The “dural tail” adjacent to meningiomas studied by dynamic contrast-enhanced MRI: a comparison with histopathology

We examined 32 patients with intracranial tumors (17 meningiomas, 8 neuromas, 7 pituitary adenomas) by conventional and dynamic contrast-enhanced MRI. Our aim was to clarify whether the pathological dural contrast enhancement adjacent to meningiomas (the dural tail) is specific to meningiomas and, more important, whether it represents neoplastic dural infiltration or hypervascularization as a tumor accompanying reaction. A dural tail was found in 9 of 17 meningiomas. None of the other extra-axial tumours (neuromas, pituitary adenomas) showed comparable dural enhancement. Dynamic examinations with an ultrafast single slice imaging technique (snapshot-FLASH) after a bolus injection of contrast medium showed a dural tail in seven out of these nine meningiomas, while in two cases the dural tail turned out to be a cortical vein with a characteristic dynamic contrast enhancement pattern. In the dynamic study all seven dural tails were found to have earlier, steeper contrast enhancement than the corresponding tumours. All the tumours and part of the adjacent dura mater in four of the seven meningiomas with dural enhancement were examined histopathologically. In none of these four cases was neoplastic tissue found more than 2 mm away from the main tumour. The results strongly support the suggestion that the dural tail adjacent to meningiomas represents a hypervascular, non-neoplastic dural reaction.     

Spring coil embolization of a patent ductus arteriosus in an adult

To date, coil embolization has been reserved for occlusion of the small patent ductus arteriosus (PDA) because of potential dislodgement of the coils. We report a case of a larger, hemodynamically significant PDA in an adult which was successfully closed by two spring coils using a crossed catheter technique for coil delivery.The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.     

Spontaneous malignant transformation of conventional giant cell tumor

Spontaneous malignant transformation of conventional giant cell tumor (GCT) of bone is exceedingly rare. We report on a case of GCT of the iliac crest in a 35-year-old woman with malignant change into a high-grade osteosarcoma 10 years after the first appearance of GCT on a radiograph. Since the patient refused therapy for personal reasons the tumor remained untreated until sarcomatous transformation occurred. Image cytometry showed DNA aneuploidy and a suspiciously high 2c deviation index (2cDI) in the primary bone lesion. A thorough review of the world literature revealed only seven fully documented cases of secondary malignant GCT which matched the definition of a sarcomatous growth that occurs at the site of a previously documented benign giant cell tumor and not treated by radiotherapy. These cases as well as the current one suggest that a spontaneous secondary malignant GCT presents as a frankly sarcomatous tumor in the form of an osteosarcoma or malignant fibrous histiocytoma. It usually appears at sites of typical GCTs—often without any recurrent intermediate state—and is diagnosed 3 or more years after the primary bone lesion. The prognosis is poor.     

Mesenteric whirlpool sign detected at color doppler ultrasound: Diagnostic value in adults

The purpose of this study was to evaluate the diagnostic value of the whirlpool sign detected at color Doppler sonography in adults complaining of acute abdominal pain. During a 2-year period, the whirlpool sign was systematically looked for with color Doppler sonography in all patients admitted in the emergency room for acute abdominal pain. The whirlpool sign was observed in 13 patients: 2 cases of surgically proven primary volvulus of the small bowel, 10 cases of proven or suspected small bowel obstruction secondary to adhesions, and 1 case of acute leukemia with enlarged mesenteric lymph nodes. In the first 12 cases, the whirlpool sign was associated with radiologic (N=9) and sonographic (N=12) signs of small bowel obstruction. In the last case, no sign of obstruction was observed. In patients who had the whirlpool sign and who underwent operations (N=6), primary or secondary volvulus was present in 3 cases but was absent in the other 3 cases. The whirlpool configuration detected with color Doppler sonography has to be considered as a sign of limited value, because it may be observed in various conditions, including primary or secondary volvulus, postsurgical adhesions without volvulus, and acute abdominal diseases without obstruction.     

Primary tumors of the patella

This study reports 42 cases of histologically proven and radiographically correlated primary patellar tumors. Despite diverse histologic diagnoses, the radiographic appearances of benign as opposed to malignant patellar neoplasms are essentially indistinguishable. Although the literature suggests that giant cell tumor is the most frequent benign tumor of the patella, the most common benign neoplasm in this series is chondroblastoma (16 cases). Only four primary malignant lesions were encountered, three cases of lymphoma and one case of hemangioendothelioma. Since 38 (90%) of the 42 cases were benign, a benign etiology should be strongly favored, notwithstanding the radiographic appearance, whenever a primary patellar tumor is encountered.The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.     

Multiple skeletal fibroxanthomas: radiologic-pathologic correlation of 72 cases

Out of a series of 900 biopsy-proven cases of skeletal fibroxanthoma (nonossifying fibroma, fibrous cortical defect), we studied 72 patients with more than one lesion. Age, sex, coexistent conditions such as neurofibromatosis, and histologic and radiographic appearance of the lesions were evaluated. Multiple skeletal fibroxanthomas are probably more common than previously suspected. (At least 8% of the 900 patients in our archives had multiple lesions). Only a small percentage (5%) of patients with multiple skeletal fibroxanthomas had coexistent neurofibromatosis. These lesions are histologically indistinguishable from their solitary counterparts and most commonly present in the lower extremities. Four radiographic patterns were noted: (1) clustered lesions-usually about the knee. (2) nonclustered lesions-in opposite ends of long bones. (3) coalescent lesions-several lesions coalescing over time. This observation has not been previously reported. (4) emergent lesions-lesions appearing in previously unaffected bone. Familiarity with these features may obviate biopsy.The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.     

Die Abhängigkeit des Faktors β von der Konzentrationshöhe

Zusammenfassung Die Begriffe des Konzentrationsabfalles \ und des Reduktionsfaktors sowie die Variationsbreiten dieser Größen werden diskutiert.Die mittlere Abbaugeschwindigkeit während langer Zeitspannen lag bei Blutalkoholkonzentrationen oberhalb 1,5 mindestens bei 0,16, wenn der errechnete Höchstwert (r = 0,7) annähernd erreicht wurde.Die statistische Auswertung von den 4118 Einzelentnahmen und den Entnahmen in zeitlichem Abstand bei 922 Personen zeigt die am häufigsten beobachtete Blutalkoholkonzentration bei 1,8und ein mittleres \₆₀ von 0,184.Der Faktor nimmt mit steigender Blutalkoholkonzentration zu. Die Unterschiede zwischen den Bereichen 0,41—1,2 und oberhalb 2,0 sind statistisch gesichert, die mittleren \₆₀-Werte von 0,17 bzw. 0,203 damit signifikant.Auszugsweise vorgetragen auf dem Kongreß für Gerichtliche und Soziale Medizim 1954 in Kiel.     

The dural tail of intracranial meningiomas on fluid-attenuated inversion-recovery images

We evaluated the dural tail associated with 48 intracranial meningiomas on fluid-attenuated inversion-recovery (FLAIR) and contrast-enhanced T1-weighted images. In 30 (62.5%), a dural tail was observed on contrast-enhanced T1-weighted images, and thickening of the dura mater and abnormal signal were identified in the corresponding region on FLAIR images. Thus, FLAIR imaging was useful for showing dural abnormality associated with meningiomas without the needed for contrast medium.     

Problems with the “dural tail” sign

Prominent enhancement of the dura mater, the dural tail adjacent to a peripherally located mass on gadolinium-enhanced MRI has been described as being characteristic of meningiomas. We present a cerebral glioma showing the classical dural tail.     

Aggressive fibrous dysplasia of the maxillary sinus

Fibrous dysplasia is usually a slowly progressive, benign disease that develops over several years and presents with deformity or mild symptomatology. Five of 34 patients (ages 4–21 years), who were subsequently diagnosed histologically as having fibrous dysplasia of the maxillary sinus, rapidly developed soft tissue masses of the malar region over a period of less than 4 months with accompanying pain (2 patients) and nasal obstruction and exophthalmos (2 patients). Each was clinically suspected of having a sarcoma; two had been thought to have an osteofibrosarcoma on initial biopsy at outside hospitals. After resection, all lesions developed regrowth. At histopathologic examination, both initial and recurrent masses proved to be typical fibrous dysplasia with spicules of woven bone in cellular, sometimes vascular, fibrous tissue. No malignant degeneration was found.On conventional radiography, aggressive fibrous dysplasia produced opacification and expansion of the maxillary sinus and apparent disruption of its wall with an associated soft tissue mass. Computed tomography (CT) demonstrated voluminous heterogeneous masses with ground glass appearance, calcifications, areas of enhancement, low attenuation, cystic areas, and a thinned, sometimes interrupted, maxillary wall. Despite the aggressive clinical course for both initial and recurrent lesions, the CT findings of a ground glass mass with calcifications surrounded by a maxillary sinus wall, even if incomplete, can suggest the diagnosis of aggressive fibrous dysplasia.Deceased     

骨巨细胞瘤MRI诊断价值的初步探讨(附9例报告)

目的探讨MRI对巨细胞瘤的诊断价值及对其良恶性评估方面的意义.方法男4例,女5例,年龄14～68岁,平均32岁.其中胫骨上端5例,股骨远端2例,桡骨远端1例,肩胛骨1例.全部病例有平片对照,7例有CT对照.9例术后均行病理检查.结果所有病例在T1WI上均呈等、低信号,T2WI上均匀高信号5例,呈不均匀高、等、低信号4例.有骨皮质破坏5例,3例无骨嵴,2例显示关节及软组织受累.3例信号不均匀者大体病理呈暗红或棕褐色,5例信号较均匀者呈棕黄或黄色.结论MRI、CT、X线比较(1)在骨皮质破坏和骨嵴的显示方面,CT优于MRI.(2)显示骨外软组织及关节的受侵情况,MRI优于CT及X线.(3)在定性诊断方面MRI无明显优势,但术前评估肿瘤范围方面MRI有明显优势.     

The angiographic response of osteosarcoma following pre-operative chemotherapy

The prognosis of osteosarcoma has improved significantly with recent advances in chemotherapy. Evaluation of the effect of chemotherapy is important for optimal timing of surgery, for selecting an alternative drug regimen in instances of poor response to chemotherapy and for testing combinations of new drugs. The purpose of this paper is to define the value of plain radiographs and angiography in assessing tumor response to chemotherapy. Studies were obtained before and after chemotherapy. The radiographic results were correlated with histologic evaluation of the resected specimen. Patients with less than 10% residual viable tumor in the resected bone were designated responders and patients with more than 10% of remaining viable tumor were nonresponders. Angiographic appearances correctly separated 15 patients with good response to chemotherapy from seven patients who were not responsive. Conversely, comparison of plain radiographs obtained before and after chemotherapy did not allow a reliable differentiation between patients with good, poor, or no response to chemotherapy. The current role of angiography in the management of patients with osteosarcoma is discussed. It is concluded that — in contrast to plain film radiography — angiography is an accurate method for assessing the response of osteosarcoma to chemotherapy.     

Aneurysmal bone cyst and other nonneoplastic conditions

Aneurysmal bone cyst is a benign proliferative tumefaction of bone. Histologic similarities indicate a kinship among classic aneurysmal bone cysts, essentially solid proliferative lesions in bones; giant cell reparative granulomas of the jaws, at the base of the skull, and in the small bones of the hands and feet; skeletal lesions of hyperparathyroidism; and even pseudosarcomatous myositis ossificans, proliferative myositis, and proliferative fasciitis.     

Infratentorial brain maturation: a comparison of MRI at 0.5 and 1.5T

Our purpose was to establish parameters for normal infratentorial brain maturation at 0.5 and 1.5T and to evaluate the field strength criteria for the assessment of infratentorial brain maturation with MRI. We examined 27 children with normal psychomotor development (3 days to 24 months) with a 1.5T system and 22 (4 days to 29 months) with a 0.5T system; standard T2-weighted spin-echo sequences (TR/TE 2500/90 ms at 1.5T and TR/TE 2200/90 ms at 0.5T) were obtained. The signal intensity of infratentorial anatomical structures compared to their surroundings was classified as high, isointense or low by three neuroradiologists. For anatomical structures with age-related contrast changes, the time of these changes was determined statistically for the 0.5T and 1.5T system independently. The delineation of the structures without age-related contrast changes at the two field strengths was compared using a ² test. Age-related contrast changed were found in the same anatomical structures (marker sites) at 0.5 and 1.5T. Generally, these changes were apparent in larger structures (pons, middle cerebellar peduncles, medulla, cerebellar folia, red nuclei, cerebral peduncles), with only slight field-strength-dependent differences in the time of the contrast changes. Contrast changes from high to isointense signal were observed slightly earlier at 0.5T and changes from isointense to low signal slightly later at 0.5T. The delineation of the smaller anatomical structures was significantly better at 1.5T but these structures did not show age-related contrast changes. The differences in the assessment of infratentorial brain maturation between 0.5 and 1.5T can be attributed to a lower signal-to-noise ratio at lower magnetic field strengths. These differences do not complicate temporal classification of the stage of infratentorial brain maturation using the same marker sites and the same temporal criteria at 0.5 or 1.5T. However, higher field strengths are preferable for the assessment of smaller structures with physiological signal differences; this may imply better detection of small lesions at higher field strengths.     

Large vessel disease in Chinese patients with capsular infarcts and prior ipsilateral transient ischaemia

Summary Carotid angiography was carried out in 21 Chinese patients with acute capsular infarcts; all had had a previous ipsilateral transient ischaemic attack (TIA) or reversible ischaemic neurological deficit (RIND) during the preceding 6 months. Sixteen (group 1) showed lacunar capsular infarcts, and 5 (group 2) either giant lacunae or striatocapsular infarcts. Angiography showed that 81% of group 1 and all group 2 patients had ipsilateral severe stenosis or occlusion of either the M1 segment of the middle cerebral artery or the internal carotid artery. Ten group 1 patients and 3 group 2 patients also had contralateral intra- or extracranial carotid artery stenosis. Apart from hypertension, other risk factors such as hyperfibrinogenaemia, polycythaemia, and low HDL-cholesterol level seem to play a role. Haemorheological abnormalities in the presence of atherostenosis at the orifice of lenticulostriate arteries and/or artery-to-artery embolism might be the cause of infarcts in the majority of the patients. A fifth of patients had recurrent large ipsilateral infarcts. Thus capsular lacunar syndromes with prior ipsilateral TIA or RIND are not as benign as previously thought, and they should indicate more intensive studies including cerebral angiography, and more vigorous therapy.     

Gefährdung und Schädigung von Kindern und Jugendlichen

Zusammenfassung Die Vorverlagerung dissozialer und krimineller Handlungen und die daraus resultierende Gefahr einer Zunahme der Jugendkriminalität verleihen der Frage nach der Bedeutung von Gefährdung und Schädigung von Kindern und Jugendlichen aktuelle Bedeutung.In Ärztekreisen ist noch viel zu wenig bekannt, daß häufig bereits Einordnungs-, Erziehungs- und Schulschwierigkeiten eine Gefährdung im Sinne späterer kriminogener Entwicklungsmöglichkeiten darstellen.Die rechtzeitige Erfassung entsprechender Persönlichkeitseigenschaften und Reaktionsbildungen erfordert die Berücksichtigung genetischer, reifungsbiologischer, konstitutioneller, jugendpsychiatrischpsychologischer, sozialer und raum-zeitlicher Faktoren.Als entscheidendes Bedingungsmoment für die Ätiologie und Persistenz einer Gefährdung bzw. für die sozial negativen Auswirkungen einer Schädigung hat sich der Einfluß der Familienstruktur erwiesen.Aber nicht nur die jugendliche Delinquenz, sondern auch die kindlichen und jugendlichen Opfer von Sittlichkeitsverbrechern oder Gewalttätern haben uns zu beschäftigen. Das intellektuell minderbegabte oder cerebralgeschädigte Kind ist in dieser Hinsicht besonders gefährdet. Ein unterdurchschnittliches geistiges Niveau war bei der Hälfte der untersuchten Inzestopfer nachweisbar.Neben den durch Mißhandlungen gegebenen Schädigungsmöglichkeiten werden die dadurch hervorgerufenen Fehlentwicklungen, die sich später in Aggressionshandlungen, Körperverletzungs- und Tötungsdelikten äußern können, oft übersehen.Außer der rechtzeitigen Erkennung von Gefährdungs- und Schädigungsmöglichkeiten ist eine positive Einstellung der Erwachsenenwelt und die Bereitschaft zur Schaffung eines echten Vertrauensverhältnisses zwischen der jüngeren und älteren Generation erforderlich.

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Summary Nowadays dissocial and criminal actions and the resulting danger of increase of juvenile delinquency take place much earlier. Thus the importance of all questions of endangering and harming children and juveniles.It is not yet a commonly known fact that already difficulties in education and at school represent a danger in the sense of later developmental posibilities towards a criminal development.It therefore will be necessary to observe these character traits and the forming of reactions under the view-point of genetic, constitutional, social facts, and facts of juvenile-psychiatry and -psychology, of maturation-biology, and space-and-time.The influence of the family-structure has proved to be a major cause for the etiology and persistency of a menace, that is to say for the negative results of a harm.But we do not only deal with juvenile delinquency but we also deal with children and adolescents who are victims of indecent assault and outrage. In this respect the less mentally talented or brain-damaged child is especially endangered. A subnormal mental level is characteristic for half of the examined victims of in-breeding.Apart from the possibilities of harm, which stem from maltreatment or cruelty, very often developmental malfunctions are overlooked which result lateron in aggressive activities, bodily injury, and murder.Apart from recognizing any endangering or harming possibility it is necessary for any adult to create an atmosphere of positiveness and confidential relationship between the younger and older generation.

     

[<Superscript>18</Superscript>F]FLT-PET in oncology: current status and opportunities

In recent years, [¹⁸F]-fluoro-3-deoxy-3-L-fluorothymidine ([¹⁸F]FLT) has been developed as a proliferation tracer. Imaging and measurement of proliferation with PET could provide us with a non-invasive staging tool and a tool to monitor the response to anticancer treatment. In this review, the basis of [¹⁸F]FLT as a proliferation tracer is discussed. Furthermore, an overview of the current status of [¹⁸F]FLT-PET research is given. The results of this research show that although [¹⁸F]FLT is a tracer that visualises cellular proliferation, it also has certain limitations. In comparison with the most widely used PET tracer, [¹⁸F]FDG, [¹⁸F]FLT uptake is lower in most cases. Furthermore, [¹⁸F]FLT uptake does not always reflect the tumour cell proliferation rate, for example during or shortly after certain chemotherapy regimens. The opportunities provided by, and the limitations of, [¹⁸F]FLT as a proliferation tracer are addressed in this review, and directions are given for further research, taking into account the strong and weak points of the new tracer.     

Mixed-sclerosing-bone-dystrophy: Report of a case and review of the literature

We present clinical, laboratory, radiologic, genetic, and pathologic findings in a 49-year-old man with mixed-sclerosing-bone-dystrophy (MSBD), review the six cases previously reported as MSBD, and examine the nosology of this rare bone dysplasia. Our asymptomatic patient showed radiographic changes consistent with osteopoikilosis, osteopathia striata, and melorheostosis and had widespread osteosclerosis of the axial skeleton. Several previous reports of combined osteosclerotic disorders suggest the latter finding represents osteopetrosis, however, histologic examination of our patient's iliac crest excluded that diagnosis. Limited radiographic surveys of his eight children were unremarkable except for isolated bone islands in two sons. Literature review revealed that MSBD has actually been used generically to describe the association of a variety of osteosclerotic bone dysplasias when they occur together in a single patient.     

Recurring osteoblastoma initially presenting as a typical osteoid osteoma

Two patients each underwent inadequate excision of an osteoid osteoma and some months later developed a large tumor in the same location showing the radiographical and histological features of osteoblastoma. This rare occurrence again suggests that osteoid osteoma and osteoblastoma are closely connected benign neoplasms. Indeed some authors in the past have suggested classification as a single tumor showing different clinical and radiographical patterns.Supported by: Grant n 88.01124.44, Italian National Council of Researches, Special Project Oncology. A.I.R.C. (Italian Association for Cancer Research). Regione Emilia-Romagna, law n 1970 of May 13th, 1986. Istituto Ortopedico Rizzoli Research Funds. Interdepartmental Center for Cancer Research G. Prodi of the University of Bologna     

Giant cell reparative granuloma and other giant cell lesions of the bones of the hands and feet

The present paper is a clinico-pathologic study of 52 osteolytic lesions containing giant cells, affecting the hands and feet and comprising 11 giant cell reparative granulomas, nine giant cell tumors, six chondroblastomas, and 26 aneurysmal bone cysts. The nature of osteolytic lesions of hands and feet must be carefully established in order to plan appropriate treatment without damaging the surrounding structures. Giant cell reparative granuloma has to be distinguished from other lesions containing giant cells. Clinical and radiologic findings proved of limited diagnostic value; the definitive diagnosis can be established only by histologic examination. Surgical treatment is discussed.