3D CISS Research Articles

Meningioma Detection and Characterization Using Brain MR Imaging: A Case Study

Meningiomas commonly manifest as granulations, dense clusters exhibiting hyperintense signals on the meningeal layers and close to cranial nerves. Detailed and isotropic imaging are key in the diagnostic evaluation. Nevertheless, standard MRI sequences have been inadequate in capturing these granulations, incorporating the T2 3D CISS axial sequence for improved visualization. Our case study aims to meticulously evaluate the diagnostic imaging strategies used for meningioma cases, explicitly focusing on cranial nerve imaging. The MRI protocol encompassed axial, coronal, and sagittal T2_TSE and DWI sequences and post-contrast T1-weighted imaging. A detailed calibration of the 3D CISS sequence parameters was performed to enhance the imaging of cranial nerves affected by the suspected meningioma. Our findings highlight the necessity of a meticulous MRI protocol, which includes precise imaging sequences, to evaluate meningiomas effectively, particularly for assessing the potential involvement of the cranial nerves.

Evaluasi Pemeriksaan MRI Brain dengan Klinis Vertigo di Rumah Sakit Otak dr. Drs. M. Hatta Bukittinggi

Background: Vertigo is a symptom that arises as a result of disturbances in the balance of the vestibular system or disorders of the central nervous system. A radiological examination that can detect clinical vertigo is an MRI examination. There is a difference in the MRI Brain examination protocol for clinical vertigo between theory and the field, namely the addition of the 3D CISS protocol. The aim of this research is to determine the role of adding 3D CISS to MRI Brain examinations in clinical vertigo.Methods: This research is qualitative descriptive research, use 10 patients, and do in January to November 2023. Data was collected by observation, conducting interviews and questionnaires. This research use 13 sequences, namely Axial T2 TSE, DWI, Axial T2 TSE Dark Fluid, T2 SWI, Sagittal T1 TSE, Sagittal T2 TSE FS, Axial T1 TSE, Coronal T2 TSE, Coronal T1 TSE, Axial T1 TSE, Coronal, Sagittal + Contrast with cuts at the upper border of the vertex and the lower border of the cerebellum and T2 3D CISS axial isotropic sequences for the cuts used, namely at the level of the sponge, showing the vestibulocochlear cranial nerve (VIII).Results: The results of the assessment on the T2 3D CISS Axial Isotropic sequence showed that anatomical detail was clearly visible as much as 75% and the spatial resolution was clearly visible as much as 75%.Conclusions: Brain MRI examination with clinical vertigo provides information that helps in understanding the causes of vertigo, allowing for a more accurate and effective treatment approach.

Assessment of prevalence of vascular contact of the facial nerve in asymptomatic patients using three-dimensional constructive interference in steady-state (3D CISS) MRI acquisition.

To evaluate the prevalence of vascular contact of the facial nerve in patients without hemifacial spasm or facial palsy using magnetic resonance imaging (MRI). Our radiology database was accessed to find a series of consecutive adult patients who underwent MRI of the brain during the study period, excluding those with a history of hemifacial spasm (HFS), facial palsy, traumatic brain injury, intracranial tumour, intracranial surgery, trigeminal neuro-vascular compression, brain radiation therapy, and studies with poor image quality. A total of 112 (224 sides) MRIs of the posterior fossa were independently reviewed by 2 radiologists for neurovascular contact involving the facial nerve. The presence of neuro-vascular contact, the number of points of contact, the location of contact along the intracranial course of the facial nerve, the culprit vessel, and the severity of compression were recorded in the CISS MRI sequence in the cohort of patients without HFS and facial palsy. The prevalence of neurovascular contact involving the facial nerve can be as high as 51% in patients asymptomatic for HFS and facial palsy. It is frequently caused by the anterior inferior cerebellar artery and commonly involves the cisternal portion with mild to moderate severity. In asymptomatic patients, the pulsatile neurovascular contact of the intracranial segment of the facial nerve typically occurs at one point, involving the distal portion with milder severity in contrast to patients with HFS. These results in the asymptomatic cohort should be considered when evaluating the candidacy of HFS patients for microvascular decompression.

Three-Dimensional Constructive Interference in Steady State (3D CISS) Imaging and Clinical Applications in Brain Pathology.

Three-dimensional constructive interference in steady state (3D CISS) is a steady-state gradient-echo sequence in magnetic resonance imaging (MRI) that has been used in an increasing number of applications in the study of brain disease in recent years. Owing to the very high spatial resolution, the strong hyperintensity of the cerebrospinal fluid signal and the high contrast-to-noise ratio, 3D CISS can be employed in a wide range of scenarios, ranging from the traditional study of cranial nerves, the ventricular system, the subarachnoid cisterns and related pathology to more recently discussed applications, such as the fundamental role it can assume in the setting of acute ischemic stroke, vascular malformations, infections and several brain tumors. In this review, after briefly summarizing its fundamental physical principles, we examine in detail the various applications of 3D CISS in brain imaging, providing numerous representative cases, so as to help radiologists improve its use in imaging protocols in daily clinical practice.

Challenges in preoperative diagnosis of glossopharyngeal nerve schwannoma: own findings analysis

Medical history, disease onset, clinical symptoms, and results of neuroimaging of 14 glossopharyngeal schwannoma patients, who were exa­mined and treated in the Subtentorial Neurooncology Department of the State Institution, Romodanov Institute of Neurosurgery of the NAMS of Ukraine (8 patients) and the Neurosurgery Department No. 2 of the Municipal Enterprise, Mechnikov Dnipropetrovsk Regional Clinical Hospital of Dnipropetrovsk Regional Council (6 patients) in 2018 to 2021 have been analyzed in details. The study inclusion criteria were as follows: patient’s age over 18, pre­sence of unilateral primary glossopharyngeal nerve schwannoma. Our study showed that most of clinical signs and symptoms of the glossopharyngeal nerve schwannoma are associated with otolaryngological disorders (such as hearing loss, tinnitus, hoarseness, or dizziness) or cerebellar disorders (such as ataxia, nystagmus, or dizziness). Neuroimaging cerebellopontine angle tumors diagnosis must include brain computed tomography (with mandatory assessment of the state of jugular foramen and internal auditory canal) and IV contrast brain magnetic resonance tomography and inclusion of high-resolution sequences, gradient echo (3D CISS, DRIVE, TRUFFI, B-FFE) with the aim of better visualization and differentiation of various cerebellopontine angle cranial nerves. The study demonstrates the com­plexity of a reliable preoperative diagnosis when using standard diagnostic tools. Preoperative jugular foramen and cerebellopontine angle tumors diagnosis should be based on a systematic approach and include a comparison of results of comprehensive clinical and instrumental examination and neuroimaging studies.

In vivo Assessment of Supra-Cervical Fetal Membrane by MRI 3D CISS: A Preliminary Study.

In approximately 8% of term births and 33% of pre-term births, the fetal membrane (FM) ruptures before delivery. In vitro studies of FMs after delivery have suggested the series of events leading to rupture, but no in vivo studies have confirmed this model. In this study, we used a three-dimensional constructive interference in steady state (3D-CISS) sequence to examine the FM at the cervical internal os zone during pregnancy; 18 pregnant women with one to three longitudinal MRI scans were included in this study. In 14 women, the FM appeared normal and completely intact. In four women, we noted several FM abnormalities including cervical funneling, chorioamniotic separation, and chorion rupture. Our data support the in vitro model that the FM ruptures according to a sequence starting with the stretch of chorion and amnion, then the separation of amnion from chorion, next the rupture of chorion, and finally the rupture of amnion ruptures. These findings hold great promise to help to develop an in vivo magnetic resonance imaging marker that improves examination of the FMs.

Postoperative patency assessment of Cystocisternostomy and Cystoventriculostomy stomas in cases with Arachnoidal cyst.

The goal of this study was to determine stoma and flow patency with 3D SPACE T2 and 3D CISS sequences in cases with cystocisternostomy or cystoventriculostomy. A total of sixty three patients (total 106 MRI examinations) with endoscopic cystocisternostomy or cystoventriculostomy of arachnoid cyst underwent 1.5-3T MRI to determine flow patency between June 2007 and April 2018. Postoperative results, the patients' clinic and arachnoid cyst volume were used to confirm stoma and flow patency in MRI. The stoma was open and functional in forty three patients. Minimal flow was detected in five patients. Fifteen patients with closed stoma (total 17 MR images) were evaluated with the clinician. Patients' clinic, physical examination, and growth (for pediatric patients) were evaluated. Three of fifteen patients were re-operated. Operative findings and postoperative follow-up MR imaging findings were correlated with our preoperative MRI results. The findings were in compliance in both groups (operated-non-operated groups). 3D SPACE T2 and 3D CISS are effective sequences in addition to other routine conventional sequences to evaluate stoma and flow patency.

Correlation between pain assessment scale and neurovascular compression distance to the root exit zone in trigeminal neuralgia analysis using 3D CISS MRI sequence

BACKGROUND Trigeminal neuralgia (TN) is primarily caused by neurovascular compression (NVC) at root exit zone (REZ) in cerebellopontine angle cistern. In some NVC cases, it was suspected that clinical symptoms may be correlated with the distance of trigeminal nerve root to vascular contact. Pain assessment scale (PAS) was the most common scale used to evaluate TN pain, therefore this study was conducted to analyze the correlation between PAS usingnumeric rating scale (NRS) and distance from the NVC to REZ location in patients with TN using 3D CISS MRI sequence.
 METHODS This cross-sectional study was conducted at the Department of Radiology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, using secondary data of 32 patients, collected from Picture Archiving and Communication System from January 2013 to January 2016. Statistical analysis was performed using SPSS, version 20.0. Spearman p-value of < 0.05 was considered significant.
 RESULTS A total of 32 patients met the inclusion criteria. The mean (SD) distances from the NVC to the REZ were 2.1 (2.1), 2.31 (2.25), and 3.22 (2.63) mm on the shortest, medial, and lateral sides, respectively. The correlation coefficients (r) between the PAS value and the NVC distance in relation to the trigeminal nerve REZ were −0.39 (p = 0.021), −0.57 (p < 0.01), and −0.57 (p = 0.294) on the shortest, lateral, and medial sides, respectively.
 CONCLUSIONS PAS using the NRS instrument exhibited an inverse correlation to NVC distance to the REZ of the trigeminal nerve. Shorter distance increased the PAS value.

The Role of 3D CISS MRI in the Evaluation of Primary Trigeminal Neuralgia

The Role of 3D CISS MRI in the Evaluation of Primary Trigeminal Neuralgia

High-Field MRI Contribution in Tolosa-Hunt Syndrome (THS). Report of Two Cases and Review of Literature

Background: Tolosa Hunt Syndrome is an inflammatory condition of unknown etiology of the cavernous sinus and superior orbital fissure. Because of the difficulty in establishing histological evidence, his diagnosis is based on a set of arguments established by the International Headache Society. MRI allows indirect visualization of the granuloma and plays a key role in diagnosis and follow-up. Aim: To illustrate High-field MRI contribution in Tolosa-Hunt Syndrome (THS). Cases Presentation: Two patients, a 25-year-old female and a 40-year-old male were recruited in this retrospective case report study at the Radiology service of Fann University Hospital (Dakar Senegal). The first patient has been suffering from a right retro-orbital pain and diplopia for 2 months and the second from a painful oculomotor nerve palsy for 3 months. Blood tests, lumbar puncture, thyroid hormone levels and an infectious screen were done. Screening for converting enzymes, and serum antibodies were also done. They underwent a high field MRI (Siemens 1.5T) with T1, T2, FLAIR, T2*, diffusion B1000, TOF polygon, CISS 3D and T1 gadolinium sequences in the 3 planes space. No significant abnormality was detected in blood tests or CSF analysis. Screening for converting enzymes and serum antibodies screen were also negative. For each patient, MRI examinations showed a non tumoral thickening of the right cavernous sinus, suggesting a granulomatous involvement. Tolosa Hunt Syndrome was evoked firstly. They were put on corticotherapy at high doses with a spectacular regression of symptoms. The Criteria of the International Headache Society of THS were met in both patients. Conclusion: High-field MRI is a significant diagnostic tool in the assessment of painful ophthalmoplegia. It allows a direct visualization of the granuloma of the cavernous sinus and assesses its course throughout the disease.

MRI Imaging considerations of cartilage damage after traumatic knee injury

The presentation will outline ACL tear diagnosis using CISS 3d imaging and also CISS 3D imaging of Grade 1 to Grade IV Modified Outerbridge classification of Cartilage changes and correlation to histology and a proposed MRI reporting system used for matching arthroscopic technique of looking at the knee cartilage from anterior to posterior of both medial and lateral cartilage.

Implanting Glioblastoma Spheroids into Rat Brains and Monitoring Tumor Growth by MRI Volumetry.

The outcome of patients suffering from glioblastoma multiforme (GBM) remains poor with a median survival of less than 15 months. To establish innovative therapeutical approaches or to analyze the effect of protein overexpression or protein knockdown by RNA interference in vivo, animal models are mandatory. Here, we describe the implantation of C6 glioma spheroids into the rats' brain and how to follow tumor growth by MRI scans. We show that C6 cells grown in Sprague-Dawley rats share several morphologic features of human glioblastoma like pleomorphic cells, areas of necrosis, vascular proliferation, and tumor cell invasion into the surrounding brain tissue. In addition, we describe a method for tumor volumetry utilizing the CISS 3D- or contrast-enhanced T1-weighted 3D sequence and freely available post-processing software.

Redundant nerve root syndrome of the cauda equina: the benefits of 3D CISS MRI sequence

Redundant nerve root syndrome of the cauda equina: the benefits of 3D CISS MRI sequence

Intracranial trigeminal schwannoma.

Intracranial trigeminal schwannomas are rare tumors. Patients usually present with symptoms of trigeminal nerve dysfunction, the most common symptom being facial pain. MRI is the imaging modality of choice and is usually diagnostic in the appropriate clinical setting. The thin T2-weighted CISS 3D axial sequence is important for proper assessment of the cisternal segment of the nerve. They are usually hypointense on T1, hyperintense on T2 with avid enhancement post gadolinium. CT scan is supplementary to MRI, particularly for tumors located in the skull base. Imaging plays a role in diagnosis and surgical planning. In this pictorial essay, we retrospectively reviewed imaging findings in nine patients with pathologically proven trigeminal schwannoma. Familiarity with the imaging findings of intracranial trigeminal schwannoma may help to diagnose this entity.

Three dimensional MRI study: Safety of short versus long needle peribulbar anesthesia

BackgroundThe standard technique of Peribulbar block is to use 25g 25mm needle at the junction between the lateral one third and medial two third of the lower orbital rim in the infero-temporal quadrant of the orbit. Theoretically, insertion of longer needles increases the potential of injury to important structure; however, safety of the shorter needle had never been demonstrated. This study describes the anatomy of the orbital structures with magnetic resonance imaging (MRI) using the three-dimensional constructive interference in steady state (3D CISS) sequence to present a morphological basis for needle entry at 12.5 and 25mm lengths. Statistical comparisons were performed at the 12.5 versus 25mm depths. Statistical significance was indicated by P<0.05. MethodFifty patients free of orbital pathology with normal axial length were selected for MRI with the 3D CISS sequence. Original axial and multiplanar image reconstruction (MPR) images were selected for image interpretation. Orbital structures were identified at 12.5 and 25mm depths from the orbital rim to compare significant differences in anatomy between the two imaging planes at the expected needle depth and to assess the size of the globe and the orbit. ResultsThe cross sectional area of the extraocular muscles were statistically significantly smaller at the 12.5mm plane (P=0.001). The area of inferotemporal fat was statistically significantly larger at the 12.5mm plane (P=0.033). There was no statistical difference in the inferonasal and superonasal fat areas at different depths (P=0.34, P=0.35 respectively). The size of the orbit and globe was significantly larger at 12.5mm (P=0.001). There was no difference between depths in the presence or absence of neurovascular bundles and supporting structures including the intramuscular septae. ConclusionThere is a larger structure-free space at a depth of 12.5mm than at 25mm. Therefore, the inference is that a needle inserted in the infero-temporal zone to a depth of 12.5mm is less likely to injure the eyeball or extra-ocular muscles than one advanced to 25mm.

Automated Quantitation of the Posterior Scleral Flattening and Optic Nerve Protrusion by MRI in Idiopathic Intracranial Hypertension

Subjective determination of the posterior sclera flattening and optic nerve protrusion in MRI is challenging because of the 3D nature of the globe morphology. This study aims to develop and compare quantitative measures of globe flattening and optic nerve protrusion with subjective rating, and assess relationships with papilledema grade and intraocular and CSF pressures. Data of 34 globes from 7 overweight female patients with idiopathic intracranial hypertension and 6 age- and weight-matched healthy female control subjects were assessed, as well as a subcohort of 4 of the patients with idiopathic intracranial hypertension who underwent follow-up MR imaging 2 weeks after lumbar puncture and initiation of treatment with acetazolamide. MR imaging examination included a 3D CISS sequence on 1.5T and 3T scanners with 0.6-mm isotropic resolution. Subjective ratings of globe flattening were obtained by experienced and inexperienced readers. Quantitative measures of globe flattening, nerve protrusion, and maximal deformation were derived by use of a 2D map of the distances from the globe center to the posterior wall. Contingency coefficients for globe flattening agreements with subjective rating by the experienced and inexperienced readers were 0.72 and 0.56, respectively. Mean values of the 3 deformation measures were significantly poorer in the idiopathic intracranial hypertension group, with nerve protrusion demonstrating the strongest difference (P = .0002). Nerve protrusion was most strongly associated with papilledema grade with a contingency coefficient of 0.74 (P = .01), whereas globe flattening was negatively correlated with intraocular pressure (R = -0.75, P < .0001). Maximal deformation was negatively associated with CSF opening pressure (R = -0.86, P = .0001). After treatment, only the changes in nerve protrusion and maximal deformation were significant. Automated measures of globe deformation improve reliability over subjective rating. Of the 2 globe deformation measures, nerve protrusion had the strongest predictive value for papilledema grade and had the highest sensitivity for assessment of treatment efficacy in idiopathic intracranial hypertension.

Endoscopic third ventriculostomy associated 3D-construcive inference steady state MRI for obstructed hydrocephalus: A retrospective study

BackgroundEndoscopic third ventriculostomy (ETV) is a developing therapeutic stratagem for obstructive hydrocephalus (OH). The aim of this study was to determine the relevance of third ventricle diagnostic imaging by three-dimensional constructive inference in steady state (3D CISS) MRI in patients with OH and to access the preoperative and postoperative values of this technique in patients undergoing endoscopic third ventriculostomy (ETV). MethodsForty-six patients with an existing obstruction below the posterior part of the third ventricle underwent 3D CISS sequence MRI on a 1.5T superconductive MR scanner and were included into this retrospective study. 19 patients were treated with ETV. Regression analysis of the correlation between third ventricle enlargement (TVE) and hydrocephalus degree (HD) and between TVE and third ventricle floor thickness (TVFT) was calculated. In the 19 ETV cases the incisions were marked according to MR images, and the 3D-CISS sequence imaging and the surgical outcome were compared before and after ETV. ResultsBy virtue of 3D-CISS 97.83% third ventricle floors and 91.30% basilar arteries (BA) could be visualized, and there was a positive correlation between TVE and HD and a negative correlation between TVE and TVFT in this group. All incision sites on the scalp could be marked correctly. The degree of enlargement of the third ventricle allowed a prediction of the technical challenge to puncture the third ventricle floor. The position and route of BA could be demonstrated avoiding intraoperative iatrogenic lesions. At follow-up, 100% of the fistulas of the third ventricle floor could be measured on 3D-CISS images. The mean diameter of the fistulas was 6.12±0.96mm; in 91.67%, new CSF fluid directions could be demonstrated; in 83.33%, enlarged ventricle system got withdrawn, and 91.67% patients showed relief of initial symptoms. 1 patient needed the implantation of a ventriculoperitoneal shunt 7 months after EVT. The preoperative HD compared with postoperative HD (P<.01); the preoperative TVE compared with postoperative TVE (P<.05). ConclusionImages of the 3D-CISS sequence on MRI can visualize the third ventricle accurately and provide a reliable method for the evaluation of ETV pre- and postoperatively. The degree of enlargement of the third ventricle in patients with obstructive hydrocephalus is associated with the thickness of third ventricle floor and allows a prediction of the difficulty to puncture in ETV.

Outer diameter measured by 3D CISS MRI and quasi-Moyamoya disease

1. The pathology of Moyamoya disease, especially its pathological vessel walls, compared with those of other cerebrovascular diseases like atherosclerosis. One has to observe not only changes of the inner diameter of the pathological vessels but also that of the outer diameter caused by remodeling of vascular wall originating in the pathological process of a disease. Until now, we have paid attention only to the inner diameter, namely luminal stenosis or occlusion on the basis of angiographical or MRI findings. The 3D-CISS MRI has been revealed to be a good tool for measurement of the outer diameter to observe the latter process for instance changes of vascular wall thickness due to its remodeling. 2. The definition of Moyamoya disease and its differentiation from related diseases. The terminology Quasi-Moyamoya disease ( Moyamoya disease in Japanese) could be found, so far as the author has searched around, initially in a chapter of the book Moyamoya disease edited by Prof. J Suzuki (one of finders of this disease and has coined the name of “Moyamoya”) in 1983 [3]. Watanabe T and Suzuki N classified as “rui” Moyamoya disease which was however out of diagnostic criteria of Moyamoya disease, including: a. Only one side corresponds with the criteria of Moyamoya disease (1) but the other side having normal vasculatures. b. Cases with one side or bilateral middle cerebral artery MCA stenosis at the origin associated with Moyamoya vessels, however, combined with neither internal carotid artery ICA nor anterior cerebral artery ACA stenoses c. Combination with congenital malformation: AVM, primitive trigeminal artery d. Associated with apparent basic disease such as: von Recklinghausen disease, head trauma (mechanical vasoconstriction), fibromuscular dysplasia, tuberculous meningitis, atherosclerosis, post-irradiation, Fanconi’s anemia, sickle cell anemia, nonspecific arteritis, connective tissue anomaly, cerebral angiitis due to leptospirosis

Does MR Sialography Have A Greater Diagnostic Accuracy Than Conventional X-Ray And Digital Subtraction Sialography In Detecting Salivary Glands Disease? A Literature Review

Aim: The main aim was to determine the diagnostic accuracy of MR Sialography as compared to conventional x-ray and digital sialography in detecting salivary gland diseases on the basis of research evidences available in the literature. Description: It is noticed that almost all people develop illness of salivary glands at some stage of their lives. The major effects on salivary glands become evident as stones; infection tumors which may also involve related organs. Imaging methods like Ultrasound, Computed Tomography (CT) and Digital subtraction sialography (DSS) are used for assessment of parotid, sub-mandibular and sub-lingual glands in addition to conventional x-ray sialography which is marked as a gold standard for salivary glands assessment. Due to the non-invasive nature and level of comfort, MR Sialography is now being considered as an advanced technique for the detection of stones and tumor spread in the soft tissues with no risk of radiation exposure. Methods and Results: Different databases which include Science direct, CINAHL, Ebesco Host, PubMed, Swetswise, Wiley Interscience, sage pub, and The Cochrane library were explored to get published literature. Total 10 studies were included and critically appraised under critical appraisal skills programme (CASP) tool. Conclusion: The review proposed that though the use of MRS as the only diagnostic examination is useful but X-ray sialography remains the standard investigation tool due to its higher spatial resolution. MRS can be utilized as an alternative imaging technique by using special MR sequences such as 3D CISS and RARE where x-ray sialography cannot be performed. DOI: http://dx.doi.org/10.3126/njr.v1i1.6329 Nepalese Journal of Radiology Vol.1(1): 70-77

Use of 3D CISS as part of a routine protocol for the evaluation of intracranial granulomas

© 2011. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).