of this algorithm. We offer an algorithm for estimation of the volume and surface area of anatomical sites. The advantages and disadvantages for the clinical use of these algorithms are discussed.

Cystic lesions associated with intracranial meningiomas.

Three unusual cases of large, peritumoral cystic lesions associated with intracranial meningiomas are reported. In each case, the cyst caused difficulty in the interpretation of the computed tomogram when the latter was considered as a diagnostic test by itself, but the composite information obtained from the clinical history, cerebral angiography, and a radionuclide brain scan led to the correct preoperative diagnosis. The cyst was extrinsic to the tumor and contained xanthochromic fluid with a high protein content. The cyst wall consisted of brain parenchyma that showed glial cell proliferation (confirmed by the presence of glial fibrillary acidic protein by immunoperoxidase staining).

Computerized tomography scan findings in children with acute lymphocytic leukemia treated with three different methods of central nervous system prophylaxis.

Computerized tomography (CT) scans of the head were done on 93 children with acute lymphocytic leukemia in continuous complete remission who had been randomly assigned to three different methods of central nervous system (CNS) prophylaxis. Twenty‐nine children had received six doses of intrathecal methotrexate, 30 had received six doses of intrathecal methotrexate plus 2400 rad of cranial irradiation, and 34 had received six doses of intrathecal methotrexate plus three courses of intermediate‐dose intravenous methotrexate. The overall incidence of abnormal scans was 35%, of which 91% were felt to represent minimal abnormalities. CT scan abnormalities were noted in 30% of the children receiving intrathecal methotrexate only, in 40% of those receiving intrathecal methotrexate plus cranial irradiation, and in 35% of those receiving intrathecal methotrexate plus intermediate dose methotrexate. These differences were not statistically significant. None of the three methods of CNS prophylaxis resulted in significant CT scan abnormalities. However, the few moderately or markedly abnormal scans evaluated were restricted to patients who received intrathecal methotrexate plus cranial irradiation. The clinical significance of CT scan abnormalities in leukemic children receiving these treatments remains unclear.

Computed tomography of sacral and presacral lesions.

SummaryForty-two patients with various sacral and presacral lesions were examined by computed tomography (CT). CT was sensitive in detecting intraosseous neoplasms and presacral soft tissue masses and in seven cases identified lesions not visible on plain films. The total extent of each lesion was readily determined using CT. However, CT is diagnostically nonspecific and differentiation between primary and secondary tumors of the sacrum is generally not possible from the CT appearance alone. CT is also of considerable use in the evaluation of several non-neoplastic conditions of the sacrum, including spinal dysraphism, anterior and internal meningocele and trauma.

Magnetic resonance imaging in the evaluation of intracranial tumors of childhood

Magnetic resonance imaging (MRI) is a noninvasive imaging technique that demonstrates intracranial anatomy without the use of ionizing irradiation and intravenous contrast agents. Image quality is dependent on various factors, including field strength, scanning sequence, and imaging time. Although there is currently no concensus as to how to visualize intracranial lesions optimally, MRI has already been shown to be sensitive in the detection of brain tumors. It can detect many different types of tumors; however, its specificity is unclear. Intracranial tumor extent is extremely well‐demonstrated by MRI. The advantages and disadvantages of MRI compared with computerized tomography are reviewed. Cancer 56: 1767‐1772, 1985.

Abdominal pseudocysts as a complication of ventriculoperitoneal shunt. A report of two cases.

SummaryThe preoperative diagnosis of abdominal cerebrospinal fluid pseudocyst, in association with ventriculoperitoneal shunts, was made in two patients. Computed tomography and/or ultrasound are radiologicol procedures of choice to demonstrate and localize these cysts.

Aneurysm of the left middle cerebral artery caused by myxoid degeneration of the vessel wall.

Myxoid degeneration of arterial walls may result in dissection and dissecting aneurysms in extracranial and intracranial portions of cerebral arteries. Rarely, saccular aneurysms may also develop on that basis, but thus far these have only been reported in the cervical portions of the carotid arteries. We describe a case of a nondissecting aneurysm of the left middle cerebral artery caused by myxoid degeneration of the media. Case Description A 39-year-old man had acute onset of frontal headache and neck stiffness. Computed tomographic scan and lumbar puncture established the presence of subarachnoid hemorrhage. Angiography demonstrated a left middle cerebral artery aneurysm. This was clipped and the wall biopsied. Microscopically the entire thickness of the vascular wall showed marked myxoid alterations. No dissection was present. The patient had an uneventful recovery. Conclusions This observation confirms that myxoid degeneration of arterial walls may cause aneurysms with eventual rupture even in the absence of dissection. Rare cases of this type of aneurysm have been reported to occur in the cervical portions of the carotid arteries, but this is the first reported observation of such changes involving an intracerebral artery.

A prototype digital image management system

A prototype digital image management system has been designed, implemented and is being evaluated by our department. The system satisfies two major requirements: (a) an on-line access, rapid response microcomputer network providing 9 day archiving of digital data; (b) a long-term, low demand archiving system. This paper provides an estimate of the cost of the system, the potential cost-savings, and identifies the digital data throughput using the Ethernet communications protocol.

Radiologic guidelines in assessing children with intracranial tumors

Computed tomography (CT) is currently the primary and generally the definitive imaging modality for the diagnosis, evaluation, and management of intracranial neoplasms in children. The value of CT in the postoperative period is discussed. The role of CT and myelography is stressed in the evaluation of cerebrospinal fluid seeding. CT is also important in demonstrating the iatrogenic disturbances of the central nervous system as a result of radiation and chemotherapy. The authors recommend that CT scans with and without contrast be obtained 2 weeks after surgery and before starting any form of adjuvant treatment. CT slices should be contiguous and 5‐mm thick. Subsequent scans should be obtained every 3 to 4 months for the first year and every 6 months thereafter. Where necessary, CT scans after the introduction of intrathecal metrizamide may be necessary to evaluate the lower portion of the posterior fossa and brain stem. Cancer 56: 1756‐1762, 1985.

The Diagnostic Radiological Utilization Of 3-D Display Images

In the practice of radiology, computer graphics systems have become an integral part of the use of computed tomography (CT), nuclear medicine (NM), magnetic resonance imaging (MRI), digital subtraction angiography (DSA) and ultrasound. Gray scale computerized display systems are used to display, manipulate, and record scans in all of these modalities. As the use of these imaging systems has spread, various applications involving digital image manipulation have also been widely accepted in the radiological community. We discuss one of the more esoteric of such applications, namely, the reconstruction of 3-D structures from plane section data, such as CT scans. Our technique is based on the acquisition of contour data from successive sections, the definition of the implicit surface defined by such contours, and the application of the appropriate computer graphics hardware and software to present reasonably pleasing pictures.