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Biomedical subjects

M D Deck

Publications and source records attributed to M D Deck.

At least 55 records · Page 3Linked to original sources
PubMed1986

Comparison of magnetic resonance imaging and computed tomography in the evaluation of head injury.

Thirty-five patients who had incurred head trauma were studied with computed tomography (CT) and magnetic resonance imaging (MRI). CT was performed using a General Electric 8800 scanner. MRI was conducted with a Technicare Teslacon system using a 5.0 kG (0.5 T) magnetic field. Clinically, patients varied from those with mild concussions without focal neurological signs to those with severe neurological dysfunction including posttraumatic coma. MRI was superior to CT in imaging 23 of 41 extracerebral fluid collections, both in estimating the size of the collections and in diagnosing small collections. MRI was also superior to CT in distinguishing chronic subdural hematomas from hygromas. Further, MRI was superior to CT in visualizing nonhemorrhagic contusion in 15 of 21 lesions. Because of the potential failure of MRI to diagnose acute subarachnoid or acute parenchymal hemorrhage, CT remains the procedure of choice in diagnosing head injury less than 72 hours old.

Adolescent↗
PubMed1986

Periventricular hyperintensity as seen by magnetic resonance: prevalence and significance.

Periventricular hyperintensity was identified using long repetition and echo times in spin-echo magnetic resonance imaging of patients with white-matter disease (e.g., multiple sclerosis) caused by local demyelination and in hydrocephalic patients caused by transependymal migration of spinal fluid. A review of 365 consecutives studies revealed that some degree of periventricular hyperintensity is present in most patients (93.5%) regardless of diagnosis. Mild periventricular hyperintensity was seen in patients with no other evidence of intracranial pathology. Periventricular hyperintensity is a normal finding that should not be considered indicative of either demyelinating disease or hydrocephalus. More extensive and severe periventricular hyperintensity is associated with intracerebral pathology, but the finding often is nonspecific. For example, mild periventricular edema from hydrocephalus is impossible to differentiate from the increased periventricular hyperintensity seen in patients with multiple white-matter lesions. Thus, the pattern of periventricular hyperintensity has proven to be of limited value in the clinical assessment of hydrocephalic patients.

Adolescent↗
PubMed1986

Focal recurrent hemorrhage on magnetic resonance at 0.5 tesla. An aid to the diagnosis of cryptic cerebral vascular malformations.

The MR appearance of focal recurrent hemorrhage is characteristic and highly suggestive of an underlying cryptic vascular malformation. We reviewed the MR findings in 14 cases (3 biopsy proven), 9 in the brainstem and 5 supratentorial. CT in all cases demonstrated the lesion to be hyperdense before contrast with minimal to moderate enhancement post contrast. The angiograms were negative in all 14 cases demonstrating mass effect in some but no blush or neovascularity. MR showed focal hyperintensities on both short (T1) and long (T2) TR sequences surrounded by a well-circumscribed hypointense rim particularly on the long TR sequence. Focal central hyperintensity is felt to be secondary to the presence of methemoglobin and indicates relatively recent hemorrhage. In our experience hyperintensity in a solitary hemorrhage usually resolves in 4-6 weeks. In 8 cases serial MR studies over 2-3 years demonstrated evidence of repeated hemorrhage as manifested by increases in size and persistent or new hyperintensity. The intense rim due to a short T2 did not correlate with vessels angiographically nor with calcification on the pre-contrast CT and, therefore, does not represent the vascular malformation itself but rather some portion of the hematoma, possibly the hemosiderin laden capsule. Using CT and angiography alone it is difficult to differentiate cryptic arteriovenous malformations from a neoplasm particularly in the brainstem. MR's specific configuration of focal recurrent hemorrhage can make a more definitive diagnosis at 0.5 T as well as at 1.5 T.

Adult↗
PubMed1985

Sellar and juxtasellar lesion detection with MR.

We compared the effectiveness of magnetic resonance (MR) imaging and computed tomography (CT) in evaluating sellar and juxtasellar lesions. Fifty-five lesions were imaged with a Technicare 0.5-T superconducting MR imager and GE 9800 and 8800 CT scanners: 26 pituitary adenomas (including six microadenomas), six craniopharyngiomas, two empty sellae, five meningiomas, four optic chiasmal gliomas, five hypothalamic gliomas, two giant aneurysms, and one each of teratoma, gasserian ganglion neuroma, histiocytoma, cholesteatoma, and metastases. Although CT scans showed the abnormalities in most cases, MR was superior in delineating distortions of the optic chiasma and other suprasellar structures, and in demonstrating the status of the carotid arteries. MR can reveal fat, hematoma, and cyst and can be used to differentiate the pathologic features of many lesions. Microadenomas that do not enlarge the sella were not demonstrated with current MR techniques.

Adenoma↗
PubMed1985

MRI assessment of human callosal surgery with neuropsychological correlates.

MRI imaging using recovery and spin-echo techniques was carried out on three patients after surgical section of the corpus callosum to control intractable epilepsy. The scans revealed that the total callosotomy had been obtained in two patients, while partial sparing of splenial and rostral fibers was seen in the third.

Corpus Callosum↗
PubMed1985

MR imaging of syringomyelia and hydromyelia.

The relative effectiveness of plain computed tomography (CT), metrizamide CT, conventional myelography, and magnetic resonance (MR) imaging was compared for the examination of cystic spinal cord lesions. Intramedullary cavities in 18 patients were demonstrated by MR imaging: cavities were uncomplicated in 13 patients, associated with spinal tumors in two, and studied after occipital craniectomy for treatment of Chiari malformation and syringomyelia in two. Cavities were shown by MR imaging in all enlarged spinal cords, but a cavity was shown in only one of four small cords. The rostral limits of the cavities were demonstrated better than were the caudal extensions. Ventricular communication was not demonstrated. Chiari malformation was shown only in cavities that did not involve the medulla. Syringes associated with tumor were indistinguishable from uncomplicated cavities, but the tumor had abnormal signal on long spin-echo sequences in two cases. Cystic cord tumor (one case) had an inhomogeneous appearance. Caudal displacement of the cerebellar hemisphere through the surgical defect associated with compression of the fourth ventricle was shown in two cases after posterior fossa craniectomy. Thirteen patients were studied with metrizamide CT also. MR imaging proved to be as accurate as metrizamide CT in the diagnosis of intramedullary cavities that result in spinal cord enlargement, but it was less sensitive in detecting cavities within normal-sized or diminished spinal cords. It had the advantage that tumor tissue could be distinguished from associated syrinx cavities by differences in signal characteristics; and cerebellar ectopia was evaluated easily on sagittal MR views.

Arnold-Chiari Malformation↗
PubMed1984

Cranial nuclear magnetic resonance imaging in head trauma.

Nuclear magnetic resonance imaging revealed focal intracranial lesions consisting of extraaxial hematomas or nonhemorrhagic contusions in 3 patients with severe neurological disability following head trauma. In all 3, standard skull radiography and computed tomography had been unremarkable.

Adult↗
PubMed1984

Metronidazole in the treatment of metastatic brain tumors. Results of a controlled clinical trial.

We measured the effect of the radiation enhancer metronidazole on patients with metastatic brain tumors undergoing radiation therapy (RT) in a randomized controlled study. Metronidazole was given in a dose of 6 g/m2 4 hr before each of the first 3 doses of RT to the whole-brain. A total of 3000 rad was delivered in 6 doses. Patients were followed by serial neurological examinations and CT scans. The metronidazole group did not differ from the control group when measured in terms of survival, clinical improvement or improvement on CT scan, whether measured 2 months or 6 months following treatment. Nausea and vomiting was a significant side effect, preventing about 10% of patients from completing the treatment. Metronidazole appears to have no substantial radiation enhancing effect on metastatic brain tumors.

Anticonvulsants↗
PubMed1984

Posterior fossa lesions: magnetic resonance imaging.

Studies of 40 patients with abnormalities of the posterior fossa shown on magnetic resonance (MR) imaging were reviewed and compared with CT scans. Thirteen lesions were demonstrated on MR only. Twenty-four lesions were shown on CT but MR provided more data. Three lesions were better shown on CT than on MR. MR is superior to CT because of the lack of streak artifacts and better contrast discrimination. At least two imaging sequences are required for evaluation of the lesions.

Brain Diseases↗
PubMed1983

Intra-arterial BCNU in the treatment of metastatic brain tumors.

Thirty-one patients with metastatic brain tumors that either failed to respond or recurred after conventional therapy were treated by intra-arterial infusion of 100 mg/m2 of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) into either a carotid or vertebral artery. Five patients (three with lung cancer, one with breast cancer and one with melanoma) had a partial response of the tumor(s) in the distribution of the injected artery. In two patients, brain metastases not in the distribution of the injected artery enlarged, while the tumors perfused by the injected artery responded. In one of these patients, subsequent infusion of BCNU to the enlarging tumor resulted in a partial response. Among responders, the median survival following onset of BCNU was 17 weeks. One patient remains alive and well at 30 weeks. No permanent neurological, retinal or systemic toxicity was observed.

Adult↗
PubMed1982

An inexpensive video patient repositioning system for use with transmission and emission computed tomographs.

We have designed and constructed a portable video system from commercially available components (total cost $5,000) to facilitate accurate patient repositioning for sequential computed tomographic (CT) and positron emission tomographic studies and for therapeutic radiation therapy. The repositioning accuracy of the video system, employed in conjunction with a Delta-Scan 2020 CT scanner, was compared qualitatively (skull phantom and patient subjects) and quantitatively (precision cone phantom) with that of a GE 8800 CT scanner equipped with ScoutView and crossed Gammex lasers (SVL system). Although the SVL and video systems both facilitated accurate repositioning, the video system proved slightly superior. With experience, Z-axis repositioning accuracy of better than 1 mm could be achieved.

Humans↗
PubMed1981

CT scans of long-term survivors of various childhood malignancies.

Forty-two children with various systemic malignancies in continuous remission for 1 to 3 years after the completion of chemotherapy had CT scans with normal ventricular dimensions, similar to a noncancer "control" population. Seventeen of these patients had acute lymphocytic leukemia (ALL) treated either with prophylactic cranial irradiation and intrathecal methotrexate [7] or intrathecal methotrexate alone [10] and the remaining 25 patients had soft tissue sarcomas. Sixteen other patients with sarcomatous meningitis had enlarged ventricles while on chemotherapy. Nine had ALL. Seven had soft tissue sarcomas, none of whom received any prior CNS irradiation or intrathecal chemotherapy. In this retrospective study no evidence of hydrocephalus or significant white matter hypodensity was detected in long-term survivors of childhood cancer, regardless of whether prophylactic intrathecal chemotherapy and/or cranial irradiation was given. Direct involvement of the CNS with meningeal cancer was the most important association with ventriculomegaly.

Adolescent↗
PubMed1981

Metastasis to the base of the skull: clinical findings in 43 patients.

We studied 43 patients with metastases to the base of the skull to determine whether clinical symptoms localized the lesions accurately. We identified five clinical syndromes: orbital, parasellar, middle fossa, jugular foramen, and occipital condyle. The orbital and parasellar syndromes were characterized by frontal headache, diplopia, and first-division trigeminal sensory loss. Proptosis occurred with the orbital but not the parasellar syndrome. The middle-fossa syndrome was characterized by facial pain or numbness. The jugular foramen syndrome was characterized by hoarseness and dysphagia, with paralysis of the ninth through eleventh cranial nerves. The occipital condyle syndrome was characterized by unilateral occipital pain and unilateral tongue paralysis.

Adolescent↗
PubMed1981

Lateral and third-ventricular CSF formation after metrizamide CT ventriculography.

We calculated the rates of lateral and third-ventricular (LTV) cerebrospinal fluid (CSF) formation in three patients undergoing metrizamide computed tomography (CT) ventriculography with reference to Ct estimates of ventricular volume and the time course of LTV metrizamide washout (elimination). Elimination rate constants for metrizamide were derived from measurements of LTV metrizamide concentration on serial postventriculography CT scans, and LTV volumes were estimated by partial volume analysis. CSF formation in the combined lateral ventricles averaged 0.14 ml per minute, and third-ventricular CSF formation averaged 0.014 ml per minute. Thus, the third ventricle accounted for approximately 10% of total LTV CSF production, which accords with relative weights of choroid plexus tissue in the lateral and third ventricles.

Adult↗
PubMed1981

Pituitary metastasis: incidence in cancer patients and clinical differentiation from pituitary adenoma.

Symptomatic pituitary metastases are uncommon and may be difficult to differentiate from pituitary adenomas. In order to ascertain the incidence of pituitary tumors in cancer patients and to characterize the clinical presentation of pituitary metastases, we reviewed the clinical experience with these tumors at Memorial Sloan-Kettering Cancer Center (MSKCC) during the period 1976-1979 and a recent series of 500 consecutive autopsies in which the pituitary fossa and gland were examined. In the clinical series, a histologic diagnosis was made in three of five patients. Radiologic evaluation, including polytomography and computed tomography, did not reliably distinguish metastasis from adenoma, but the clinical syndromes were distinctive. In the autopsy series, pituitary metastases were found in 3.6% of cases, pituitary adenomas in 1.8%.

Adenoma↗
PubMed1981

Radiation necrosis after treatment of solitary intracranial metastases.

During the period from July 1977 to June 1980, 75 patients underwent the surgical excision of solitary brain metastases, and 61 of these patients received whole brain radiation. Three patients developed chronic radiation necrosis. In the 3 patients with necrosis, computed tomography suggested recurrent tumor; the histological diagnosis of necrosis only was obtained at operation in 2 of these patients and by autopsy in the third. Radiation damage resulted in the death of 1 patient, a chronic vegetative state in another, and severe neurological deficit in the third. An additional 4 patients had neurological complications probably related to radiation therapy. As the survival of such patients is prolonged by aggressive treatment, the incidence of radiation-induced complications is likely to increase. The optimal dose of radiation necessary to destroy microscopic foci of tumor after the surgical resection of a single brain metastasis is unknown. Because of the significant incidence of damage after radiation as currently delivered, studies using graded, lower doses are indicated.

Adenocarcinoma↗