RESUMO
BACKGROUND AND PURPOSE: Gadolinium SWI is MR imaging that has recently been reported to be effective in the evaluation of several neurologic disorders, including demyelinating diseases. Our aim was to analyze the accuracy of gadolinium SWI for detecting the imaging evidence of active inflammation on MS plaques when a BBB dysfunction is demonstrated by a focal gadolinium-enhanced lesion and to compare this technique with gadolinium-enhanced T1 spin-echo and T1 spin-echo with magnetization transfer contrast. MATERIALS AND METHODS: MR imaging studies of 103 patients (170 examinations) were performed using a 1.5T scanner. Two neuroradiologists scrutinized signal abnormalities of the demyelinating plaques on gadolinium SWI and compared them with gadolinium T1 before and after an additional magnetization transfer pulse. Interrater agreement was evaluated among gadolinium T1 magnetization transfer contrast, gadolinium SWI, and gadolinium T1 spin-echo using the κ coefficient. The T1 magnetization transfer contrast sequence was adopted as the criterion standard in this cohort. Thus, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated for gadolinium T1 spin-echo and gadolinium SWI sequences. RESULTS: Differences in BBB dysfunction were evident among gadolinium SWI, gadolinium T1 spin-echo, and gadolinium T1 magnetization transfer contrast. Gadolinium T1 magnetization transfer contrast demonstrated the highest number of active demyelinating plaques. Gadolinium SWI was highly correlated with gadolinium T1 magnetization transfer contrast in depicting acute demyelinating plaques (κ coefficient = 0.860; sensitivity = 0.837), and these techniques provided better performance compared with gadolinium T1 spin-echo (κ coefficient = 0.78; sensitivity = 0.645). CONCLUSIONS: Gadolinium SWI was able to better detect BBB dysfunction in MS plaques and had a better performance than gadolinium T1 spin-echo. Increasing SWI sequence applications in clinical practice can improve our knowledge of MS, likely allowing the addition of BBB dysfunction analysis to the striking findings of the previously reported central vein sign.
Assuntos
Encéfalo/diagnóstico por imagem , Gadolínio , Imageamento por Ressonância Magnética/métodos , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Neuroimagem/métodos , Adolescente , Adulto , Algoritmos , Barreira Hematoencefálica/diagnóstico por imagem , Barreira Hematoencefálica/patologia , Encéfalo/patologia , Estudos de Coortes , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
Multinodular and vacuolating neuronal tumor of the cerebrum is a recently reported benign, mixed glial neuronal lesion that is included in the 2016 updated World Health Organization classification of brain neoplasms as a unique cytoarchitectural pattern of gangliocytoma. We report 33 cases of presumed multinodular and vacuolating neuronal tumor of the cerebrum that exhibit a remarkably similar pattern of imaging findings consisting of a subcortical cluster of nodular lesions located on the inner surface of an otherwise normal-appearing cortex, principally within the deep cortical ribbon and superficial subcortical white matter, which is hyperintense on FLAIR. Only 4 of our cases are biopsy-proven because most were asymptomatic and incidentally discovered. The remaining were followed for a minimum of 24 months (mean, 3 years) without interval change. We demonstrate that these are benign, nonaggressive lesions that do not require biopsy in asymptomatic patients and behave more like a malformative process than a true neoplasm.
Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Ganglioneuroma/diagnóstico por imagem , Ganglioneuroma/patologia , Adulto , Cérebro , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neurônios/patologia , Substância Branca/diagnóstico por imagem , Substância Branca/patologiaRESUMO
Limbic encephalitis is far more common than previously thought. It is not always associated with cancer, and it is potentially treatable. Autoantibodies against various neuronal cell antigens may arise independently or in association with cancer and cause autoimmune damage to the limbic system. Neuroimaging plays a key role in the management of patients with suspected limbic encephalitis by supporting diagnosis and excluding differential possibilities. This article describes the main types of autoimmune limbic encephalitis and its mimic disorders, and emphasizes their major imaging features.
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Doenças Autoimunes/diagnóstico , Encefalite Límbica/diagnóstico , Autoanticorpos/imunologia , Diagnóstico Diferencial , Encefalite/diagnóstico , Doença de Hashimoto/diagnóstico , Humanos , NeuroimagemRESUMO
Neurocutaneous melanosis is a rare, congenital, non-inherited syndrome characterized by numerous and/or large congenital nevi with intracranial leptomeningeal melanocytosis. This report describes two patients, presenting with a giant congenital nevus involving a major portion of the posterior trunk with satellite congenital nevi scattered all over the body, who developed seizures at 4 and 6 months of age, respectively. Changes in follow-up magnetic resonance (MR) examinations over an 8-year period were seen in case 1, while parenchymal melanocytic accumulation was reported in the region of the amygdala in case 2. These cases emphasize that neurocutaneous melanosis should be suspected in patients with giant congenital nevus with or without neurological symptoms. Also, neuroaxial MR screening should be performed in all cases and, ideally, before myelination of the brain to provide the highest sensitivity for detecting melanin deposits in the leptomeninges.
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Imageamento por Ressonância Magnética , Melanose/tratamento farmacológico , Melanose/patologia , Síndromes Neurocutâneas/tratamento farmacológico , Síndromes Neurocutâneas/patologia , Ácido Valproico/uso terapêutico , Feminino , Humanos , Lactente , Recém-Nascido , Resultado do TratamentoRESUMO
Tolosa-Hunt syndrome (THS) consists of a painful ophthalmoplegia with typical features in magnetic resonance imaging (MRI). The recurring nature of this affliction has been known since its first description. However, compromise of the contralateral cavernous sinus, known as alternating THS, is very rare and has never been examined using MRI. We report clinical data, laboratory data and imaging features of a patient with alternating THS. According to our literature review, this is the first MRI study of THS.
Assuntos
Artérias Carótidas/patologia , Seio Cavernoso/patologia , Imageamento por Ressonância Magnética , Órbita/patologia , Síndrome de Tolosa-Hunt/patologia , Feminino , Humanos , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: Hippocampal abnormalities are known as highly epileptogenic precursor lesions in the general population, primarily manifesting as MTS. The purpose of this study was to evaluate the occurrence of hippocampal abnormalities on MR imaging in patients with TS to explore the possible underlying mechanisms of the abnormalities and to identify the relationship between an abnormal HF and epilepsy. MATERIALS AND METHODS: We studied MR images and clinical data from 31 patients with TS. The MR imaging protocol was identical for all patients and included tilted coronal images of their temporal lobes. The diagnosis of TSC was made according to established criteria. The HFs of the patients were evaluated from coronal images according to size, morphology, and signal intensity. The data were submitted to statistical analysis, and P values < or = .05 were considered significant. RESULTS: We found HF abnormalities in 5 patients. Four had typical MTS, and 1 had HIMAL. We found a positive correlation between childhood febrile seizures and MTS in patients with TS. We also confirmed that patients with altered hippocampi had a tendency to exhibit more cortical tubers. CONCLUSIONS: Analysis of this series of patients demonstrated the presence of HF abnormalities, mainly MTS in patients with TS. We also found that the occurrence of febrile seizures during the first year of life appears to be one of the determining factors for MTS development in these patients.