Witold Gajewicz

Magnetic Resonance Imaging of Rare Intracranial Neoplasms – Role of the In Vivo 1 H Spectroscopy in the Radiological Differential Diagnostics

BACKGROUND The object of this study was to evaluate the usefulness of magnetic resonance (MR) spectroscopy in differentiating rare intracranial tumours in adult patients. Review of the literature on results of MR spectroscopy in these lesions is also included. MATERIAL AND METHOD 89 patients with brain tumours were evaluated preoperatively with in vivo 1.5 T MR spectroscopy (according to eTumour study requirements). 8 of them were diagnosed as having very rare neoplasms: haemangiopericytoma (2), lymphoma (2), plexus papilloma (2), chondroma (1) and purkinjoma (1). Spectra of these tumours were compared to spectra of common brain tumours that could resemble these lesions. RESULTS MR spectroscopy enabled discrimination between meningiomas and haemangiopericytomas, meningiomas and lymphomas, and purkinjomas or chondromas and other brain tumours. The method was unreliable in distinguishing between glioblastomas and lymphomas. CONCLUSION The small number of patients made statistical analysis impossible. However, at present, it seems that neuroradiological diagnosis should not rely on MR spectroscopy alone.

Współistnienie nerwiaka słuchowego i guza szyszynki u chorego z nagłą głuchotą

Summary Introduction Acoustic neuroma usually presents as an unilateral tumor, seldom – bilateral and rarely in coexistence with other central nervous system neoplasms. The following paper reports such a case of a 21-year-old male patient presented with sudden deafness in left ear accompanied with tinnitus and vertigo. Symptoms started 4 weeks prior hospitalization. Their aggravation has been observed 7 days before admission to the hospital. Audiometry revealed moderate sensorineural hearing loss in left ear (for low and middle frequencies), brainstem auditory evoked potentials were absent on the left side and ENG examination showed left peripheral vestibular impairment. Initially patient received i.v. vasodilatators showing 20–25 dB improvement in low frequencies after 3 days of treatment. MRI study revealed in the left internal acoustic meatus mass (7 × 7 × 14 mm) suggesting acoustic neuroma and an oval mass (7 × 9 × 14 mm) in the pineal gland presenting radiological features of pinealoma. Patient has been qualified for neurosurgical treatment. Acoustic neuroma has been removed by suboccipital approach and pinealoma has been left for further observation as it was found incidentally. Histopathological examination confirmed diagnosis of left VIII nerve schwannoma. The left facial palsy (House-Brackmann III/IV grade) and profound hearing loss appeared after surgery. The postoperative course shows no evidence of acoustic neuroma recurrence.INTRODUCTION Acoustic neuroma usually presents as an unilateral tumor, seldom - bilateral and rarely in coexistence with other central nervous system neoplasms. The following paper reports such a case of a 21-year-old male patient presented with sudden deafness in left ear accompanied with tinnitus and vertigo. Symptoms started 4 weeks prior hospitalization. Their aggravation has been observed 7 days before admission to the hospital. Audiometry revealed moderate sensorineural hearing loss in left ear (for low and middle frequencies), brainstem auditory evoked potentials were absent on the left side and ENG examination showed left peripheral vestibular impairment. Initially patient received i.v. vasodilatators showing 20-25 dB improvement in low frequencies after 3 days of treatment. MRI study revealed in the left internal acoustic meatus mass (7 x 7 x 14 mm) suggesting acoustic neuroma and an oval mass (7 x 9 x 14 mm) in the pineal gland presenting radiological features of pinealoma. Patient has been qualified for neurosurgical treatment. Acoustic neuroma has been removed by suboccipital approach and pinealoma has been left for further observation as it was found incidentally. Histopathological examination confirmed diagnosis of left VIII nerve schwannoma. The left facial palsy (House-Brackmann III/IV grade) and profound hearing loss appeared after surgery. The postoperative course shows no evidence of acoustic neuroma recurrence.

Ocena fenotypowa pacjentów z zespołem Pendreda

INTRODUCTION The Pendred syndrome (PS) is an autosomally recessively inherited disease. Its diagnosis requires identification of the classical triad of symptoms, including hypoacusis, thyroid goitre and iodine organification defect in the thyroid, which may lead to thyroid functional disorders of hypothyroidism. SP is accompanied by anatomical anomalies. The objective is the hearing and balance system evaluation and the analysis of the inner ear structure and also the assessment of the function and structure of thyroid gland. MATERIAL AND METHODS For the research four families were qualified, 7 persons with PS, 12 persons altogether. In all the patients the anamnesis in the form of a questionnaire and laryngological examination were performed. It was followed by pure tone, speech and impedance audiometry and brainstem response testing as well. ENG was also conducted. Patients with hearing loss were subjected to magnetic resonance of temporal bone. For the whole group thyroid hormones levels and iodine organification in the thyroid identified in a test with potassium perchlorate were measured and also USG and scyntography were conducted. RESULTS In audiological examination in 3 cases deafness, in 2 cases profound hypoacusis and in 2 mild hypoacusis were recognised. In the group in 2 patients the hypoacusis was of a mixed type. In radiological assessment the labirynth showed anatomical anomalies in the form of enlargement of the vestibular aqueduct and the endolyphatic sac, yet in 3 patients the anomalies also concerned the structure of cochlear and semicircular canals. Endocrine examination showed hypothyroidism in 5, its subclinical form in 1, diffuse thyroid goitre in 4 and nodular thyroid goiter in 2 cases. CONCLUSIONS A complex clinical evaluation: endocrine and audiological, together with radiological diagnostic imaging, supported by molecular studies of SLC26A4 gene, are the procedures, necessary for complete and accurate diagnosis of PS and EVAS.Summary Introduction The Pendred syndrome (PS) is an autosomally recessively inherited disease. Its diagnosis requires identification of the classical triad of symptoms, including hypoacusis, thyroid goitre and iodine organification defect in the thyroid, which may lead to thyroid functional disorders of hypothyroidism. SP is accompanied by anatomical anomalies. The objective is the hearing and balance system evaluation and the analysis of the inner ear structure and also the assessment of the function and structure of thyroid gland. Material and methods For the research four families were qualified, 7 persons with PS, 12 persons altogether. In all the patients the anamnesis in the form of a questionnaire and laryngological examination were performed. It was followed by pure tone, speech and impedance audiometry and brainstem response testing as well. ENG was also conducted. Patients with hearing loss were subjected to magnetic resonance of temporal bone. For the whole group thyroid hormones levels and iodine organification in the thyroid identified in a test with potassium perchlorate were measured and also USG and scyntography were conducted. Results In audiological examination in 3 cases deafness, in 2 cases profound hypoacusis and in 2 mild hypoacusis were recognised. In the group in 2 patients the hypoacusis was of a mixed type. In radiological assessment the labirynth showed anatomical anomalies in the form of enlargement of the vestibular aqueduct and the endolyphatic sac, yet in 3 patients the anomalies also concerned the structure of cochlear and semicircular canals. Endocrine examination showed hypothyroidism in 5, its subclinical form in 1, diffuse thyroid goitre in 4 and nodular thyroid goiter in 2 cases. Conclusions A complex clinical evaluation: endocrine and audiological, together with radiological diagnostic imaging, supported by molecular studies of SLC26A4 gene, are the procedures, necessary for complete and accurate diagnosis of PS and EVAS.

The role of MRI and spiral CT with 3D reconstruction techniques in the temporal bone tumor surgical treatment

Abstract The aim of the study was to present and compare the diagnostic value of MRI and spiral CT with 3D reconstruction techniques in the surgical treatment of the temporal bone tumors. The study group comprised of nine patients aged 22–75. A clinical suspicion of temporal bone tumors was made preoperatively. All the studied patients underwent the CT and MRI study prior to surgical treatment. The spiral CT protocol was as follows: slice thickness 1–2 mm, with 1 mm index and pitch 1.0. in axial and/or coronal planes. Following this, MPR and 3D SSD were deployed. The MRI study was performed with 1.5 T unit, in T1- and T2-weighted images (axial and coronal planes) using SE and CISS-3D sequence. Surgical findings (confirmed with histopathology result) were as follows: four hemodectomas, two cholesteatomas, two carcinomas of external auditory meatus and one angiosarcoma. Conclusions: 1. The MRI study appeared to have a higher diagnostic value than CT study in the assessment of tumor spread in the surrounding soft tissues and intracranial invasion. 2. CT with MPR and 3D reconstruction appeared to have significantly higher diagnostic value in bone destruction assessment. 3. MRA with axial GE scans makes the jugular foramen visualization as well as the hemodectomas vascular changes significantly more apparent. 4. The CISS-3D sequences appeared to be a reliable method in visualizing the degree of inner ear and cranial nerves destruction.