William T. Djang

Quantitative cerebral anatomy of the aging human brain A cross‐sectional study using magnetic resonance imaging

Seventy-six healthy adults underwent magnetic resonance imaging (1.5 T) to investigate the effects of age on regional cerebral volumes and on the frequency and severity of cortical atrophy, lateral ventricular enlargement, and subcortical hyperintensity. Increasing age was associated with (1) decreasing volumes of the cerebral hemispheres (0.23% per year), the frontal lobes (0.55% per year), the temporal lobes (0.28% per year), and the amygdalahippocampal complex (0.30% per year); (2) increasing volumes of the third ventricle (2.8% per year) and the lateral ventricles (3.2% per year); and (3) increasing odds of cortical atrophy (8.9% per year), lateral ventricular enlargement (7.7% per year), and subcortical hyperintensity in the deep white matter (6.3% per year) and the pons (8.1% per year). Many elderly subjects did not exhibit cortical atrophy or lateral ventricular enlargement, however, indicating that such changes are not inevitable consequences of advancing age. These data should provide a useful clinical context within which to interpret changes in regional brain size associated with “abnormal” aging.

Treatment of trilateral retinoblastoma with vincristine and cyclophosphamide

Current therapy for patients with trilateral retinoblastoma, consisting primarily of surgical intervention and radiotherapy, has resulted in no long-term survivors. The use of adjuvant chemotherapy has not improved this outcome. After observing a tumor response to cyclophosphamide in a patient with suprasellar retinoblastoma, we treated a subsequent patient with trilateral retinoblastoma with both vincristine and cyclophosphamide. Objective tumor regression resulted. Although the tumor ultimately progressed in both patients, these findings suggest that vincristine and cyclophosphamide are active in patients with intracranial (trilateral) retinoblastoma.

Criteria for termination of phase II chemotherapy for patients with progressive or recurrent brain tumor

We report six patients with progressive primary tumors of the brain who had prolonged periods with stable contrast-enhancing CT lesions following initial responses to chemotherapy. Chemotherapy was discontinued after 21 to 36 months, despite the persistence of apparent disease in each patient. PET using (F-18) fluorodeoxyglucose was performed in three patients, revealing hypometabolic lesions. All six patients are alive and well, with no clinical or radiographic evidence of progressive disease at 24 to 57+ months following termination of treatment. The usual criteria for terminating phase II chemotherapy in patients with a recurrent brain tumor are evidence of progressive disease or unacceptable toxicity. However, chemotherapeutic success mandates that these criteria be expanded to include patients whose response following the initiation of phase II treatment is followed by prolonged (greater than 1 year) radiographic and clinical stability. Complete response, ie, disappearance of all evidence of disease, is unusual in patients with recurrent primary brain tumors, even with highly effective therapy. Continued improvement in the therapy of patients with these tumors will allow wider application of these criteria.

Transient late magnetic resonance imaging changes suggesting progression of brain stem glioma: implications for entry criteria for phase II trials.

An 8-year-old boy was treated with irradiation (66 Gy) for a brain stem glioma. Five months after the completion of radiotherapy, magnetic resonance imaging demonstrated apparent tumor progression despite the patients neurological improvement. The child continued to improve, with subsequent radiographic evidence of tumor regression, without additional therapeutic intervention. The evaluations of response and recurrence of brain tumors as well as entry criteria for Phase II studies are discussed.

Radiology of Acute Spinal Trauma

Radiologic diagnostic modalities utilized to evaluate acute spine trauma include plain films, tomography, computerized tomography (CT), myelography and CT-myelography, and magnetic resonance imaging. The initial evaluation is aimed at delineating the nature and extent of both boney and soft tissue injuries, with particular attention directed toward differentiating intrinsic cord damage from extrinsic spinal cord or nerve root compression that may respond to surgical intervention. The selection of the optimal radiologic diagnostic algorithm requires familiarization with the techniques and limitations of each diagnostic procedure.