Biomedical subjects
Publications and source records attributed to G Wilms.
Except for glioblastomas, metastases of astrocytomas and of intracerebral tumors are in general very rare. It is well known that the process of spreading can be provoked or accelerated by surgical procedures. The presented patient, with the initial diagnosis of grade III astrocytoma developed peritoneal metastases after placement of a ventriculo-peritoneal shunt.
A case of congenital agenesis of the cervical internal carotid artery with rerouting via the inferior tympanic artery and the embryonic hyoid artery to the horizontal internal carotid artery is presented. At otoscopy the anomaly simulated a glomus tumor. CT scan, by demonstration of the absence of the vertical portion of the carotid canal, the enlargement of the inferior tympanic canaliculus, and the soft tissue mass within the middle ear in continuity with the horizontal internal carotid artery, diagnosed the anomaly very accurately.
A case of fatal intracranial aspergillosis, extending from the sphenoid sinus via the orbit into the subarachnoid space of the optochiasmatic cistern and the cistern of the middle cerebral artery is presented in an immunosuppressed patient with multiple myeloma. Adequate treatment was not instituted and the patient died because the condition was not recognised and interpreted as a soft tissue extension of an orbital localization of myeloma. MRI, especially after intravenous injection of Gadolinium, depicted very accurately the extension of the disease, as defined at autopsy.
Intraspinal synovial or ganglion cysts of the cervical spine are rare. We present the third reported case of a degenerative articular cyst of the upper cervical spine, involving the quadrate ligament of the odontoid process. Magnetic resonance examination reveals typical images. A new, more general terminology is proposed.
Thirty-seven patients with chronic low-back pain and an atypical irradiation to one or both legs were examined by conventional tomography of the facet joints. A disc herniation was excluded by computed tomography (CT) in 31 patients. The facet joints were considered normal in 4 patients. Four grades of facet joint disease were used to classify the pathological changes. Correlation of the radiological findings with the facet joint block by injection of a local anesthetic was obtained in 12 patients. It appears that conventional tomography is a very sensitive technique as it is possible to detect even discrete abnormalities of the facet joints. However, as it is time consuming and high in radiation dose, the examinations should be reserved for patients with a normal CT examination of the lumbar spine in whom there still remains a high suspicion of facet joint disease.
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Localized proton spectroscopy of the brain was performed on MS patients (n = 18) and the results are compared with those of a control group (n = 17). The experiments were performed in a 1.5-T Siemens Magnetom using the stimulated echo method and selective water suppression. Acquisition parameters were TR/TE/TM = 3000/270/30 ms, NA = 256, and Acq = 13 min. Localized volumes ranged from 8 to about 80 cc. The patients (ages 25 to 66) were at various stages of the disease. Three of the eighteen patients did not show any plaques on the MR images. VOIs were chosen to contain as much plaque volume as possible in the cerebrum white matter. In the controls and in the patients with no plaques, the VOI were localized in similar white matter regions. All spectra were characterized by the presence of Cho (3.2 ppm), PCr + Cr (3.0 ppm), and NAA (2.0 ppm). The ratios NAA/Cho and NAA/(PCr + Cr) were calculated for both the MS and the control group. The results for the three MS patients with no detectable plaques did not differ significantly from the results of the control group. The former group is, however, too limited to draw any conclusion for the moment. For the MRI positive patients, the following values were found (means +/- 1 SD); NAA/Cho = 1.98 +/- 0.33 and NAA/(PCr + Cr) = 2.16 +/- 0.14. In the normals, these values were NAA/Cho = 2.54 +/- 0.39 and NAA/(PCr + Cr) = 2.76 +/- 0.25. The results quoted are TR and TE dependent.(ABSTRACT TRUNCATED AT 250 WORDS)
MRI was performed in 41 patients with ocular lesions: 27 cases of malignant melanoma, 5 of haemorrhage, 3 of choroidal metastasis, 3 of senile disciform macular degeneration, 2 retinoblastomas and 1 hamartoma. On MRI 5 small lesions (less than 2 mm thick): 1 melanoma, the 3 metastases and the hamartoma, were not seen. All the malignant melanomas visualised were hyperintense compared to the vitreous on T1-weighted images. On T2-weighted images 24 of 26 lesions were hypointense compared to the vitreous. The remaining two lesions were almost isointense, corresponding to amelanotic lesions. These MRI features did not differ significantly from those of retinoblastomas, senile disciform macular degeneration or subacute choroidal haemorrhage. Major shortcomings of MRI in lesions of the globe lie in a lack of spatial resolution and poor specificity of the findings.
The radiologic findings in a case of an extradural diploic epidermoid tumor (ET) of the frontal bone, examined with plain X rays, CT and MRI, are reported. A head injury with traumatic inclusion of epidermis could have been the origin of the tumor. This report stresses the importance of the plain skull X ray in the diagnosis of extradural ET.
Up to 5 years ago, the radiological diagnosis of leukodystrophy was based on computed tomography (CT). More recently, magnetic resonance imaging (MRI) has been used to study pathology of the white matter with great success. The abnormalities in eight patients with different types of leukodystrophy are described, using high-field MRI. CT and MRI show comparable sensitivity in detecting the pathological changes of leukodystrophy. MRI seems to be superior in visualizing the extent of the lesions, their precise anatomical location and any involvement of the brain stem and cerebellum. Differential diagnosis among the three types of leukodystrophy by MRI is difficult but may be attempted by some features. Specific diagnosis can be achieved only by laboratory examination or histology. The role of MRI should be to suggest the proper biochemical test at an earlier stage.
Two patients with ruptured intracranial dermoids, examined with both CT and MRI are reported. Clinical presentation was transient cerebral ischemia in one patient and acute meningeal signs in the other. CT scan showed typical fat density of the tumor and the subarachnoid space. On MRI both the tumor and the subarachnoid fat, were strongly hyperintense on T1-weighted images.
A case of a congenital nasolacrimal mucocele is reported. This very uncommon finding presents usually with a diagnostic triad on CT: an intranasal cystic mass, a dilated nasolacrimal duct and lacrimal sac.
Laser angioplasty with direct argon laser light, combined with a special centering balloon (Lastac system) was performed in 12 patients with a single superficial femoral artery occlusion. The mean length of the occlusion was 5.4 +/- 2.15 cm with a mean duration of occlusion of 7.8 +/- 5.9 months. Initial angiographic success was obtained in 9/12 procedures. Reason of failure was perforation in 1 patient and impossibility to pass the stenosis due to calcifications in 2 patients. Early rethrombosis in 1 patient reduced the primary success rate to 8/12 procedures. Peripheral emboli occurred in 2 patients, both successfully treated by thrombolysis or surgery. Of the 8 recanalized arteries, all remained patent with a mean follow-up of 7.1 +/- 0.68 months. It remains to be determined on larger series whether the Lastac system offers substantial advantages over other, less expensive systems of laser angioplasty.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
A case of isolated unilateral extraocular muscle myositis following an acute upper respiratory tract infection is reported. Painful eye movements, restricted eye motility and exophthalmus but a normal visual acuity are the most important clinical findings. High resolution contrast enhanced CT and MRI are the imaging modalities of choice to differentiate from other orbital pathologies. The solitary enlarged muscle was clearly seen on both the contrast enhanced CT and the MR examination. Preseptal cellulitis was better seen on MRI, whereas high resolution CT was superior in the demonstration of periscleritis. Graves' ophthalmopathy and orbital cellulitis first have to be excluded. Corticosteroids are the therapy of choice in orbital myositis. A control, contrast enhanced CT after 4 weeks showed an almost normal muscle.