Computerized tomography and prognosis in early aneurysm surgery

A study of computerized tomography (CT) scans was performed in a consecutive series of 100 patients with ruptured saccular cerebral aneurysms who were admitted, diagnosed, and operated on within 72 hours after subarachnoid hemorrhage (SAH) and treated with calcium antagonists. The aneurysms were in the anterior portion of the circle of Willis in 95% of patients and in the posterior portion in 5%; 12% had multiple aneurysms. Preoperative neurological grades according to Hunt and Hess were I to III in 74% of patients and IV or V in 26%. Subarachnoid hemorrhage as determined by CT scanning was minor in 20%, moderate in 43%, and severe in 37% of patients. All patients received intraoperative and postoperative administration of the calcium antagonist nimodipine. Three days postoperatively, SAH (as measured by CT) was significantly reduced in the majority of patients but was still moderate in 18%. In the postoperative course, 2% of patients developed delayed ischemic neurological symptoms due to vasospasm. In two additional patients, ischemic symptoms were transient and fully reversible. At the 6-month follow-up interval, a significant prognostic difference was found between two patient groups with different CT scan findings. Among the patients with SAH only, the rate of good outcome (no or minimal deficit) was 93% when the preoperative neurological Grade was I or II; but even with a Grade of III to V, there was a good outcome in 84% of patients. By contrast, in patients with additional intracerebral and/or intraventricular hemorrhage, the good-outcome rate was only 44%. From these data it is concluded that morphological preoperative CT findings are of prognostic value and may even be superior to clinical grading in predicting outcome.     

Computerized tomography and prognosis in paediatric head injury

Summary The authors have analysed the computerized tomography (CT) findings and their correlation with the clinical state, early and late outcome in children and adolescents with head injuries (HI). This study represents clinical and CT data of 82 consecutive HI patients under 18 years of age. Among them 51 (62%) were boys and 31 (38%) girls. The application of CT to the evaluation of the morphologic manifestations of HI in children has shown some differences in forms and mechanisms of injury and in outcome compared to adults. In the paediatric HI the most frequent finding was diffuse brain swelling with CT evidence of ventricular and cisternal compression or obliteration. Prognostically the most unfavourable findings were shearing injury, intracerebral and subdural haematomas combined with brain swelling and parenchymal damage. According to the Lidcombe impairment scale, outcome from severe paediatric HI was determined in the 3rd and 6th months, one year and 2 years after the injury. The outcome two years after severe HI varied to a great extent and was better in children than in adults. Although there was long-term disruption of the patient's quality of life, our data show that as there are no predictors of individual outcomes in child HI, no child should be excluded from early and long-term rehabilitation.     

Computerized axial tomography for the diagnosis of cerebral cysticercosis

Summary Computerized Axial Tomography (CAT) has proved extremely useful for the diagnosis of cerebral cysticercosis. The calcified small, multiple, and scattered cysts provide a typical image on CAT.The collection of non-calcified cysts in the subarachnoid spaces (racemose form) or in the ventricles may produce areas of low density similar to that of the cerebrospinal fluid. The dilatation of the ventricular system, extreme degrees of hydrocephalus, areas of cerebral atrophy, and other related changes induced by the cysts in the subarachnoid spaces are also clearly shown in the CAT. Four personal cases are reported.     

Cysts in malignant gliomas. Identification by computerized tomography

The clinical course, computerized tomography (CT) scans, and postmortem reports for 265 patients treated for malignant brain tumors were reviewed. Forty-one patients underwent reoperation for tumor recurrence and one had needle aspiration as a diagnostic procedure; of these patients, seven (3% of 265 and 17% of 42) were diagnosed as harboring tumor cysts and 10 (25% of 41) as having necrotic tumor centers. The CT scans on the 17 patients harboring tumors with surgically confirmed cysts and necrotic centers were reviewed; criteria for distinguishing between cysts and central necrosis are suggested. The relative benefits of repeated aspiration and surgical therapy for these cystic lesions are discussed.     

Prognostic significance of lymphoid infiltration in cerebral malignant gliomas

Data concerning a study on lymphoid infiltration in 61 cerebral malignant gliomas are reported. Lymphoid cellular infiltrates were found in 28 cases (45.9%): 8 (13.1%) with marked and 20 (32.8%) with slight infiltration; the remaining 33 cases (54.1%) did not exhibit lymphoid infiltration. The mean survival time (+/- standard deviation) of patients harboring gliomas with marked lymphoid infiltration was 20.5 (+/-19.9) months, and that of patients with slight lymphoid infiltration in their glioma was 10.3 (+/- 7.5) months; those patients having gliomas without lymphoid cellular infiltrates showed a mean survival time (+/- standard deviation) of 7.2 (+/-6.1) months.     

Positron emission tomography in the detection of malignant degeneration of low-grade gliomas

The management of low-grade gliomas represents a challenge to the physician as a significant proportion may undergo malignant degeneration to a high-grade tumor. We present the positron emission tomography (PET) scans, using [18F] fluorodeoxyglucose (FDG), of 12 patients who have histological and/or clinical evidence of malignant degeneration of a low-grade glioma. Each scan displays a focal area of hypermetabolism similar to that of malignant gliomas which arise de novo. Three patients also underwent PET scanning prior to malignant degeneration. When the initial scan is compared with the postmalignant degeneration study, a difference in tumoral glucose uptake can be recognized. A region previously shown to be hypometabolic develops focal hypermetabolism as malignant changes evolve. This study displays the utility of FDG-PET in the evaluation of malignant degeneration of low-grade gliomas. The knowledge that a neoplasm has altered its biological behavior may influence subsequent therapeutic options. If these findings can be confirmed in larger series and by other investigators, it is possible that FDG-PET may be adopted as one of the diagnostic tools for guiding the management of low-grade gliomas.     

Computerized tomography as a possible aid to histological grading of supratentorial gliomas.

Computerized tomography (CT) is known to be very helpful in demostrating the presence and extent of supratentorial gliomas, practically in combination with intravenous injection of contrast material. Certain specific density patterns were found to exist and enabled us to differentiate with confidence the low-grade gliomas from the glioblastomas. Overlapping did occur, however, as was to be expected, since histological proof was sometimes obtained by the needle biopsy with its inherent doubt as to true tumor representation. Future CT techniques such as sequential scanning after intravenous injection of contrast material may further increase the usefulness of CT scans in the diagnosis and therapeutic approach to the patient with a suspected glioma.     

Stereotaxic biopsy and positron emission tomography correlation of cerebral gliomas

Computer-directed stereotaxis was used to obtain tissue diagnosis in two cases of cerebral glioma, one low grade, and the other high grade. Both lesions had a similar computed tomographic appearance. Positron emission tomography was performed in each case using [18F]fluorodeoxyglucose. A correlation was made in each case between the metabolic activity of the tumor as measured by positron emission tomography, the radiographic appearance, and the tumor histology.     

Computerized tomography in paleopathology

Paleopathology is the study of human ailments in bygone times of which written records are non-existent or inadequate. Essentially, it is based on osteological findings. Radiologic examination, which reveals the inner structure of the bones, plays an important role. Additional information can be obtained with CT, primarily because there is no superimposition of the bones. The very detailed radiologic demonstration of a periosteal reaction on a tibia in a case of acquired syphilis is illustrated.     

Hemorrhage in cerebral gliomas

A study of 48 clinical cases with supra- and subtentorial localization to reveal poor prognostic factors leading to intratumoral haemorrhage is offered. Haemorrhage most frequently occurs in patients older than 40 years and characterized by insult-like course. Poor prognostic factors of such condition are: astrocytic type of structure, giant size of tumor, cystic degeneration, high vascularity and partial removal of the tumour.     

Chemotherapy of malignant gliomas

Summary Chemotherapy of malignant glioma has been discussed in relation to recent advances in experimental and clinical studies. It is now obvious that chemotherapy is of increasing importance in the multidisciplinary treatment of malignant gliomas. Survival time of patients was prolonged by intensive and prolonged chemotherapy and by second treatment upon tumour recurrence. Further progress of chemotherapy will be gained by the progressive accumulation of all experiences, however small, in all the varied routes of approach.     

Immunotherapy of malignant gliomas

Some recent immunological approaches to therapy of cancer are briefly considered. The possibility of the application of immunotherapy to malignant gliomas was investigated in vitro, evaluating the cytotoxic activity of Interleukin-2-activated lymphocytes against cultured human glioma cells. The possibility of generating valid cytotoxic effectors from glioma patients peripheral blood was also investigated in consideration of the immunological alterations reported in such patients.     

Computerized tomography in the diagnosis of subdiaphragmatic abscess

Examination of 49 patients suspected of the presence of a suppurative process in the subdiaphragmatic space was performed. The use of computed tomography allowed the author to exclude the subdiaphragmatic abscess in 22 (44.9%) of the patients, in the others the exact localization of the abscess, its size and relationships with the neighbouring organs were determined. Results of the computed tomography were of great importance in choice of the surgical tactics for treatment of the patients.     

Computerized tomography in the surgery of esophageal cancer

Preoperative X-ray computerized tomography (CT) was performed in 60 patients with carcinoma of the esophagus at the All-Union Oncology Research Centre, USSR AMS in 1986-1989. The method is evaluated on the basis of comparison with the operative findings in determining the depth of invasion of the esophageal wall and adjoining structures by the tumor, metastatic involvement of the lymph nodes below the diaphragm, and metastases in the liver. Informativeness of X-ray CT proved to be highest in patients in whom the tumor had not spread beyond the esophageal wall. It was established that the method possesses high resolving possibilities in identification of enlarged lymph nodes in the abdominal cavity. Small metastases in the liver, measuring 0.5 to 2 cm in diameter, cannot be revealed by the method in some cases. The data gained by means of X-ray CT allows tactics of the surgical intervention to be determined and the late-term results to be predicted.     

Computerized tomography in instability of the femoropatellar joint

Compared with normal X-ray examination, a CT scan can give more information about patellar alignment, especially close to full extension of the knee-joint. We compared the normal knee-joints of 10 volunteers with the knee-joints of 15 patients (19 recurrent luxations, 5 habitual subluxations). We were able to distinguish between instabilities with and without changes seen on the X-ray pictures, making it possible to develop a systematic concept of treatment. In the case of recurrent dislocation with radiologically visible instability, surgical repair is the treatment of choice, while for habitual subluxation without radiologically visible instability the primary treatment of choice is conservative therapy with physiotherapy and muscle training. This is successful in most cases. If physiotherapy fails surgical repair is the next step in treatment. This dynamic type of investigation (the patella is stabilized by tension of the quadriceps femoris muscle) makes an objective judgement of the result of therapy possible.