Computed tomographic findings in cerebral hemiatrophy

Summary The clinical, plain skull radiographic, brain scan, and CT findings of four patients with cerebral hemiatrophy are described. CT scanning is the most innocuous and most sensitive diagnostic method available to confirm the clinical diagnosis when plain skull radiographic changes are not confirmatory.     

Unilateral cerebral polymicrogyria with ipsilateral cerebral hemiatrophy

We evaluated six children in whom MR imaging showed unilateral cerebral polymicrogyria associated with ipsilateral cerebral atrophy and ipsilateral brain stem atrophy. The aim of this study was to clarify whether this disorder based on neuroimaging constitutes a new homogeneous clinical entity. The subjects were six children whose ages at the time of MR imaging ranged from 8 months to 11 years. Their clinical and MR features were analyzed. All of the children were born between 38 and 42 weeks gestation, without any significant perinatal events. Spastic hemiplegia and epilepsy were observed in all of the patients, and mental retardation was observed in four. The MR findings included unilateral cerebral polymicrogyria associated with ipsilateral cerebral hemiatrophy and ipsilateral brain stem atrophy in all patients. The ipsilateral sylvian fissure was hypoplastic in four patients. These patients showed relatively homogeneous clinical and neuroimaging features. Although the additional clinical features varied according to the site and the extent affected by the polymicrogyria, this disorder could constitute a new relatively homogeneous clinical entity.     

MRI of porencephalic cyst associated with cerebral hemiatrophy

Whereport seven cases of porencephalic cyst associated with cerebral hemiatrophy. One case was due to an unknown prenatal factor. One case had maternal injury and shock, which presumably caused temporary fetal asphyxia. One case had perinatal asphyxia. The other four cases had infantile head injury; of these, two cases had serial follow-up computed tomography (CT) and magnetic resonance imaging (MRI) that verified the evidence of post-traumatic infarction of the brain, and then caused porencephaly with cerebral hemiatrophy. In the other two cases, MRI clearly showed ulegyria on the side of the lesion, which is evidence of remote hypoxic ischemic damage. These cases lead us to believe that hypoxic ischemic damage of the brain is the etiology of porencephalic cyst when associated with cerebral hemiatrophy or when adjacent ulegyria is present. Correspondence to: W.-C. Shen     

CT and MRI findings in cerebral hydatid disease

Cerebal hydatid cysts account for 2% of all intracranial masses. Preoperative diagnosis is important since cyst rupture and spillage may cause an anaphylactic reaction. CT is the primary modality for the diagnosis. Two forms of cerebral hydatid cysts have been reported on the basis of CT appearances: unilocular and multilocular. Demostration of the cyst wall is important for the diagnosis. MRI is superior to CT for demostrating the cyst capsule and perifocal oedema. We retrospectively reviewed the CT and MRI findings of 6 surgically proven cases of cerebal hydatid cyst and compared the two modalities on the basis of their demonstration of findings helpful in the diagnosis, such as the capsule and perifocal oedema. In 1 case CT showed the capsule. In 2 cases MRI showed a hypointense capsule around the cyst on T2-weighted images. While CT is the modality of choice, in clinical practice MRI is superior for demonstrating the cys capsule, which is a helpful findings in the diagnosis and can be used in inconculsive cases. Correspondence to: U. Topal     

Diffuse cerebral air embolism following trauma: striking postmortem CT findings

We report a woman with fatal head injuries in whom CT demonstrated pneumocephalus and diffuse intravascular air.     

Cerebral hydatid cysts: CT findings

Summary The CT features of cerebral hydatid cysts are divided into two groups. In the unilocular cases, the cyst is large, spherical in shape with sharply defined borders. One side of the cyst wall is very close to the calvarium. The cyst may calcify and may have septae inside. There is no enhancement with contrast media and also no edema surrounding the cyst. In the second group there are multiple and small multilocular cysts. These cysts are in ovoid or polygonal forms like a bunch of grapes, with perifocal edema. After contrast media administration, there is enhancement in the cyst wall. In one case there were numerous cysts in both hemispheres.     

CT of cerebral hydatid disease

Summary Six cases of cerebral hydatid disease (CHD) were seen in Kuwait over a period of 8 years. The typical CT appearance of a large well-defined spherical nonenhanced unilocular cyst was seen in four cases. Two unusual but characteristic types of calcification were seen, one in each of the remaining two cases.     

Neuroimaging findings in children with retinopathy-confirmed cerebral malaria

Purpose

To describe brain CT findings in retinopathy-confirmed, paediatric cerebral malaria.

Materials and methods

In this outcomes study of paediatric cerebral malaria, a subset of children with protracted coma during initial presentation was scanned acutely. Survivors experiencing adverse neurological outcomes also underwent a head CT. All children had ophthalmological examination to confirm the presence of the retinopathy specific for cerebral malaria. Independent interpretation of CT images was provided by two neuroradiologists.

Results

Acute brain CT findings in three children included diffuse oedema with obstructive hydrocephalus (2), acute cerebral infarctions in multiple large vessel distributions with secondary oedema and herniation (1), and oedema of thalamic grey matter (1). One child who was reportedly normal prior to admission had parenchymal atrophy suggestive of pre-existing CNS injury.Among 56 survivors (9-84 months old), 15 had adverse neurologic outcomes—11/15 had a follow-up head CT, 3/15 died and 1/15 refused CT. Follow-up head CTs obtained 7-18 months after the acute infection revealed focal and multifocal lobar atrophy correlating to regions affected by focal seizures during the acute infection (5/11). Other findings were communicating hydrocephalus (2/11), vermian atrophy (1/11) and normal studies (3/11).

Conclusions

The identification of pre-existing imaging abnormalities in acute cerebral malaria suggests that population-based studies are required to establish the rate and nature of incidental imaging abnormalities in Malawi. Children with focal seizures during acute cerebral malaria developed focal cortical atrophy in these regions at follow-up. Longitudinal studies are needed to further elucidate mechanisms of CNS injury and death in this common fatal disease.     

Hyperdense middle cerebral artery CT sign

Summary The early CT finding of an hyperdensity of a portion of the middle cerebral artery Hyperdense Middle Cerebral Artery Sign (HMCAS), in patients with supratentorial stroke, is often indicative of an embolic occlusion. Aim of this study was to verify the incidence and reliability of the HMCAS and its possible correlation with early CT findings and with the extent of late brain damage. We studied 36 patients presenting with symptoms of stroke in the MCA territory, by means of CT and angiography performed respectively within 4 and 6 hours. Follow-up CT scans were then obtained after one week and three months from the ischemic event. The HMCAS was present in 50% of our patients and in this group it always correlated positively with the angiographic finding of occlusion. The same group presented a high incidence of erly CT hypodensity (88%). Finally the presence of HMCAS might be considered a negative prognostic sign for the development of extensive brain damage.     

Comparative evaluation of cerebral aneurysms with selective arterially enhanced CT and DSA

The purpose of our study was to compare selective arterially enhanced spiral computed tomographs (ACT) with digital subtraction angiographies (DSA) in the presurgical assessment of cerebral aneurysms. A total of 24 aneurysms in 18 patients were explored in a prospective study by ACT and DSA, using an interactive combined CT-angiography suite. Dimensions of the aneurysm, its relation to the parent vessel, and the aneurysmal index were defined on DSA and on surface-shaded display of 3D reformatted images obtained from ACT. Results were correlated with surgical findings. Three aneurysms suspected on DSA were not confirmed by ACT. One fusiform aneurysm suspected on DSA corresponded to a sacciform aneurysm on ACT. Surgical findings confirmed 20 sacciform aneurysms. The aneurysmal index could be measured in all 20 cases of sacciform aneurysms on ACT and could not be determined with confidence in 55 % of the cases on DSA. DSA and ACT gave identical results in 35 % of cases. In 10 %, the index measured by ACT was superior to that determined by DSA for aneurysms which had a diameter of less than 3 mm. In conclusion, the combination of DSA and ACT improved the results of DSA alone. ACT is a reliable method to measure the aneurysmal index in aneurysms with a diameter superior to 3 mm. Received 4 September 1997; Revision received 20 November 1997; Accepted 24 December 1997     

Comparison of the measurements of the cerebral ventricles obtained by CT scanning and pneumoencephalography

Summary This study was undertaken to compare the accuracy of measurements of the ventricular system obtained by the CT scanner and pneumoencephalography (PEG). In it the ventricular system was evaluated in each case by measuring the span of the frontal horns, cellae mediae and third ventricle in relation to the diameter of the inner and outer tables of the skull from the PEG films. The indices of Evans, Schiersmann, and Schaltenbrand and Nürnberger were applied to these measurements. The same indices were obtained using the appropriate CT printouts. A very good measure of agreement was obtained with the indices arrived at from both the CT scan printouts and the pneumoencephalograms.     

脑出血外科治疗脑水肿变化与CT动态观察分析

目的探讨CT动态观察在脑出血手术治疗中对脑血肿、脑水肿及预后的评估价值。方法对我科136例脑出血患者于入院当天行头颅CT检查,观察出血量、出血部位及占位效应,并于术后第2天及第7天复查头颅CT,动态观察手术前后出血量与脑水肿变化。结果术前CT显示血肿越大,血肿灶周围水肿体积增大越明显,占位效应及中线移位越显著。术后血肿完全清除或大部分清除者,占位效应消失或明显好转。血肿部分清除或较术前加大者,脑水肿和占位效应也加重。结论 CT不仅能显示血肿部位、出血量、是否破入脑室及脑移位情况,并能动态观察手术前后脑血肿及脑水肿演变过程,为临床制定手术方案、观察疗效及估测预后提供直接依据。     

The diagnostic value of CT for radiotherapy of cerebral tumors

Summary The paper deals with CT followup studies on 73 patients with cerebral tumors who received radiotherapy. The value of CT for the indication of radiotherapy, for followup therapy and for the demonstration of therapeutic success are discussed. Since the cerebral tumors become visualized by means of CT in their entire extent and can be differentiated from perifocal edema, the question arises whether radiotherapy should consist of higher doses in the future. It is also suggested that the clinical malignancy may be used to compare the behavior of cerebral tumors when there is no exact histological classification. The possible histopathological effects of radiotherapy (edema, necrosis) and their demonstration by CT are discussed.Supported by the Deutsche Forschungsgemeinschaft     

320层容积CT全脑灌注成像技术在缺血性脑血管病中的初步应用

目的：初步探讨320层容积CT全脑灌注对于评估缺血性脑血管病的价值。方法：对8例缺血性脑血管病患者在症状出现至常规CT平扫与全脑灌注成像检查时间在4h-1个月。间隔2-3天后复查的CT和／或MRI影像学资料综合分析。比较CT平扫与脑灌注图像发现缺血灶的敏感性,对比评价4层灌注及全脑灌注,并统计辐射剂量。结果：根据8例患者复查的影像学资料综合分析,共发现22处脑缺血灶;8例患者首次常规Cr平扫仅发现9处低密度区,脑灌注图像中发现11处异常灌注区;11处异常灌注区中表现为CBF与CBV均下降,并MTT延长4处,CBF下降,CBV增高,并MTT延长7处。全脑灌注显示病灶范围优于4层灌注。辐射剂量总剂量为4．6mSy。结论：320层容积Cr灌注成像可以通过一次对比剂注射,获得常规CT扫描、全脑灌注、CTA的数据,可以实现对缺血性脑血管病的全面评估。     

Brain tumors with ipsilateral cerebral hemiatrophy

Brain tumors with secondary ipsilateral cerebral hemiatrophy are so rare that only seven cases have been reported in the literature. Three new cases are presented and the clinical findings in all 10 cases are reviewed. The diagnostic value of computed tomography (CT) is emphasized. The authors conclude that nodular high-density lesions located deep in the cerebrum and showing slight contrast enhancement on CT may be associated with ipsilateral cerebral hemiatrophy in young male patients with slowly progressive hemiparesis, dementia, and personality change. In such cases, early diagnosis of germinoma and subsequent radiotherapy may prevent unnecessary surgery.     

应用CT定向经颅钻孔抽吸治疗脑出血（附120例报告）

目的评价CT导向经颅钻孔抽吸治疗脑出血的效果。方法120例经CT证实自发性脑出血(≥40ml)患于临床症状出现后6小时至7日内均接受经颅钻孔抽吸治疗。其中抽吸治疗1次100例,2次15例,3次5例,抽吸治疗后,全部病例经CT复查及临床随访。结果治疗后随访3个月以上的结果表明,除4例死亡外,其余116例存活的临床表现均有不同程度的改善,其中,完全恢复37例(30．8％),部分恢复即日常生活能自理41例(34．2％),需依杖行走34例(28．3％),仍卧床休养但意识清楚4例(3．3％)。总有效率96．7％。结论CT导向颅钻孔抽吸治疗脑出血,比开颅清除血肿手术安全、方便,值得推荐。     

CT and MR imaging findings of xanthogranulomatous cholecystitis: correlation with pathologic findings

The aim of this study was to evaluate CT and MRI findings in xanthogranulomatous cholecystitis (XGC) and to correlate the imaging findings with various pathologic parameters. The study included 13 patients with histopathologically confirmed XGC. The CT (n=13) and MRI (n=5) obtained in these patients were evaluated retrospectively. On CT, low-attenuation areas in the wall of XGC correlated with foam and inflammatory cells or necrosis and/or abscess in XGC. Areas of iso- to slightly high signal intensity on T2-weighted images, showing slight enhancement at early phase and strong enhancement at last phase on dynamic study, corresponded with areas of abundant xanthogranulomas. Areas with very high signal intensity on T2-weighted images without enhancement corresponded with necrosis and/or abscesses. Luminal surface enhancement (LSE) of gallbladder wall represented preservation of the epithelial layer. The early-enhanced areas of the liver bed on dynamic CT and MR images corresponded with accumulation of inflammatory cells and abundant fibrosis. Our results indicate that CT and MRI findings correlate well with the histopathologic findings of XGC.     

Abdominal aspergillosis: CT findings

Objective

In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients.

Materials and methods

CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients (5 women, 1 man; mean age, 43.4 years; range, 23-59 years) with pathologically proved abdominal aspergillosis by two gastrointestinal radiologists in consensus. Medical records were also reviewed to determine each patient's clinical status and outcome.

Results

All patients were immunocompromised state: 4 patients received immunosuppressive therapy for solid organ transplantation and 2 patients received chemotherapy for acute myeloid leukemia. Aspergillosis involved blood vessels (n = 3), liver (n = 2), spleen (n = 2), gastrointestinal tract (n = 2), native kidney (n = 1), transplanted kidney (n = 1), peritoneum (n = 1), and retroperitoneum (n = 1). CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum.

Conclusion

Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis.     

Functional circulation time images in the diagnosis of cerebral lesions by angio CT

An application of angio CT as an adjunct to contrast enhancement evaluation of cerebral lesions is presented. We performed rapid sequential scanning following intravenous bolus injection of an iodinated contrast medium, analyzed the time contrast curves and generated a functional circulation time image. This was accomplished by calculating on a pixel-by-pixel basis the first mathematical moment of the monitored time-density curves about injection time which corresponds to regional arm brain circulation time (rABCT). This method increased the rate of detection of cerebral lesions by contrast enhancement from 30 to 90%.     

外伤性脑梗死的CT诊断(附39例分析)

目的：探讨螺旋CT在外伤性脑梗死诊断中的价值及其特征。方法：对39例头颈部外伤后临床主要表现为不同程度的偏瘫患者行横断面螺旋CT扫描,分析外伤性脑梗死的CT表现。结果：根据临床和CT表现分为两型：I型(21例),外伤性腔隙性脑梗死,好发于基底节-内囊区,均位于豆状核、尾状核及内囊区,呈小片状腔隙性低密度区;Ⅱ型(18例),外伤性大面积脑梗死,为脑叶梗死呈扇形低密度区,与大脑前中后供血动脉或颈内动脉分布一致,范围较大。结论：螺旋CT扫描检查对外伤性脑梗死的准确诊断、估计病变程度,分析两型脑梗死的不同发生机制,为临床诊断、治疗及判断预后提供重要信息。