One hundred six patients with a known or suspected diagnosis of bone cancer (11 patients with biopsy-proved primary tumors, 95 patients with metastatic disease) were evaluated with scintigraphy and MR imaging to determine the relative sensitivity of each technique in the detection of bone disease. MR imaging was performed at 0.5 T as part of the entry evaluation into Intramural Research Board protocols (30%), for evaluation of cord compression, or because of an equivocal scintigram. MR was performed with T1-weighted (e.g., 300-500/10-20 [TR/TE]), T2-weighted (e.g., 2000/80) spin-echo (SE), and a short-TI inversion recovery (STIR) pulse sequence. Scintigrams were performed with 99mTc-methylene diphosphonate. A retrospective analysis showed that in 30 (28%) of 106 patients, MR imaging performed over a limited region of interest revealed a focal abnormality consistent with tumor that was not observed on scintigraphy. Only one patient had an abnormality on scintigraphy, caused by a metastasis, that was not found on MR images. In 73 (69%) of the 106 patients, the results of MR imaging and scintigraphy were equivalent; in 41 cases results of both techniques were normal. A McNemar analysis of the discordant cases showed MR imaging to be more sensitive than scintigraphy was (p less than .001). Our results suggest that although MR imaging has a greater sensitivity in detecting focal disease, scintigraphy is still the most useful screening test for evaluating the entire skeleton. MR imaging should be reserved for clarification of scintigraphic findings when suspicion is high for tumor.

Adolescent↗

PubMed1990

Metalloporphyrin magnetic resonance contrast agents. Feasibility of tumor-specific magnetic resonance imaging.

The criteria for tumor-specific MRI contrast agents are considered. The metalloporphyrins have been shown to be potential tumor-specific contrast agents due to their selective retention by cancer cells. The Mn(III) water-soluble porphyrin complexes are preferred on the basis of relaxivity and stability. Protein binding in human plasma enhances the relaxivity of Mn(III)-tetraphenylsulfonato-porphyrin (MnTTPS). In preliminary work this agent was shown to enhance MRI contrast at 0.5 T in subcutaneous human colon carcinomas grown in nude mice. Here we report further evidence of enhanced contrast in the same system, and extend this work to human breast tumors in nude mice using a 2 T animal imager. Questions of metalloporphyrin stability, toxicity and dose-contrast relationship are discussed.

Animals↗

PubMed1990

Acute transverse myelitis in systemic lupus erythematosus: magnetic resonance imaging and review of the literature.

We describe a patient with systemic lupus erythematosus (SLE) who presented with acute transverse myelitis. Magnetic resonance imaging (MRI) of the cervical spine demonstrated increased signal intensity and diffuse edema in the cervical cord. The patient had low titer of IgG antiphospholipid antibodies and hypocomplementemia. Cerebrospinal fluid analysis showed pleocytosis, increased protein and decreased glucose. Clinical improvement of the neurologic impairment was noted after high dose corticosteroids and intravenous bolus cyclophosphamide. A repeat MRI 12 days after the treatment was normal. MRI of the spine can be useful in the diagnosis and followup of patients with SLE presenting with an acute myelopathic syndrome. Early aggressive treatment may contribute to complete recovery of these patients.

Adolescent↗

PubMed1990

Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation.

We performed magnetic resonance imaging on sixty-seven individuals who had never had low-back pain, sciatica, or neurogenic claudication. The scans were interpreted independently by three neuro-radiologists who had no knowledge about the presence or absence of clinical symptoms in the subjects. About one-third of the subjects were found to have a substantial abnormality. Of those who were less than sixty years old, 20 per cent had a herniated nucleus pulposus and one had spinal stenosis. In the group that was sixty years old or older, the findings were abnormal on about 57 per cent of the scans: 36 per cent of the subjects had a herniated nucleus pulposus and 21 per cent had spinal stenosis. There was degeneration or bulging of a disc at at least one lumbar level in 35 per cent of the subjects between twenty and thirty-nine years old and in all but one of the sixty to eighty-year-old subjects. In view of these findings in asymptomatic subjects, we concluded that abnormalities on magnetic resonance images must be strictly correlated with age and any clinical signs and symptoms before operative treatment is contemplated.

Adult↗

PubMed1989

Positron emission tomography in the detection of malignant degeneration of low-grade gliomas.

The management of low-grade gliomas represents a challenge to the physician as a significant proportion may undergo malignant degeneration to a high-grade tumor. We present the positron emission tomography (PET) scans, using [18F] fluorodeoxyglucose (FDG), of 12 patients who have histological and/or clinical evidence of malignant degeneration of a low-grade glioma. Each scan displays a focal area of hypermetabolism similar to that of malignant gliomas which arise de novo. Three patients also underwent PET scanning prior to malignant degeneration. When the initial scan is compared with the postmalignant degeneration study, a difference in tumoral glucose uptake can be recognized. A region previously shown to be hypometabolic develops focal hypermetabolism as malignant changes evolve. This study displays the utility of FDG-PET in the evaluation of malignant degeneration of low-grade gliomas. The knowledge that a neoplasm has altered its biological behavior may influence subsequent therapeutic options. If these findings can be confirmed in larger series and by other investigators, it is possible that FDG-PET may be adopted as one of the diagnostic tools for guiding the management of low-grade gliomas.

Adult↗

PubMed1989

The effect of intravenous interleukin-2 on brain water content.

Parenteral treatment with interleukin-2 (IL-2) is effective against certain advanced cancers outside the central nervous system. Prior to commencement of Phase II trials in patients with brain tumors, the neurological and neuroradiological features of 10 patients treated with intravenous administration of repeated doses of IL-2 were studied. Three patients had malignant gliomas, and seven patients had extracranial cancer without evidence of intracranial metastasis. All were treated with intravenous doses of 10(5) U/kg three times daily for up to 5 days. The patients with gliomas received cranial computerized axial tomography (CT) scans before IL-2 therapy was initiated and during the later stages of treatment. The patients with extracranial cancer underwent T2-weighted magnetic resonance (MR) imaging before and later during therapy. After two to 11 doses of IL-2, the patients with gliomas had marked neurological deterioration that was associated with a mild to marked increase in peritumoral edema and mass effect visible on CT scans. With cessation of treatment and appropriate supportive care, all returned to their pretreatment state. The patients with extracranial cancer were either neurologically unchanged or underwent minor transient changes in mental status (lethargy and confusion). In these patients, the MR signal intensity was quantified and compared in eight anatomic regions of interest. In six of the seven patients, there were increases in gray and white matter signal intensity consistent with increased cerebral water content. The percentage changes (means +/- standard error of the means) were 12.6% +/- 7.3% in the gray matter and 17.0% +/- 6.2% in the white matter. This study demonstrates that treatment with a high parenteral dose of IL-2 is not tolerated by patients with gliomas due to increased cerebral edema. In patients with extracranial cancer but no brain disease, parenteral IL-2 induces an increase in the cerebral water content of both gray and white matter.

Brain Chemistry↗

PubMed1988

Cerebral necrosis after radiotherapy and/or intraarterial chemotherapy for brain tumors: PET and neuropathologic studies.

Cerebral necrosis after radiotherapy for brain tumors is being recognized as a problem more common than previously estimated. Distinction between this iatrogenic complication and tumor recurrence cannot be made by either CT or MR imaging. By using positron emission tomography (PET) with 18F-deoxyglucose (FDG) we were able to reach a diagnosis of radiation necrosis, later verified, in 10 of 95 patients referred for the purpose of differentiating tumor recurrence from necrosis. The critical PET-FDG feature was focal hypometabolism in the area of necrosis, which contrasted with the hypermetabolism associated with the residual/recurrent tumor. In addition, four cases of cerebral necrosis after supraophthalmic, intraarterial chemotherapy (BCNU) were studied with the PET-FDG method. The area of chemotherapy damage was also characterized by marked hypometabolism. Histology revealed both similarities and differences between radio- and chemonecrosis.

Adolescent↗

PubMed1988

Intraparenchymal hemorrhage in preterm neonates: a broadening spectrum.

Among 800 neonates screened for cerebral bleeding, perinatal sonography identified 35 preterm neonates with intraparenchymal hemorrhage (IPH). The observed IPHs were categorized in five general groups: classical grade-IV hemorrhage (16 patients), grade-IV hemorrhage with coexisting but anatomically separate hemorrhages (four patients), grade-IV hemorrhage with later development of secondary parenchymal hemorrhages at distant sites (five patients), hemorrhagic periventricular leukomalacia (four patients), and parenchymal hemorrhage unrelated to grade-IV hemorrhages (six patients). Thirty IPHs had concurrent germinal matrix hemorrhages, but in only 16 patients did the IPH represent an extension of the subependymal hematoma and therefore qualify as pure grade-IV hemorrhage according to the most popular classification. The high concurrence of periventricular leukomalacia (80-100% in most groups) and germinal-matrix-remote IPHs supports the concept that most IPHs in preterm neonates represent secondary hemorrhages into ischemic brain tissue.

Brain↗

PubMed1987

Contributions of magnetic resonance imaging in the evaluation of optic gliomas.

Eleven patients with gliomas in the optic chiasm were studied using a 0.5 Tesla superconducting system and third generation computed tomography scanners. All tumors were identified with both modalities, but in the majority of cases, the posterior extension of the tumor and its relationship to adjacent brain, important to both prognosis and management, were shown better by magnetic resonance imaging.

Adolescent↗

PubMed1987

A comparison between chemical analysis and magnetic resonance imaging with the clinical diagnosis of multiple sclerosis.

Ninety-five patients suspected of having multiple sclerosis (MS) were evaluated by medical history and neurologic examination. Based on this evidence they were divided into three groups: clinically definite MS, not-definite MS, and not MS. The adjunct tests, chemical analysis, and magnetic resonance imaging (MRI), were also performed to assess the diagnosis of MS. Chemical analyses of paired serum and cerebrospinal fluid (CSF) samples were performed to identify oligoclonal immunoglobulin bands and to estimate both the albumin quotient and the IgG index. A positive correlation was found between the chemical test results and definite MS in 73 of 73 cases. In 11 of 12 cases of not-definite MS the chemical results were positive for MS. A positive correlation was also found between ten of ten cases that were not MS and negative chemical test results. MRI scans were positive for MS in 48 of 51 clinically definite MS cases and in 4 of 4 not-definite MS cases. MRI scans were negative for MS in five of six cases that were not MS. These findings demonstrate that combined determinations of serum and CSF proteins by simple zone electrophoresis and commercial immunochemical tests can be useful laboratory aids in the diagnosis of MS. The MRI scans provide additional evidence to support the diagnosis of MS.

Albumins↗

PubMed1987

Facet joint disorders and their role in the production of back pain and sciatica.

This article, say the authors, serves as a reminder that the posterior articulations of the lumbar spine are key elements in the production of low back pain and sciatica.

Back Pain↗

PubMed1987

Cushing syndrome: pituitary CT scanning.

Proper treatment of patients with Cushing syndrome depends on knowledge of whether the condition derives from a pituitary or adrenal adenoma or an ectopic tumor that secretes adrenocorticotropic hormone (ACTH). Fifty-seven patients with Cushing syndrome were prospectively evaluated to determine whether computed tomography (CT) of the pituitary gland is useful in diagnosing or excluding an ACTH-producing adenoma and in predicting the site of the adenoma within the pituitary gland. Findings on CT scans were normal in 35 of 50 patients with surgically confirmed Cushing disease and in seven patients with ectopic ACTH-producing tumors. Of the 15 patients with Cushing disease for whom CT results were abnormal, eight had macroadenomas and seven had microadenomas. This study demonstrates a low sensitivity (30%) and low diagnostic accuracy (39%) of CT in the detection of ACTH-producing pituitary tumors and indicates the need for alternative methods of confirming the pituitary origin of excessive ACTH secretion in most patients.

Adenoma↗

PubMed1987

Glucose utilization of visual cortex following extra-occipital interruptions of the visual pathways by tumor. A positron emission tomography study.

To assess the effect of extra-occipital lesions on the local cerebral glucose utilization of the primary and associative visual cortex, 29 patients were studied in the unstimulated state by positron emission tomography and [18F]2-deoxyglucose. Quantitative Goldmann perimetry was done in each patient at the time of the positron emission tomographic study. Nine patients showed homonymous defects, either hemianopsia or quadrantanopsia, whereas nine patients had heteronymous defects. Eleven control subjects, free of any neurological symptoms and with normal visual fields, were also studied with [18F]2-deoxyglucose positron emission tomography. In the normal control subjects and in patients with a heteronymous defect, left-to-right differences in the local cerebral metabolic rate for glucose of the visual cortex varied less than 10%. In patients with hemianopic defects, differences ranged from 8 to 38%, with the hypometabolic cortex always contralateral to the field defect. In patients with quadrantanopic defects, the visual cortex contralateral to the field defect demonstrated differences from 14 to 24% above and below the calcarine fissure, the cortex that received greater input from the affected field being hypometabolic.

Adult↗

PubMed1986

Cerebral mapping of apraxia in Alzheimer's disease by positron emission tomography.

The ability to mimic skilled movements or to pantomime them in response to spoken command was compared with psychometric performance and with regional glucose utilization as estimated by [18F]fluorodeoxyglucose positron emission tomography in 17 right-handed patients with Alzheimer's disease and 6 age-matched normal subjects. Apraxia scores, both on tests to command and to imitation, were significantly lower in the Alzheimer patients. Imitation scores correlated best with performance on tests of visual--spatial ability and with cortical metabolism in the right parietal lobe; command scores related most closely with the results of tests reflecting verbal proficiency and with cortical metabolism in the left inferior hemisphere, especially frontally. Apraxia to command and imitation may thus reflect neuronal dysfunction in distinct cerebral regions in patients with Alzheimer's disease.

Aged↗