Cauda Equina Intradural Extramedullary Cavernous Haemangioma: Case Report and Review of the Literature

Cavernous haemangioma (cavernoma) is a benign vascular lesion, exceptionally located in cauda equina. We report a case, diagnosed and operated in the Department of Neurosurgery from Pitesti County Emergency Hospital, of a 60-year-old woman with history of lumbar region distress, who presented with low back pain, paravertebral muscle contracture, and bilateral lumbar radiculopathy, with sudden onset after lifting effort. The preoperative diagnosis was done using computed tomography (CT) and magnetic resonance imaging (MRI), and the patient underwent surgery—two level laminectomy, dural incision, and tumor dissection from the cauda equina nerve roots under operatory microscope. Histopathological examination confirmed the positive diagnosis of cavernoma of cauda equina. The patient''s outcome was favorable, without postoperative neurological deficits.     

Soluble CD30 concentrations in ESRD patients with and without panel reactive HLA antibodies

BACKGROUND: In this retrospective study we compared accuracy of panel reactive antibodies (PRA) with serum soluble CD30 (sCD30) contents in predicting acute rejection crisis post-renal transplant. METHODS: Pre-transplant sera from 115 patients were evaluated for their PRA and sCD30 concentrations. All patients received calcineurin inhibitor-based immunosuppressive therapy. Objective measurements for rejection were biopsy-proven acute rejection (AR) episodes within first six months of the transplant. Post-transplant sera of patients with AR were tested for the presence of donor-specific HLA antibodies (DSA). RESULTS: Overall AR rate was 16% (18/115). Patients positive for PRA and sCD30 tests were at significantly higher risk for AVR compared with those patients negative for both the tests (36% vs. 5%, p=0.01). Among negative PRA patients risk for AR was significantly elevated if they were also tested positive for sCD30 concentrations (21% vs. 5%, p=0.04). Of the 18 patients with AR, 14 were positive for sCD30, and 13 of them (93%) developed DSA post-transplant (p=0.001). CONCLUSION: These data showed that patients positive for sCD30 contents are at high risk for the development of DSA and AR post-transplant regardless of their pre-transplant PRA.     

Half‐fourier‐acquisition single‐shot turbo spin‐echo (HASTE) MRI of the lung at 3 Tesla using parallel imaging with 32‐receiver channel technology

Purpose

To assess the feasibility of half‐Fourier‐acquisition single‐shot turbo spin‐echo (HASTE) of the lung at 3 Tesla (T) using parallel imaging with a prototype of a 32‐channel torso array coil, and to determine the optimum acceleration factor for the delineation of intrapulmonary anatomy.

Materials and Methods

Nine volunteers were examined on a 32‐channel 3T MRI system using a prototype 32‐channel‐torso‐array‐coil. HASTE‐MRI of the lung was acquired at both, end‐inspiratory and end‐expiratory breathhold with parallel imaging (Generalized autocalibrating partially parallel acquisitions = GRAPPA) using acceleration factors ranging between R = 1 (TE = 42 ms) and R = 6 (TE = 16 ms). The image quality of intrapulmonary anatomy and subjectively perceived noise level was analyzed by two radiologists in consensus. In addition quantitative measurements of the signal‐to‐noise ratio (SNR) of HASTE with different acceleration factors were assessed in phantom measurements.

Results

Using an acceleration factor of R = 4 image blurring was substantially reduced compared with lower acceleration factors resulting in sharp delineation of intrapulmonary structures in expiratory scans. For inspiratory scans an acceleration factor of 2 provided the best image quality. Expiratory scans had a higher subjectively perceived SNR than inspiratory scans.

Conclusion

Using optimized multi‐element coil geometry HASTE‐MRI of the lung is feasible at 3T with acceleration factors up to 4. Compared with nonaccelerated acquisitions, shorter echo times and reduced image blurring are achieved. Expiratory scanning may be favorable to compensate for susceptibility associated signal loss at 3T. J. Magn. Reson. Imaging 2009;30:541–546. © 2009 Wiley‐Liss, Inc.     

Four‐dimensional velocity‐encoded magnetic resonance imaging improves blood flow quantification in patients with complex accelerated flow

Purpose:

To evaluate the use of four‐dimensional (4D) velocity‐encoded magnetic resonance imaging (VEC MRI) for blood flow quantification in patients with semilunar valve stenosis and complex accelerated flow.

Materials and Methods:

Peak velocities (Vmax) and stroke volumes (SV) were quantified by 2D and 4D VEC MRI in volunteers (n = 7) and patients with semilunar valve stenosis (n = 18). Measurements were performed above the aortic and pulmonary valve with both techniques and, additionally, at multiple predefined planes in the ascending aorta and in the pulmonary trunk within the 4D dataset. In patients, 4D VEC MRI streamline analysis identified flow patterns and regions of highest flow velocity (4D_{max‐targeted}) for further measurements and Vmax was also measured by Doppler‐echocardiography.

Results:

In patients, 4D VEC MRI showed higher Vmax than 2D VEC MRI (2.7 ± 0.6 m/s vs. 2.4 ± 0.5 m/s, P < 0.03) and was more comparable to Doppler‐echocardiography (2.8 ± 0.7 m/s). 4D_{max‐targeted} revealed highest Vmax values (3.1 ± 0.6 m/s). SV measurements showed significant differences between different anatomical levels in the ascending aorta in patients with complex accelerated flow, whereas differences in volunteers with laminar flow patterns were negligible (P = 0.004).

Conclusion:

4D VEC MRI improves MRI‐derived blood flow quantification in patients with semilunar valve stenosis and complex accelerated flow. J. Magn. Reson. Imaging 2013;37:208–216. © 2012 Wiley Periodicals, Inc.     

P53 gene mutations in acute myeloid leukemia with 17p monosomy

We looked for mutations of exons 5 to 8 of the P53 gene in 10 patients with acute myeloid leukemia (AML) and 17p monosomy, and 36 patients with AML and no cytogenetic abnormalities of 17p. DNA was analyzed by polymerase chain reaction, single-strand conformation polymorphism analysis, and nucleotide sequencing. Four of the 10 patients with 17p monosomy showed point mutation, single-nucleotide deletion, or insertion in exons 7 or 8. By contrast, only 1 of the 36 patients with AML and no cytogenetic abnormalities of 17p showed a mutation of the P53 gene in exons 5 to 8 (P less than .01). These results suggest that alterations of the P53 gene may have a role in leukemogenesis in some cases of AML. The fact that P53 gene mutations occurred more often in patients with 17p monosomy seems to support the "recessive" model of tumor suppressive activity of the P53 gene rather than the "dominant" model, in which alteration of only one allele is sufficient for the development of malignancy.     

Lipomatous tumors of the liver: evaluation with CT and US

Seven cases of lipomatous masses within the liver parenchyma were demonstrated with computed tomography (CT). Five of these cases were obtained from a retrospective review of 50 cases of renal angiomyolipoma in which the liver was adequately demonstrated. The other two cases were from the files of the Armed Forces Institute of Pathology and had no associated renal lesions. Three of the five cases were associated with tuberous sclerosis. In all seven cases, the fatty tumors appeared on CT scans as a well-defined, 0.8-13-cm mass, with attenuation coefficients of less than -30 HU. On ultrasound studies, the lesions were well circumscribed, highly echogenic, and similar to hemangiomas. While distinctly rare lesions, these lipomatous masses are not as unusual as the literature would indicate. One may anticipate such masses in patients with renal angiomyolipomas and in a relatively high percentage of those with tuberous sclerosis.