Diagnosis Of Intracranial Disease Research Articles

Incidence and Predictors of Neurologic Death in Patients with Brain Metastases

Neurologic death is the most serious consequence of intracranial disease among patients with brain metastases. Identifying patients with brain metastases at increased risk of neurologic death can improve care and guide further research. We sought to delineate factors predictive of neurologic death among patients with brain metastases. We identified 1218 patients with newly diagnosed brain metastases managed at Brigham and Women's Hospital/Dana-Farber Cancer Institute from 2008-2015. Factors predictive of neurologic death were assessed via univariable and multivariable Fine and Gray competing risks regression. On multivariable analysis, neurologic death was associated with number of brain metastases (hazard ratio [HR] 1.01 per 1 metastasis increase, 95% confidence interval [CI] 1.01-1.02, P < 0.001) and 3 primary tumor sites (reference=non-small cell lung cancer): melanoma (HR 4.67, 95% CI 3.27-6.68, P < 0.001), small cell lung cancer (HR 2.33, 95% CI 1.47-3.68, P < 0.001), and gastrointestinal cancer (HR 2.21, 95% CI 1.28-3.82, P= 0.005). Conversely, a reduction in neurologic death was found in patients with good Karnofsky performance status (90-100 vs. 30-80, HR 0.67, 95% CI 0.48-0.95, P= 0.03) and progressive extracranial metastases at diagnosis of intracranial disease (HR 0.50, 95% CI 0.38-0.67, P= 0.001). Among patients with breast primaries, HER2+ patients displayed increased neurologic death relative to the reference of HR+/HER2- (univariable analysis only: HR 2.41, 95% CI 1.00-5.84, P= 0.05). Patients with melanoma, small cell lung cancer, gastrointestinal cancer, and HER2+ breast cancer primaries, as well as greater intracranial versus extracranial disease burden, harbor significant risk of neurologic death. Future research investigating novel intracranial approaches should focus on these populations.

P3.08-15 Lung Squamous Cell Carcinoma with Solitary Ocular Metastasis，Successful Treatment: An Interesting and Rare Case Report

The incidence of ocular metastases from lung cancer is reported to be 0.1%-7% according to the international literature. Adenocarcinoma and small-cell lung cancer occupied the most proportion. Lung squamous cell carcinoma with solitary symptomatic ocular metastasis as the initial manifestation who accepted the multidisciplinary team (MDT) treatment has never been reported. In the diagnosis of intracranial disease, ophthalmofundoscopy can be used for follow-up observation and evaluation of therapeutic effects. Whole body PET -CT imaging can be used to identify the primary cancer and determine the disease staging. A 62-year-old woman presented to ophthalmology of hospital with a 1-week history of left eye pain, blurred vision. The ophthalmologist performed ophthalmofundoscopy and optical coherence tomography on the patient(Fig.1A). The ophthalmologist initial diagnosis is metastatic carcinoma to the eye. The diagnostic work was completed with PET-CT which confirmed the central lung cancer in the lower lobe of the right lung with ocular metastasis. After multiple disciplinary team consultations, including surgery, internal medicine, ophthalmology, radiotherapy and imaging department, the patient underwent the right lower lobe resection and lymph node dissection in December 2016. Postoperative pathology diagnose the right lung-squamous-cell carcinoma staged T2aN1. In February 2017, the patient reviewed the eye examination and indicated that the ocular lesions were enlarged. The patient received 4 courses of gemcitabine plus cisplatin regimen chemotherapy. The eye symptoms disappeared completely after 4 courses (Fig.2B). The progression-free time was 11.9 months. There're 16.5 months for the patients has been followed up (March, 2018) from surgery, and the lesion of ocular was still controlled very well without any specific ocular treatment. It's the first report of a rare case with solitary ocular metastasis as the initial manifestation of lung squamous cell carcinoma. The successful treatment of this case was reported to provide a new therapeutic reference for clinicians to encounter similar cases in the future.

Comparative histology of pineal calcification.

The pineal organ (pineal gland, epiphysis cerebri) contains several calcified concretions called "brain sand" or acervuli (corpora arenacea). These concretions are conspicuous with imaging techniques and provide a useful landmark for orientation in the diagnosis of intracranial diseases. Predominantly composed of calcium and magnesium salts, corpora arenacea are numerous in old patients. In smaller number they can be present in children as well. The degree of calcification was associated to various diseases. However, the presence of calcified concretions seems not to reflect a specific pathological state. Corpora arenacea occur not only in the actual pineal tissue but also in the leptomeninges, in the habenular commissure and in the choroid plexus. Studies with the potassium pyroantimonate (PPA) method on the ultrastructural localization of free calcium ions in the human pineal, revealed the presence of calcium alongside the cell membranes, a finding that underlines the importance of membrane functions in the production of calcium deposits. Intrapineal corpora arenacea are characterized by a surface with globular structures. Meningeal acervuli that are present in the arachnoid cover of the organ, differ in structure from intrapineal ones and show a prominent concentric lamination of alternating dark and light lines. The electron-lucent lines contain more calcium than the dark ones. There is a correlation between the age of the subject and the number of layers in the largest acervuli. This suggests that the formation of these layers is connected to circannual changes in the calcium level of the organ. The histological organization of the human pineal is basically the same as that of mammalian experimental animals. Pineal concretions present in mammalian animal species are mainly of the meningeal type. Meningeal cells around acervuli contain active cytoplasmic organelles and exhibit alkaline phosphatase reaction in the rat and mink, an indication of a presumable osteoblast-like activity. Using Kossa's method for the staining of calcium deposits, a higher calcium concentration was detected in the rat pineal than in the surrounding brain tissue. Since in parathyroidectomised rats calcified deposits are larger and more numerous than in controls, the regulation of the production of acervuli by the parathyroid gland has also been postulated. In most of submammalian species, the pineal organs (pineal-, parapineal organ, frontal organ, parietal eye) are photoreceptive and organized similarly to the retina. Acervuli were found in the pineal of some birds. The pineal organs of lower vertebrates (fish, amphibians, reptiles) exhibit a high calcium content by ultrastructural calcium histochemistry (PPA-method). However, concrements are not formed. The accumulation of Ca2+ seems to depend on the receptor function of the organ. Comparing pineal and retinal photoreceptors in the frog, the photoreceptor outer segments of pinealocytes as well as retinal cones and rods show a large amount of Capyroantimonate deposits. In dark adapted animals calcium ions are present in both sides of the photoreceptor membranes of the outer segment, whereas calcium is shifted extra-cellularly following light adaptation. Overviewing the data available about the pineal calcification, we can conclude that a multifactorial mechanism may be responsible for the calcification. The pineal of higher vertebrates is not just a simple endocrine gland, rather, its histological organization resembles a folded retina having both hormonal and neural efferentation. Mammalian pinealocytes preserve several characteristics of submammalian receptor cells and accumulate free Ca2+ on their membranes (1). In the thin walled retina and in the similarly organized pineal of submammalian species, the diffusion of extracellular calcium is probably easy and there is a lesser tendency to form concrements. (ABSTRACT TRUNCATED)

Brain stem and spinal metastases of supratentorial glioblastoma multiforme

Although the spread of supratentorial glioblastoma multiforme to the brain stem and spine has been extensively described in published autopsy series, information on the diagnosis, treatment, and subsequent clinical course of patients manifesting symptoms of glioblastomatous dissemination ante mortem remains scant. We report a series of 11 patients having the signs and symptoms of neuraxis dissemination of supratentorial glioblastoma multiforme. All patients had radiographic documentation of metastases by either contrast-enhanced myelograms or enhanced magnetic resonance imaging scans. Ten presented with spinal involvement, whereas one presented with lower cranial neuropathies secondary to diffuse involvement of the basal cisterns. The mean age of the patients was 38.5 years, and the mean time interval between diagnosis of intracranial disease and diagnosis of metastases was 14.1 months. After diagnosis of tumor spread, subsequent mean survival time was 2.8 months. All patients received additional radiotherapy to the areas of metastasis, but the clinical response to radiotherapy was quite poor. This study confirms previous reports in the literature suggesting that metastases occur in younger patients and in patients with extended survival. The findings suggest that the relatively infrequent clinical incidence of the symptomatic spread of glioblastoma multiforme, as compared with the frequent incidental discovery of such spread at autopsy, may be the result of the limited survival of the affected patients, and not due to the biology of the tumor.

Brain Stem and Spinal Metastases of Supratentorial Glioblastoma Multiforme: A Clinical Series

Abstract Although the spread of supratentorial glioblastoma multiforme to the brain stem and spine has been extensively described in published autopsy series, information on the diagnosis, treatment, and subsequent clinical course of patients manifesting symptoms of glioblastomatous dissemination ante mortem remains scant. We report a series of 11 patients having the signs and symptoms of neuraxis dissemination of supratentorial glioblastoma multiforme. All patients had radiographic documentation of metastases by either contrast-enhanced myelograms or enhanced magnetic resonance imaging scans. Ten presented with spinal involvement, whereas one presented with lower cranial neuropathies secondary to diffuse involvement of the basal cisterns. The mean age of the patients was 38.5 years, and the mean time interval between diagnosis of intracranial disease and diagnosis of metastases was 14.1 months. After diagnosis of tumor spread, subsequent mean survival time was 2.8 months. All patients received additional radiotherapy to the areas of metastasis, but the clinical response to radiotherapy was quite poor. This study confirms previous reports in the literature suggesting that metastases occur in younger patients and in patients with extended survival. The findings suggest that the relatively infrequent clinical incidence of the symptomatic spread of glioblastoma multiforme, as compared with the frequent incidental discovery of such spread at autopsy, may be the result of the limited survival of the affected patients, and not due to the biology of the tumor.

Magnetic resonance tomography (MR-T) at 3.4 MHz for the diagnosis of intracranial disease in children

Magnetic resonance tomography (MR-T) at 3.4 MHz for the diagnosis of intracranial disease in children

Questions of Uniqueness and Resolution in Reconstruction from Projections (Myron Bernard Katz)

Previous article Next article Questions of Uniqueness and Resolution in Reconstruction from Projections (Myron Bernard Katz)Raphael ZahlerRaphael Zahlerhttps://doi.org/10.1137/1022082PDFBibTexSections ToolsAdd to favoritesExport CitationTrack CitationsEmail SectionsAbout"Questions of Uniqueness and Resolution in Reconstruction from Projections (Myron Bernard Katz)." SIAM Review, 22(3), pp. 387–388[1] L. A. Weisberg, Computed tomography in the diagnosis of intracranial disease, Ann. Int. Med., 91 (1979), 87– CrossrefISIGoogle Scholar[2] Kennan T. Smith, , Donald C. Solmon and , Sheldon L. Wagner, Practical and mathematical aspects of the problem of reconstructing objects from radiographs, Bull. Amer. Math. Soc., 83 (1977), 1227–1270 58:9394a 0521.65090 CrossrefISIGoogle Scholar[3] R. A. Crowther, , D. J. DeRosier and , A. Klug, The reconstruction of a three-dimensional structure from projections and its application to electron microscopy, Proc. Roy. Soc., 317 (1970), 319– CrossrefGoogle Scholar Previous article Next article FiguresRelatedReferencesCited byDetails Volume 22, Issue 3| 1980SIAM Review History Published online:02 August 2006 InformationCopyright © 1980 © Society for Industrial and Applied MathematicsPDF Download Article & Publication DataArticle DOI:10.1137/1022082Article page range:pp. 387-388ISSN (print):0036-1445ISSN (online):1095-7200Publisher:Society for Industrial and Applied Mathematics

99mTc-MAA Brain Scan and CT in the Diagnosis of Intracranial Diseases

Brain scan with 99mTc-labelled macroaggregated albumin (MAA brain scan) and computed tomography studies (CT) were performed on 78 patients with intracranial diseases. 99mTc-MAA was injected into right and left carotid artery respectively, at the different time. And then diagnostic evaluation of both techniques were investigated. The MAA brain scan was useful for the detection of ischemic lesion in the early stage after onset of cerebral infarction. It was shown in 29.5% that partial field of anterior cerebral artery was injected through the contralateral artery. In these cases, the MAA brain scan was also useful. In the cases of hemorrhagic lesions, however, the CT was more useful than MAA brain scan. Therefore, the both techniques helped each other in the diagnosis of intracranial diseases.

Computed Tomography in the Diagnosis of Intracranial Disease

The introduction of computed tomography has revolutionized neurodiagnosis. This diagnostic procedure makes it possible to define intracranial anatomy by visualizing structures of different radiodensities. Computed tomography may detect and define the underlying pathologic processes more directly than is possible with other diagnostic procedures and has reduced the need for invasive contrast procedures.

Comparison of radionuclide scans with computer-assisted tomography in diagnosis of intracranial disease: Clifford JR, Conolly ES, Voorhies RM (Department of Neurosurgery, Ochsner Medical Center, New Orleans, Louisiana) Neurology 26: 1119–1123, December 1976

Comparison of radionuclide scans with computer-assisted tomography in diagnosis of intracranial disease: Clifford JR, Conolly ES, Voorhies RM (Department of Neurosurgery, Ochsner Medical Center, New Orleans, Louisiana) Neurology 26: 1119–1123, December 1976

Computed tomography and radionuclide studies in the diagnosis of intracranial disease

The accuracy of CT and radionuclide studiies in the diagnosis of intracranial disease is analyzed based on experience in 641 patients. Results indicate that both modalities give reasonably similar precision and that a modest improvement in diagnosis can be expected if both techniques are employed. It is emphasized that the radionuclide studies used routinely included what are rightfully considered adjunctive scanning procedures, so that results must be considered in this light.

The brain scan.

Brain scanning is increasingly used for screening patients suspected of having neurologic disease. The brain scan accurately detects the presence of focal pathology and, coupled with subsequent neuroradiologic procedures, frequently leads to the early diagnosis of intracranial disease.

Limitations of circulation time in the diagnosis of intracranial disease.

The mode circulation time was measured using intravenously injected technetium 99(m) and a collimation system devised to discriminate between the right and left sides of the head. The results in 21 normal men were used as a basis of assessing the findings in 205 patients, made up of five diagnostic groups (ischaemia, haematoma, subarachnoid haemorrhage, intracranial tumour, and head injury). The average mode circulation time in the affected hemisphere for the three groups with vascular disease was increased, but even in these groups half the patients had a mode circulation time within 1 SD of normal mean; similar results were found for asymmetry between the hemispheres. In serial measurements in 45 patients no correlation was found between change in mode circulation time and the clinical state. That so many results are within the normal range limits the value of this method.

Value of the Electrocardiogram in the Diagnosis of Intracranial Disease: Report of a Case

Value of the Electrocardiogram in the Diagnosis of Intracranial Disease: Report of a Case

Transillumination of the Skull in the Diagnosis of Intracranial Disease in Children up to 3 Years

SUMMARYOut of the 180 children under 3 years of age examined by transillumination of the skull, 60 showed pathological luminescence. From these findings and the clinical picture it was possible to distinguish 4 groups of diseases of the central nervous system: hydrocephaly, hydranencephaly, ‘intracranial cysts’, and cerebral atrophy.RÉSUMÉTransillumination du crâne en tant que méthode de diagnostic des maladies intracrâniennes chez les enfants jusqu'à trois ansParmi 180 enfants de moins de trois ans examinés par transillumination du crâne, 60 ont présenté une luminescence pathologique. Ces résultats et le tableau clinique ont permis de distinguer 4 groupes de maladies du système nerveux central: hydrocéphalic, hydranencéphalie, ‘kystes intracrâniens’, et atrophie cérébrale.ZUSAMMENFASSUNGDurchleuchtung des Schädels als diagnostische Methode zur Festellung intrakranieller Erkrankungen bei Kindern im Alter bis zu drei JahrenVon 180 unter dreijährigen Kindern, die mit Durchleuchtung des Schädels untersucht wurden, wiesen 60 pathologische Lumineszenz auf. Von diesem Befund und dem klinischen Bilde her war es möglich, 4 verschiedene Gruppen von Erkrankungen des zentralen Nerven‐systems festzustellen: Hydrozephalie, Hydranencephalie, ‘intrakranielle Zysten’, und Gehirnatrophie.RESUMENTransiluminacion del cráneo como método de diagnosticar enfermedades intracráneas en niños menores de tres añosEntre 180 niños menores de 3 años examinados por medio de una transiluminación del cráneo, se halló en 60 una luminiscencia patológica. Después de estudiar estos resultados y el cuadro clinico fue posible distinguir 4 grupos de enfermedades del sistema nervioso central: hidrocéfalo, hidranencéfalo, ‘quistes intracráneos’ y atrofia cérébral.

TC-99M PERTECHNETATE FOR BRAIN SCANNING.

Brain scanning is an important tool in the diagnosis of intracranial disease. With Hg203 and Hg197 as chlormerodrin, the scans are nucleographically positive in a variety of intracranial abnormalities including meningioma, primary and metastatic cerebral neoplasia, cerebral infarct, and arteriovenous malformation. The purpose of this communication is to illustrate their positive quality, with use of a new scanning agent Tc99m-sodium pertechnetate. The tumor-to-brain ratio of Tc99m-pertechnetate in mouse ependymoma is 22, a value similar to that of the radiomercurial compounds (1). The availability of short-lived radionuclide generators in clinical nuclear medicine laboratories has been a significant advance in diagnostic brain scanning (2, 3). Because of the shorter physical half-life of these nuclides, larger doses can be administered to the patient achieving: 1. Greater counting rates, and thereby improved counting statistics 2. Faster scanning speeds, because of the improved counting rate 3. Reduced pa...

Percutaneous brachial cerebral angiography.

C F.R~.Br~L angiography plays an importan t role in the diagnosis of intracranial disease. In some cases, clinical symptoms and physical findings may dictate the need to visualize only a single major artery. However, in many cases visualization of the carotid and vertebral-basilar systems bilaterally may be indicated. This problem has been discussed by Baker ~ and others23 To accomplish this ordinarily requires multiple arterial punctures and injections. This is true particularly if separate injections are required for the visualization of each carotid ar tery and the vertebral-basilar system. Visualization of the entire vascular system from thoracic origin to cranial termination, rather than the cranial circulation alone, also may be important. 8,18 Visualization of the vertebral ar tery sometimes is fraught with considerable difficulty. The development of many approaches and complicated techniques at test to this difficulty. This paper serves to describe a previously unreported, safe technique which has been used fairly extensively at this hospital with excellent results. The technique originally was suggested to one of the authors (E.B.S.) by Dr. E. S. Gurdjian 11 and Dr. Francis Murphey. 16 By means of a single, percutaneous peripheral arterial injection, without catheter or cutdown, serial visualization in two planes of the right internal carotid and vertebral-basilar systems are attained in nearly every case. Because of the ease and safety of this procedure it has replaced direct puncture of the right carotid and vertebral arteries in most patients.