Intracranial metastasis from prostatic adenocarcinoma simulating a meningioma

We report an unusual case of extra‐axial metastatic adenocarcinoma of the prostate that closely simulated a frontal, parasagittal, dural‐based meningioma. Such tumours, which satisfy several criteria for a diagnosis of meningioma, but which have proved instead to be metastatic adenocarcinoma of the prostate, form the focus of our report.     

Intracranial Low-grade Chondrosarcoma with Hyperostosis of the Skull: A Case Report

We describe a case of intracranial chondrosarcoma in a 46-year-old woman. The preoperative diagnosis was meningioma as plain radiography and computed tomography of the head revealed a tumor with discrete calcifications predominantly in the right frontoparietal region and hyperostosis of the inner table of the skull overlying the tumor. However, the tumor was histologically composed of cartilaginous tissue without meningiomatous differentiation and the final diagnosis was a low-grade chondrosarcoma based on its histological appearance and size, together with the radiologic images. Intracranial chondrosarcoma occurring above the skull base is extremely rare and 19 cases were found in our literature review. Intracranial chondrosarcoma showing hyperostosis of the skull has not been reported in the cases. The discussion includes its differential diagnosis, origin, and clinical behavior.     

CT及MR多期动态增强扫描对肝细胞肝癌介入治疗后随诊的对比分析

目的比较多排螺旋CT与MR多期动态增强扫描对肝细胞肝癌（HCC）经肝动脉化疗栓塞（TACE）后肿瘤局灶复发或残存的诊断价值。方法18例结节型HCC患者共38个病灶,TACE介入后22天-11个月分别行多排螺旋CT增强扫描及MRLAVA多期增强扫描,检查平均间隔9天（1～21天）。2位影像诊断医师分别读片,评价肿瘤复发或残存。所有病灶经血管造影、碘油CT、随诊等方法证实。通过计算2种诊断方法的ROC曲线下面积（Az）,比较两者诊断的准确性,并评价CT及MR诊断的敏感性差异。结果38个病灶中24个有肿瘤复发或存活,Az值分别为0．948±0．035和0．762±0．074（P〈0．05）,MRLAVA诊断的准确性显著高于CT扫描。根据诊断复发的评分标准,MRLAVA诊断存活肿瘤组织的敏感性为87．5％（21／24）,CT的敏感性为45．8％（11／24）,MRLAVA多期增强扫描的敏感性显著高于CT增强扫描（P〈0．05）。结论在评估肝细胞肝癌TACE治疗后肿瘤残存或复发方面,MR多期增强扫描优于CT增强扫描。     

鼻咽癌放射治疗颞叶脑损伤的动态磁共振波谱研究

目的:探讨磁共振波谱(MRS)成像在鼻咽癌放射治疗颞叶脑损伤中的应用价值。方法:对2006-07-2009-05期间80例鼻咽癌患者首次接受放射治疗前和接受剂量为20、40和60 Gy放疗剂量时行常规颅脑MR和双侧颞叶MRS成像。波谱成像以T2FLAIR序列为定位图,点分辨法进行多体素采集,动态观察不同剂量时颞叶波谱形态和主要代谢物及比值的变化趋势。结果:所有病例接受放射总剂量60 Gy,MR常规扫描未见明显异常。接受放射剂量20 Gy,部分病例(43/80)波谱形态发生改变,NAA和Cho波峰降低,以NAA更明显,NAA/Cr、Cho/Cr及NAA/Cho值均不同程度降低;40 Gy,大部分病例(56/80)NAA峰高度接近于Cho;60 Gy,67例Cho波峰高于NAA峰,13例Cho峰与NAA峰高度接近。整个治疗过程中,NAA、Cho、NAA/Cr、Cho/Cr及NAA/Cho值随射线剂量增加而降低,三者比值与所接受射线剂量呈负相关,比值差异有统计学意义(P=0.045)。结论:鼻咽癌放射性颞叶脑损伤是动态演变过程,MRS可从物质代谢水平反映不同放疗阶段脑损伤情况。     

Intracranial aspergillosis producing cavernous sinus syndrome and rupture of internal carotid artery

A case of invasive, intracranial aspergillosis in a non-immunocompromised patient, complicated by rupture of the internal carotid artery due to fungal arteritis, is presented. The computed tomography and magnetic resonance imaging findings are discussed. This is a rare condition with a poor prognosis and requires a high level of suspicion when paranasal sinus disease is detected.     

Follow up of coiled intracranial aneurysms with standard resolution and higher resolution magnetic resonance angiography

Time-of-flight magnetic resonance angiography is a non-invasive alternative to digital subtraction angiography (DSA) for follow up of coiled intracranial aneurysms. Standard cranial MRA protocols are a compromise between spatial resolution and imaging time. This study compares a standard resolution MRA protocol with a protocol at higher spatial resolution MRA (HR-MRA) in 21 follow-up occasions in 17 coiled aneurysms in 15 patients. Images were reviewed for presence of residual or recurrent aneurysm and compared with DSA as the gold standard. Aneurysm flow signal on standard resolution MRA differed significantly from HR-MRA in 6/21 cases (P = 0.02) and DSA in 6/21 cases (P = 0.02). HR-MRA had 100% concordance with DSA (P = 1.0). In this study, three-dimensional time-of-flight magnetic resonance angiography carried out at standard resolution is inadequate for follow up of coiled intracranial aneurysms. HR-MRA is comparable to DSA for detection of aneurysm recurrence.     

How accurately can multiparametric magnetic resonance imaging measure the tumour volume of a prostate cancer? Results of a systematic review

The tumour volume of a cancer within the prostate gland is commonly measured with multiparametric MRI. The measurement has a role in many clinical scenarios including focal therapy, but the accuracy of it has never been systematically reviewed. We included articles if they compared tumour volume measurements obtained by mpMRI with a reference volume measurement obtained after radical prostatectomy. Correlation and concordance statistics were summarised. A simple accuracy score was derived by dividing the given mean or median mpMRI volume by the histopathological reference volume. Factors affecting the accuracy were noted. Scores for potential bias and quality were calculated for each article. A total of 18 articles describing 1438 patients were identified. Nine articles gave Pearson’s correlation scores, with a median value of 0.75 but the range was wide (0.42–0.97). A total of 11 articles reported mean values for volume while 9 reported median values. For all 18 articles, the mean or median values for MRI volumes were lower than the corresponding reference values suggesting consistent underestimation. For articles reporting mean and median values for volume, the median accuracy scores were 0.83 and 0.80, respectively. The accuracy was higher for tumours of greater volume, higher grade and when an endorectal coil was used. Accuracy did not seem to improve over time, with a 3 Tesla magnet or by applying a shrinkage factor to the reference measurement. Most studies showed evidence of at least moderate bias, and their quality was highly variable, but neither of these appeared to affect accuracy.     

Cranial cystic epidermoid: Report of two cases and review of the literature

Intercranial epidermoid tumours are benign lesions of congenital origin that are potentially curable. Although computerized axial tomography (CT) and magnetic resonance imaging (MRI) are usually diagnostic, a few atypical features sometimes make pre-operative diagnosis difficult. Two cases of cystic epidermoids with peripheral ring enhancement are reported. Relevant literature has been reviewed.     

Imaging Analysis of Primary Malignant Intracranial Lymphoma

OBJECTIVE To investigate the images characteristics of primary malignant intracranial lymphoma.METHODS Retrospective study was conducted on CT/MRI imaging characteristics of 9 cases with primary malignant intracranial lymphoma.RESULTS The patients had lesions mostly in the supratentorial region, including the parts of deep white matter, para-ependymal regions, and corpus callosum. The shapes of the lesions were round or irregular. CT scan showed equal or slightly high density of the tumor images, compared with the normal tissue in the brain.The TIWI of MRI scan on the tumor showed low signal and the T2WI showed equal or slightly high signal. The MRI signals were homogenous. Cystic lesion, calcification, and hemorrhage were rarely seen in MRI. Edema around tumor and its occupational effect was lessened. Edema around tumor shown in MRI was not in accordance with the true volume of the tumor mass. Enhanced scan on the lesions showed homogenous enhancement, and the pia mater invaded and/or the spread along ependyma. CONCLUSION Images of primary malignant intracranial lymphoma have specific characteristics that are useful in its diagnosis and differential diagnosis.     

增强 T1- FLAIR 序列和磁化传递对比技术诊断脑微小转移瘤

目的：对比分析增强 T1液体衰减反转恢复（T1- FLAIR）序列和磁化传递对比（MTC）两种序列对脑内微小转移瘤的应用价值。方法：对60例患有脑转移瘤的病人行常规扫描后采用 T1- FLAIR 和 T1 WI ＋ MTC序列增强扫描,分别统计增强后 T1- FLAIR 和 T1 WI ＋ MTC 序列显示转移瘤的数目、大小、位置等,并比较二者对微小转移瘤的显示能力及2种序列图像的病灶-背景的对比度/噪声（C/ Ns）值。结果：60例脑转移瘤中,共计235个病灶,增强后 MTC 序列显示了231个病灶,显示率为98.3%,T1- FLAIR 序列显示了227个病灶,显示率为96.6%。T1 WI ＋ MTC 序列发现了 T1- FLAIR 序列不能显示的4个病灶,而 T1- FLAIR 序列证实了 T1 WI ＋ MTC 序列误判的2个病灶。T1 WI ＋ MTC 图像病灶-背景的 C/ Ns 值为29.85±6.43,T1- FLAIR图像病灶-背景的 C/ Ns 值为14.54±7.64,T1 WI ＋ MTC 序列的 C/ Ns 值高于 T1- FLAIR 序列的 C/ Ns 值（t=7.05,P ﹤0.05）。结论：增强 T1 WI ＋ MTC 序列和增强 T1- FLAIR 序列相互补充,二者结合能够最大程度满足微小转移瘤的显示和鉴别诊断的需要。     

Spinal arachnoiditis as a consequence of aneurysm‐related subarachnoid haemorrhage

Only a few case reports currently exist regarding symptomatic spinal arachnoiditis following aneurysm‐related subarachnoid haemorrhage. We present three patients who developed symptomatic spinal arachnoiditis following spontaneous aneurysm rupture. Following initial aneurysm and subarachnoid haemorrhage management (including ventriculo‐peritoneal shunt placement), all three patients developed gradually worsening neurological abnormalities, and subsequent imaging demonstrated spinal arachnoiditis. Despite spinal decompression, all three patients experienced progressively worsening neurological decline.     

大网膜原发性骨外软骨瘤1例并文献复习

目的:探讨大网膜原发性骨外软骨瘤的临床病理特征、鉴别诊断、治疗及预后。方法:分析一例33岁女性患者的临床资料,对病理标本进行常规HE染色和免疫组化染色,对染色结果进行分析判读,并检索国内外文献进行复习。结果:超声及CT均提示患者腹腔有包块;大体标本检查肿瘤组织部分呈分叶状,界清、质硬、灰白,周边见部分网膜组织;组织病理检查肿瘤由成熟透明软骨构成,呈小叶状排列,细胞无异型性;免疫组化检测肿瘤组织S-100阳性,Ki67阳性指数<1%;随访患者3年无复发或转移,各项结果共同支持大网膜原发性骨外软骨瘤的诊断,临床治疗方法首选完整切除。结论:大网膜原发性软骨瘤极其罕见,其发病机制尚不明确,治疗以手术完整切除为主。     

Adhesive capsulitis: Review of imaging and treatment

Adhesive capsulitis is one of the most common conditions affecting the shoulder; however, early clinical diagnosis can be challenging. Treatment is most effective when commenced prior to the onset of capsular thickening and contracture; consequently, the role of imaging is increasing. The aim of this review is to demonstrate the typical imaging appearances of adhesive capsulitis and to examine some of the evidence regarding each of these imaging modalities. An evaluation of the various management options available to the clinician is also presented.     

磁共振成像3种增强新技术在颅内肿瘤诊断中的应用

目的:比较增强后FLAIRMRI(CEFLAIR)、磁共振动态增强(DCEMRI)和灌注加权磁共振成像(PWI)3种MRI增强新技术诊断颅内肿瘤的应用价值。方法:43例脑肿瘤患者先后分别行DCEMRI、CEFLAIR和PWI检查。研究内容包括①造影增强病灶个数及强化病灶所在的部位;②不同部位、不同大小病灶的显示率、强化率;③病变大小:在增强后3种序列图像上分别测量肿瘤3个方向的最大径之乘积。结果:43例中,有5例因颅底伪影很重,PWI无法观察,余38图像质量可。38例中,病理证实有47个病灶,CEFLAIR、DCEMRI和PWI分别发现了41、42和45个病灶。3个病灶(2例位于皮层下、1例位于脑室旁)仅在CEFLAIR发现,4个病灶(均位于基底节区)仅在DCEMRI发现,7个位于大脑半球的病灶仅在PWI发现,表明3种方法对不同部位病灶的显示有显著差异(P<0.05)。强化程度上,68.4%(26/38)的病例DCEMRI强于CEFLAIR,3例CEFLAIR强于DCEMRI。PWI显示强化36例,未见强化2例。三者所显示的病灶体积(cm3)依次为DCEMRI:4.4±1.0、CEFLAIR:5.5±0.8、PWI:5.7±1.3(P<0.05)。14例CEFLAIR和DCEMRI显示的强化区与PWI及手术不一致。结论:3种新技术所显示的病灶强化数无明显差异,强化部位及大小差异显著,CEFLAIR对位于脑沟、脑室旁的病灶显示能力强,DCEMRI对基底节区的病灶显示率高,PWI     

Fast magnetic resonance imaging in spinal trauma

In a prospective comparison between fast magnetic resonance imaging (MRI) sequences and conventional spin-echo in a series of 20 patients, gradient-echo imaging was found to be inferior to spin-echo, especially in the visualization of spinal cord oedema, and the use of a rapid spin-echo sequence was limited by inferior visualization of haemorrhage. While the use of a combination of these two fast imaging techniques resulted in equivalent results to conventional spin-echo, the increased imaging time suggests that fast MRI cannot, as yet, replace conventional spin-echo techniques in acute spinal trauma.     

Primary medulla oblongata germinoma: a case report and review of the literature

We describe a case of primary intracranial medulla oblongata germinoma in a 16-year-old girl who presented with progressive headache and blurred vision. Magnetic resonance imaging demonstrated a heterogeneous exophytic mass arising from dorsal aspect of medulla oblongata with extension into fourth ventricle. The differential diagnosis for this patient had included ependymoma, exophytic glioma, medulloblastoma and choroid plexus papilloma. After surgical resection and radiation therapy, she remains alive and recurrence-free for 7 years.     

Magnetic resonance imaging of cerebrotendinous xanthomatosis

Cerebrotendinous xanthomatosis is a rare familial sterol storage disease with accumulation of cholestanol and cholesterol particularly in xanthomas, bile and brain. Magnetic resonance imaging is a useful modality for imaging the affected tissues. It contributes to the evaluation and management of the disease.     

Cerebral amyloid angiopathy: Review of clinico‐radiological features and mimics

Cerebral amyloid angiopathy (CAA) is an important cause of lobar intracerebral haemorrhage (ICH) in the elderly, but has other clinico‐radiological manifestations. In the last two decades, certain magnetic resonance imaging (MRI) sequences, namely gradient‐recalled echo imaging and the newer and more sensitive susceptibility‐weighted imaging, have been utilised to detect susceptibility‐sensitive lesions such as cerebral microbleeds and cortical superficial siderosis. These can be utilised sensitively and specifically by the Modified Boston Criteria to make a diagnosis of CAA without the need for ‘gold‐standard’ histopathology from biopsy. However, recently, other promising MRI biomarkers of CAA have been described which may further increase precision of radiological diagnosis, namely chronic white matter ischaemia, cerebral microinfarcts and lobar lacunes, cortical atrophy, and increased dilated perivascular spaces in the centrum semiovale. However, the radiological manifestations of CAA, as well as their clinical correlates, may have other aetiologies and mimics. It is important for the radiologist to be aware of these clinico‐radiological features and mimics to accurately diagnose CAA. This is increasingly important in a patient demographic that has a high prevalence for use of antiplatelet and antithrombotic medications for other comorbidities which inherently carries an increased risk of ICH in patients with CAA.