Biomedical subjects
Publications and source records attributed to C F Lanzieri.
Solitary osteochondromas rarely occur in the axial skeleton. These benign tumors may cause a variety of symptoms while remaining difficult to recognize by plain radiographic and myelographic studies. We present three cases of solitary osteochondromas of the spine and demonstrate the CT findings of these unusual tumors.
An avascular, contrast enhancing intraosseous petrous apex mass was discovered on CT in a patient with prior colonic carcinoma and acute myelocytic leukemia. A normal bone scan made metastasis unlikely and surgery revealed a neuroma. The differential diagnosis is discussed.
Intracranial hypotension, which is most commonly caused by lumbar puncture, can lead to intense meningeal enhancement, which resolves on its own once the intracranial hypotension has been corrected. The characteristic clinical presentation of severe postural headaches with a low opening CSF pressure on subsequent lumbar puncture and a history of prior dural puncture should alert one to the diagnosis, thus avoiding an extensive workup for carcinomatosis or infection.
Stereotactic biopsy of intracranial lesions has been used primarily for the diagnosis of neoplastic lesions. A series of 158 consecutive stereotactic biopsies performed at The Cleveland Clinic Foundation resulted in 28 diagnoses of non-neoplastic disorders (18%). The majority of these were infectious, inflammatory, or demyelinating disorders. Stereotactic biopsy alone was diagnostic in 17 cases (61%), and biopsy in conjunction with clinical and laboratory data established definitive diagnoses in six cases (22%). All 23 definitive diagnoses led to modifications in patient management. Permanent neurologic morbidity occurred in only two patients (7%). We maintain that this procedure is underused. Stereotactic biopsy is safe, accurate, and useful for diagnosis of non-neoplastic neurologic disorders when the diagnosis is unclear by conventional means. In such cases, its use can lead to early diagnosis and treatment.
PURPOSE: We retrospectively explored the use of the delayed mask technique for intraarterial digital subtraction angiography (IADSA) to demonstrate the anatomy of aneurysm necks. METHODS: The delayed mask technique was utilized in 22 patients who had craniotomies for aneurysms demonstrated at angiography. The operative notes were compared to the angiographic findings of both the traditionally masked IADSA and the delayed mask IADSA. In addition, an in vitro model was constructed to examine the relationship between the size of the aneurysm neck and the ability to indirectly define its anatomy by demonstrating the flow jet. RESULTS: In 12 of 22 cases, the delayed mask technique demonstrated a systolic jet that was not demonstrated by traditional subtraction techniques. In nine of 12 cases, the delayed mask technique gave more specific information regarding the size, location, and orientation of the aneurysm neck. CONCLUSION: The delayed mask technique can add important information regarding the anatomy of aneurysm without adding time or risk to the procedure.
A neurenteric cyst of the spine is a rare congenital disorder secondary to alimentary duplication and vertebral malformation. It should, however, be included in the differential diagnosis of an intradural, extramedullary spinal lesion. We present a case of a cervical neurenteric cyst associated with Klippel-Feil syndrome and discuss the clinical, radiologic, histopathologic, immunohistochemical and embryologic characteristics of this disorder.
Four patients with Sturge-Weber syndrome were evaluated with CT and MR. MR demonstrated the characteristic features of the disease: cerebral atrophy (four patients), ipsilateral bone and sinus hypertrophy (three), ocular findings (one), intracranial calcification (four), prominent deep venous system (three), and enlarged choroid plexus (two). CT demonstrated the following: cerebral atrophy (four), ipsilateral bone and sinus hypertrophy (three), calcification (four), gyral enhancement (two), prominent deep venous system (two), and enlarged choroid plexuses (three). The features of Sturge-Weber syndrome were visualized equally well with MR and CT with the exception of intracranial calcification. Conventional spin-echo MR revealed fewer calcifications, and those visualized appeared smaller than with CT. Gradient-echo acquisition sequences were more effective in the detection of intracranial calcification.
Sciatic and lower extremity neurologic symptoms may be from pathologic involvement of the sacral plexus or sciatic nerve in the region of the greater sciatic foramen. Twenty-five patients were reviewed who presented consecutively over a 4 year period with sciatic symptoms secondary to pathologic changes in the greater sciatic foramen. Malignant neoplasm alone (18 patients) and malignant neoplasm associated with infection (two patients) account for most of these cases. Neurogenic tumors (three patients), both benign and malignant, and infection alone (three patients) were less frequent. Although sciatic symptoms usually derive from spinal abnormalities, the evaluation of sciatic symptoms should not be considered complete without CT scanning of the greater sciatic foramen.
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The ability to diagnose adverse postcraniotomy or postcraniectomy events is essential for proper postoperative care. The importance of identifying postoperative changes on CT has previously been shown. The purpose of this study is to assess the normal and abnormal MR changes that may be seen in the postcraniotomy/postcraniectomy period. The postoperative MR, CT, and medical records of 41 postcraniotomy patients and 26 postcraniectomy patients were reviewed. Reasons for choosing craniectomy over craniotomy included decompression, infected flap, bony involvement by tumor, and posttraumatic skull. In general, the postoperative normal anatomy was better seen with MR. Postoperative events included hemorrhage (two), infection (five), cyst formation (10), and recurrent tumor (five). In general, MR was found to be more useful than CT for the detection of hemorrhage and infection after craniotomy or craniectomy and for the proper localization of postoperative cysts. MR proved to be a useful method for following postoperative sites in the skull.
The foramen of Vesalius is a small, variable but consistently symmetrical structure located anteromedial to the foramen ovale and lateral to the foramen rotundum and vidian canal. It transmits an emissary vein through which the cavernous sinus and pterygoid plexus communicate. Fifty high-resolution CT scans of the skull base and two three-dimensional (Cemax) reconstructions were reviewed to determine criteria for defining the normal appearance of the foramen of Vesalius. Three normal types were classified: (1) a well-formed foramen, 1-2 mm in size (n = 32); (2) lack of visualization of the foramen (n = 11); and (3) partial assimilation of the foramen with the foramen ovale (n = 7). The foramen was remarkably symmetric in a large number of cases (n = 48). Asymmetry signified abnormality in four of the six cases. Abnormal causes of asymmetry included invasion by nasopharyngeal melanoma, angiofibroma, carotid cavernous fistula with drainage through the emissary vein, and neurofibromatosis. Thus, for these usually symmetric foramina of Vesalius, asymmetry is more likely the result of a pathologic process than a normal variant.
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Twenty-six consecutive patients with pulsatile neck masses were studied with digital subtraction angiography (DSA) by venous injection, computed tomography (CT), and conventional direct angiography. The neck masses proved to be secondary to tortuous and ectatic carotid or subclavian arteries in 13 cases, resulted from subclavian artery aneurysms in three cases, and resulted from tumor in 10 cases. DSA alone was sufficient for diagnosis in 16 of 26 cases. CT was performed in 15 cases and was contributory in 10. It was most useful when a tumor was demonstrated or suspected on DSA. Conventional angiography was performed in six cases. It contributed no useful information when arteriosclerotic vascular changes were the source of the neck mass, and added useful diagnostic information in only two of 10 neck tumors.
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We report two cases of Menkes kinky hair disease in which MR and MR angiography were performed. The clinical and imaging features are reviewed. MR demonstrated characteristic cerebrovascular tortuousity and thus may be a valuable aid in diagnosis and follow-up.
We report a case of progeria and the utility of visualizing the cerebrovascular anatomy by using MR angiography. A 4-year-old child with Hutchinson-Guilford syndrome developed symptoms of ischemia and MR angiography showed bilateral occlusion of internal carotid and vertebral artery origins; the anterior spinal artery was prominent.