Radiological Evolution Research Articles

Radiological evolution of the lumbar lordosis of 78 patients with progressive lumbar or thoracolumbar scoliosis, with a 25-year follow-up in adulthood

Radiological evolution of the lumbar lordosis of 78 patients with progressive lumbar or thoracolumbar scoliosis, with a 25-year follow-up in adulthood

Medication withdrawal may be an option for a select group of patients in relapsing-remitting multiple sclerosis

This article describes the clinical and radiological evolution of a stable group of patients with relapsing-remitting multiple sclerosis that had their disease-modifying therapy (DMT) withdrawn. Forty patients, which had made continuous use of one immunomodulator and had remained free of disease for at least 5 years, had their DMT withdrawn and were observed from 13 to 86 months. Out of the followed patients, 4 (10%) patients presented with new attacks. In addition to these patients, 2 (5%) patients had new lesions revealed by magnetic resonance imaging that did not correspond to clinical attacks. Despite these results, the difficult decision to withdraw medication requires careful analysis. Withdrawal, however, should not be viewed as simply the suspension of treatment because these patients should be evaluated periodically, and the immunomodulators should be readily reintroduced if new attacks occur. Nonetheless, medication withdrawal is an option for a select group of patients.

SAT0088 First year rapid radiological progression is the best predictor of further progression in early arthritis: Results of the ESPOIR cohort

BackgroundOne of the major goal in the treatment of early arthritis is to prevent articular destruction. Several factors predicting joint destruction have been identified but the rapidity of progression during...

Retrospective analysis of the safety profile and clinical, radiological and PSA evolution in metastatic castration resistant prostate cancer (MCRPC), chemotherapy naïve patients treated with abiratarone acetate (AA)

Retrospective analysis of the safety profile and clinical, radiological and PSA evolution in metastatic castration resistant prostate cancer (MCRPC), chemotherapy naïve patients treated with abiratarone acetate (AA)

AB0932 Sapho syndrome - comparison of different methods of imaging of sterno-clavicular joints

BackgroundSAPHO syndrome is an uncommon but recognized subgroup of psoriatic arthritis and is characterized by dermatological symptoms such as palmo-plantar pulstulosis and acne and osteoarticular symptoms.Radiographic assessment belongs to the...

FRI0352 Treatment of refractory takayasu arteritis with tocilizumab: seven italian patients from a single referral center.

BackgroundTakayasu arteritis (TA) is an inflammatory large-vessel panarteritis resulting in vessel stenosis, occlusion or aneurysm formation1. Medical therapy with steroids and immunosuppressive agents is the cornerstone of TA although a...

THU0144 Two Year Radiological Follow-Up of Early Rheumatoid Arthritis Patients Treated with Initial Step Up Monotherapy or Initial Step Down Therapy with Glucocorticoids, Followed by a Tight Control Approach

BackgroundCombination therapy with disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids(GCs) or biological agents is superior in achieving clinical response and preventing joint damage compared to DMARD monotherapy in patients with early...

Intracranial meningiomas and neurofibromatosis type 2

In spite of the few clinical studies regarding the occurrence of intracranial meningiomas, their prognosis in neurofibromatosis type 2 (NF2) has not been accurately assessed and their management remains controversial. This study aims to compare NF2 patients with intracranial meningiomas to those without, and consequently to identify prognostic factors in attempt to improve the management of these tumors. This retrospective study includes a total of 80 NF2 patients followed at Lille Hospital Center between 1987 and 2011. The diagnosis of NF2 was confirmed either because the patient met the Manchester criteria or by the presence of genetic mutation. Clinical, radiological and genetic data were retrospectively recorded and analyzed. Patients underwent annual cranial and spinal MRI. Both location and size of each tumor were reported. The mean follow-up period was 8.8 years (range 1-24 years; SD: ±0.8) and the mean age at diagnosis was 27.2 years (range 6-73 years; SD: ±1.7). Among all patients, 34 harbored intracranial meningiomas. Patients with intracranial meningiomas had a higher number of intracranial schwannomas, spinal tumors and cutaneous tumors (p < 0.05). They underwent more surgical procedures (p < 0.012). Twenty five intracranial meningiomas were surgically removed in 17 patients. The decision to perform surgery was taken in 10 cases for symptomatic tumors and in 15 cases for growing asymptomatic tumors determined by radiology. The histological analysis found a high rate of fibroblastic, transitional or grade 2 meningiomas preferentially located at the cerebri falx. Intracranial meningiomas are common in NF2. They are associated with poor prognosis factors. Clinical and radiological monitoring could lead to early treatment of these tumors both when clinical symptoms are present and in case of proven radiological evolution, and thus trying to maintain a favorable functional prognosis for as long as possible.

Neurocysticercosis: HP10 Antigen Detection Is Useful for the Follow-up of the Severe Patients

BackgroundThe most severe clinical form of neurocysticercosis (NC) occurs when cysticerci are located in the subarachnoid space at the base of the brain (SaB). The diagnosis, monitoring and treatment of NC-SaB, constitutes a severe clinical challenge. Herein we evaluate the potential of the HP10 antigen detection enzyme-linked immunosorbent assay (HP10 Ag-ELISA) in the long term follow-up of NC-SaB cases. Assay performance was compared with that of Magnetic Resonance Imaging (MRI). In addition, the robustness of the HP10 Ag-ELISA was evaluated independently at two different institutions.Methodology/Principal FindingsA double-blind prospective cohort trial was conducted involving 38 NC-SaB cases and a total of 108 paired serum and cerebrospinal fluid (CSF) samples taken at intervals of 4 to 8 months for up to 43 months. At each medical visit, results of sera and CSF HP10 Ag-ELISA and MRI obtained at last visit were compared and their accuracy was evaluated retrospectively, considering radiological evolution between appointments. In the long-term follow-up study, HP10 Ag-ELISA had a better agreement than MRI with retrospective radiological evaluation. High reproducibility of HP10 Ag-ELISA between laboratories was also demonstrated.ConclusionsResults reported in this study establish for the first time the usefulness of the comparatively low cost HP10 Ag-ELISA for long term follow-up of NC-SaB patients.

Prognostic value and management of spinal tumors in neurofibromatosis type 2 patients

Neurofibromatosis type 2 (NF2) is a well-studied disease. Although spinal tumors are frequent, many issues concerning their prognosis and management still have to be clarified. The authors studied the clinical impact and radiological progression of spinal tumors in patients with NF2 to determine their prognostic value. A total of 80 NF2 patients were followed in the Lille University Hospital between 1987 and 2011. Clinical, radiological and genetic data were retrospectively recorded and analyzed. Patients underwent annual cranial and spinal MRI. Both the location and size of each tumor were reported. The diagnosis of NF2 was confirmed either because the patient met the Manchester criteria or by the presence of genetic mutation. The mean follow-up period was 8.8 years (range 1 to 24 years; SD: ±0.8), and the mean age at diagnosis was 27.2 years (range 6 to 73 years; SD: ±1.7). Among all patients, 48 harbored spinal tumors. Twenty of them were symptomatic, and 21 were operated on. Patients with spinal tumors had a lower age at diagnosis (p = 0.02), a higher number of intracranial meningiomas (p = 0.028) and schwannomas (p = 0.03), and more nonsense and frameshift mutations (p = 0.04). Spinal tumors are common in NF2, and all patients should be regularly monitored by spinal MRI. The presence of spinal tumors seems to be a factor indicating poor prognosis. Clinical and radiological monitoring of spinal tumors could lead to early treatment both when clinical symptoms are present and in case of proven radiological evolution, maintaining a favorable functional prognosis as long as possible.

Pineal cysts in children: case-based update

Pineal cysts (PC) are found in children as often asymptomatic and without change in their size over the time. However, there are some debatable issues about their evolution and management in the pediatric population. The aim of the present paper is to update the information regarding pathogenesis, clinical presentation, and management of these lesions. All the pertinent literature was reviewed, and a meta-analysis of operated on cases was carried out. An illustrative case regarding the clinical evolution of a 13-year-old girl is also presented. PC are often asymptomatic and do not evolve over the time. However, since there is a certain risk of clinical and/or radiological progression, or even sudden and severe clinical onset (apoplexy), both a clinical and radiological follow-up is recommended in the pediatric age. The surgical excision is usually limited to symptomatic patients or to cases with clear radiological evolution.

Radiological evolution and delayed resolution of an optic nerve tuberculoma: Challenges in diagnosis and treatment

Optic nerve tuberculomas are rarely reported and their natural history, prognosis, and duration of required treatment remain unclear. A 40-year-old immunocompetent male presented with complete loss of vision in his right eye, which had evolved over 6 weeks. He had optic atrophy on examination. Initial imaging showed right optic nerve swelling and thickening suggesting an infiltrative inflammatory optic neuropathy (infectious or noninfectious). Serial imaging revealed appearance of ring enhancement with a necrotic centre. Biopsy and culture of the coexistent parietal lobe lesion revealed Mycobacterium tuberculosis. Persistent optic nerve granuloma with evidence of radiological improvement was noted at 18 months follow-up with antituberculous therapy (ATT). Visual recovery could not be achieved. The salient features in this case include the clinical presentation initially mimicking an infiltrative or compressive optic neuropathy, rapidradiological evolution into a tuberculoma, subtle paradoxical radiological worsening after initiation of ATT and persistence of granuloma on follow up scan. The challenges involved in early diagnosis and during the treatment course will be discussed.

Left ventricle non-compaction cardiomyopathy: Different clinical scenarios and magnetic resonance imaging findings

Left ventricle non-compaction cardiomyopathy is currently considered as a well-defined individual entity. However, it includes a broad spectrum of clinical, radiological and pathophysiological findings. In this review we describe 3 different scenarios of this entity: an isolated case with severe left ventricle dysfunction, an "associated" case in a patient with previous atrial septum defect and pulmonary stenosis and finally, as a finding in a patient with a transient cerebrovascular ischemic attack. In the 2 last cases, both asymptomatic, morphological criteria of left ventricle non-compaction were found but, ventricular function was normal and cardiac-MRI showed no late gadolinium hyperenhancement. Periodical follow-up and familial screening were recommended. Natural history and prognosis factors of this disease are still not well known. Further and longer series of patients with this diagnosis are needed to completely define radiological criteria, clinical presentation and evolution.

Aspergilose pulmonar invasiva.

Aspergillosis, the most frequent of pulmonary mycosis, represents a group of varying pathogenesis diseases with the same etiological agent--Aspergillus. This fungus is a saprophyte of normal respiratory airways, but the disease occurs in immunocompromised hosts. There are several anatomo-clinical forms, but it is important to know that some could be fatal, being necessary an early diagnosis and therapy. The authors describe an Invasive Pulmonary Aspegillosis case, in a immunocompromised patient submitted to long term corticotherapy treatment. Was started with liposomal Amphotericin B, discontinued due to nephrotoxicity and substituted by Itraconazol, with clinical, laboratorial and radiologic favourable evolution, as it's proven by imagiological studies.

BTNL2 gene polymorphism associations with susceptibility and phenotype expression in sarcoidosis

A functional polymorphism within butyrophilin-like 2 (BTNL2) gene has been described as a potential risk factor for sarcoidosis. The association between chronicity and the rs2076530 SNP A allele has also been reported. This study evaluates the BTNL2 rs2076530 G/A allele associations with sarcoidosis susceptibility and disease evolution in a Portuguese cohort of patients. A case-control study of 151 patients and 150 controls was performed. Allele frequencies were compared with Chi-square test in a univariate analysis and with logistic regression in a multivariate analysis. BTNL2 rs206530 A allele frequencies were significantly higher in sarcoidosis with no linkage disequilibrium with HLA-DRB1 alleles, except in the subgroup of patients with Löfgren syndrome where the determinant allele was HLA-DRB1*03. The A allele was also increased in those with isolated thoracic disease, with no differences regarding radiological stages or disease evolution. HLA-DRB1*03, besides the association with Löfgren syndrome was significantly related with disease resolution. Our data confirms the association of BTNL2 rs2076530 A allele with sarcoidosis susceptibility in a Portuguese population. We found independent genetic risk factors in clinically distinct disease phenotypes: BTNL2 rs2076530 A allele in patients without Löfgren syndrome or with isolated thoracic disease, and HLA-DRB1*03 in Löfgren syndrome or disease resolution.

Evolution of congenital malformations of the umbilical-portal-hepatic venous system

ObjectiveThe objective of this study is to describe the evolution of 8 cases of congenital malformations of the umbilical-portal-hepatic venous system diagnosed before the first month of life. Materials and methodsAll cases of congenital malformation of the portal and hepatic venous system diagnosed prenatally or during the first month of life in our institution were systematically reviewed since November 2000. Clinical features, imaging, and anatomical findings were reviewed, focusing primarily on clinical and radiologic evolution. ResultsEight cases of congenital malformation of the umbilical-portal-hepatic venous system were studied. Fifty percent of these malformations were diagnosed prenatally. We report 4 portosystemic shunts. Three involuted spontaneously, and the fourth one required surgical treatment. We report a variation of the usual anatomy of portal and hepatic veins that remained asymptomatic, an aneurysmal dilatation of a vitelline vein causing portal vein thrombosis that needed prompt surgical treatment with good result, a complex portal and hepatic venous malformation treated operatively, and a persistent right umbilical vein that remained asymptomatic. ConclusionPrenatal diagnosis of malformations of the umbilical-portal-hepatic venous network is uncommon. Little is known about the postnatal prognosis. Clinical, biologic, and radiologic follow-up by ultrasonography is essential to distinguish pathologic situations from normal anatomical variants.

Recurrent acute rhombencephalomyelitis in an adult or neuromyelitis optica? Presentation of a case

IntroductionThe lack of accepted homogeneous criteria for the definition of some demyelinating diseases makes diagnostic characterization difficult and limits data interpretation and therapeutic recommendations. Recurrent encephalomyelitis (ADE-R) along with borderline cases of neuromyelitis optica (NMO) is especially controversial. ObjectiveTo describe the clinical and radiological evolution of an adult-onset ADE-R versus NMO case throughout 9 years of follow-up. Patient and methodsOur patient presented with severe symptoms of rhombencephalomyelitis and the cranial and spinal magnetic resonance imaging (MRI) showed large lesions, with gadolinium enhancement in brainstem and spinal cord, correlating with the clinical picture. Infectious aetiology was excluded, IgG index was normal and NMO antibodies were negative. After treatment with intravenous corticosteroids and plasmapheresis, there was excellent recovery in the acute phase. During follow-up, seven relapses have occurred, mainly in the spinal cord, with good recovery and the same symptomatology, albeit with different severity. Immunosuppressive treatment was introduced since the beginning. ConclusionsOur case shares common features of both ADE-R and NMO, illustrating that diagnostic characterization is not easy in spite of current criteria.

Long-term clinical and radiological evolution in one case of Susac’s syndrome

Susac's syndrome is a rare idiopathic microangiopathy affecting the precapillary arterioles of the brain, retina and cochlea leading to the clinical triad of encephalopathy, retinopathy and hearing loss. The objective of this study is to describe a new case of Susac's syndrome reactivated after a 12-year period with a good response to immunosuppressive therapy. The patient was a 32-year-old woman, complaining of diplopia, right blurred vision, progressive gait disturbance, tinnitus, attention deficit, and slight memory loss. The patient was diagnosed as having Susac's syndrome and discharged with steroid therapy. After a 12-year period of clinical stability she had a relapse. Immunosuppressive therapy resulted in significant clinical and radiological improvement. Early clinical identification of Susac's syndrome is crucial for the initiation of immunosuppressive therapy and differential diagnosis. In our case, the combined use of corticosteroids and azathioprine was key in the relapse management.

Abstract 3626: Cranio Cervical Arterial Dissection; Radiologic Variants And The Natural History, Treatment, And Prognosis

Background and Objective: Craniocervical arterial dissection (CCAD) is believed to have a relatively benign natural history &amp; generally is managed with anticoagulation or antiplatelet therapy.The purpose of this study is to identify whether clinicoradiological parameters affect prognosis of CCAD. Methods: 26 patients(M: F=12:14, mean age=41.57) with clinical evidence of CCAD and at least one of the following suggestive imaging findings on either CT Angiography or MR angiography were included. Suggestive imaging findings include:1) arterial stenosis,2) arterial occlusion, 3) ectatic change of lumen,4) pseudoaneurysm,and 5) dissection flap. The temporal clinical and radiological evolution of CCAD findings were analyzed by a stroke neurologist and neuroradiologist respectively. Results: 69.2% had spontaneous dissections (n=18/26), and 30.7%had a history of trauma (n=8/26). 15 patients presented with strokes(15/26, 57.6%), three patients had TIA(11.5%), 13 patients had neck pain (50%), and 6 patients presented with Horner’s syndrome (21%). Anterior circulation dissection contributed 23%(6/26) of all dissections and posterior circulation dissections were 76.9%(20/26), while the vast majority of cases were unilateral,3.8% of cases were bilateral(1/26). Although 38.4% (n=10/26) were lost to follow up, 61%(n=16/26) had at least one follow up vascular imaging study. Neuroradiologic evaluation of these patients revealed arterial stenoses, arterial occlusions, ectatic changes of the lumen, pseudoaneurysms, and dissection flaps. Pseudo aneurysms were present in 15.4%(n:4/26) of cases.Recanalization had occurred in 75% (12/16), while 25 % did not recanalize within 2-5 months with a mean duration of 71 days.All patients were managed with anticoagulation or antiplatelet therapy. During the follow up period, all patients were stable, without any additional neurologic sequelae.50%(n=4/8) of the traumatic cases were associated with stroke while spontaneous dissections were associated with strokes in approximately 61%(n=11/18).With regards to age we found that 70% of patients between the ages of 38 - 65 years of age had developed strokes while only 30% of those aged 21 - 35 years old had developed strokes. Conclusion: The results revealed a distinction in the prognosis based upon age and the CCAD subtypes. Younger patients were less likely to present with a stroke than their older counterparts.Radiologic subtypes of CCAD as previously demonstrated in our previous study(Lee et al) supported our data which revealed that patients with pseudoaneurysm and intimal flap do not change over time despite treatment.With medical management, more than half of the arterial stenoses after craniocervical dissection improved within a relatively short period of time and no further neurologic sequelae were observed.

Neurosarcoidosis: Report of 30 cases and a literature survey

Introduction Neurosarcoidosis accounts for approximately 5% of cases of sarcoidosis. Objective To determine the frequency of Neurosarcoidosis in our setting and analyze the clinical–radiological findings and evolution of 30 patients consecutively diagnosed. Methods The medical records of patients with a diagnosis of Neurosarcoidosis were reviewed, and data regarding the clinical features, ancillary tests performed, treatment, and outcome were recorded. We revised the literature to summarize and discuss the previous clinical series of Neurosarcoidosis. Results It accounted for 6.7% of all cases of sarcoidosis. Seven patients had definite diagnosis and 23 had probable diagnosis. The mean age at onset of Neurosarcoidosis was 48.3 years and 66.7% of patients were women. Neurologic clinical features were the first manifestation of Neurosarcoidosis in 70% of cases. Cranial neuropathy was present in 17 patients and 14 of them had facial palsy. The central nervous system was affected in 10 patients and the peripheral nervous system in 5. Chest disease, the most common extraneurologic manifestation, was present in 20 patients. All patients were treated with corticosteroids, and all those with central nervous system involvement had poor outcome. Conclusion Neurosarcoidosis requires a high degree of suspicion to establish the diagnosis. Central nervous system involvement is associated with a poor prognosis.