Abstract
Brain cystic lesions is significant neurosurgical dilemma. Differencing cystic brain lesions by CT and conventional MRI may be difficult due to similar findings clinically and similar appearance radiologically, On conventional MRI most of the lesions appear hyper intense on T2-WI and hypo intense on T1-WI. The aim of this study was to assess the role of magnetic resonance diffusion tensor tractography in the assessment and differentiation between cystic brain lesions. The study was a prospective one that was conducted on 30 patients who were suspected to have cystic brain lesions and referred to radio diagnosis department from the neuro-surgery department and outpatient clinics of Tanta university hospitals. In this study mean age of patients was 43.453 + 12.23 years, their age ranged from 5 - 60 years. DTI guides the surgeons regarding the relation between the intra-axial tumor and local WM tracts in different planes. A variety of aspects of the tumor–tract relationship can, therefore, be revealed. The nature of the tract can be suggested from its position and course, such as the corticospinal tract (CST) and optic radiations, and effect of the tumor to the tract can be appreciated. Furthermore, the location of the tumor can be seen in relation to the tract. Neurosurgery for brain tumors is comparison between maximum surgical resection on one hand and maximum sparing of functions on other hand. Total resection of the tumor reduces risk of relapse and permits following radiotherapy or chemotherapy to be much more effective.
Highlights
Brain cystic lesions is obviously neurosurgical dilemma
The study ruled out patients with magnetic resonance imaging (MRI) contraindications as: brain clips for aneurysms, implanted neural stimulators, implanted pacemakers for heart or defibrillators, cochlear implants, ocular foreign bodies and other implanted devices:, insulin pumps, metal shrapnel or bullet & allergic to contrast media
Among the 30 patients included in our study, of them 24 were males (80%) and 6 patients were females (20%). (Table 1)
Summary
Brain cystic lesions is obviously neurosurgical dilemma. Differentiation between cystic brain lesions by CT and MRI may be difficult due to similar clinical findings and similar radiologic appearance. Diffusion weighted imaging (DWI) is important diagnostic modality in differentiating brain cystic lesions. As in conventional MRI most of the cystic lesions appear hyper-intense on T2-WI and hypo-intense on T1-WI. Massive white matter infiltration by primary brain tumors is common [2]. Resection of brain tumor carries risk of destroying descending motor pathway. Diffusion tensor (DT)-imaged fiber tracking is a non-invasive magnetic resonance (MR) technique that helps to visualize the white matter fibers such as cortico-spinal (pyramidal) tract, optic radiation and arcuate fasciculus with relationship to cystic lesions and can delineate the subcortical course of the motor pathway [3]
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