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Roberts JI, Ng D, Kapadia R. Pearls & Oy-sters: Tumour-Like Mass Lesion Secondary to Primary CNS Vasculitis. Neurology 2024; 103:e209819. [PMID: 39255434 DOI: 10.1212/wnl.0000000000209819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024] Open
Abstract
Primary CNS vasculitis (PCNSV) is uncommonly considered in the differential diagnosis of tumor-like lesions. This case report of tumefactive PCNSV highlights imaging features that should increase clinical suspicion for CNS vasculitis, potentially lending to earlier diagnosis and treatment. A 62-year-old man presented with a 1-month history of focal motor seizures and cortical sensory loss localizing to the right frontoparietal lobe. Noncontrast head CT was suggestive of glioma, resulting in intravenous dexamethasone administration and admission to neurosurgery. MRI appearance was atypical for glioma, with relative preservation of regional anatomy, intralesional microhemorrhage, and patchy peripheral enhancement. Despite normal CT angiogram, CSF, and serum inflammatory markers, brain biopsy was suggestive of lymphocytic vasculitis. Extensive workup for secondary causes was negative, and he was diagnosed with tumefactive PCNSV. Treatment with corticosteroids and cyclophosphamide resulted in sustained clinical and radiologic improvement. Tumefactive PCNSV is an angiogram-negative small-vessel vasculitis that has a lymphocytic histologic pattern. Tumefactive PCNSV constitutes over 10% of PCNSV cases and can be recognized by the presence of intralesional microhemorrhages, absence of diffusion restriction, and a patchy or nodular enhancement pattern. The most important mimicker is CNS lymphoma, which has a similar imaging and histologic pattern. If individuals with tumefactive PCNSV do not have a sustained immunotherapy response, repeat biopsy should be promptly performed.
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Affiliation(s)
- Jodie I Roberts
- From the Departments of Clinical Neurosciences (J.I.R., R.K.) and Pathology and Laboratory Medicine (D.N.), and the Hotchkiss Brain Institute (J.I.R.), University of Calgary, Alberta, Canada; Neuroimmunology Centre, Department of Neurology (J.I.R.), Royal Melbourne Hospital; and Clinical Outcomes Research Unit, Department of Medicine (J.I.R.), University of Melbourne, Australia
| | - Denise Ng
- From the Departments of Clinical Neurosciences (J.I.R., R.K.) and Pathology and Laboratory Medicine (D.N.), and the Hotchkiss Brain Institute (J.I.R.), University of Calgary, Alberta, Canada; Neuroimmunology Centre, Department of Neurology (J.I.R.), Royal Melbourne Hospital; and Clinical Outcomes Research Unit, Department of Medicine (J.I.R.), University of Melbourne, Australia
| | - Ronak Kapadia
- From the Departments of Clinical Neurosciences (J.I.R., R.K.) and Pathology and Laboratory Medicine (D.N.), and the Hotchkiss Brain Institute (J.I.R.), University of Calgary, Alberta, Canada; Neuroimmunology Centre, Department of Neurology (J.I.R.), Royal Melbourne Hospital; and Clinical Outcomes Research Unit, Department of Medicine (J.I.R.), University of Melbourne, Australia
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2
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Corrêa DG, da Hygino da Cruz LC, Dos Santos RQ, Marcondes J, de Abreu MM. Brain tumefactive vasculitis in primary Sjögren syndrome. Int J Rheum Dis 2024; 27:e15304. [PMID: 39234874 DOI: 10.1111/1756-185x.15304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/21/2024] [Accepted: 08/15/2024] [Indexed: 09/06/2024]
Affiliation(s)
- Diogo Goulart Corrêa
- Department of Diagnostic Imaging, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | | | | | - Jorge Marcondes
- Department of Neurosurgery, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Mirhelen Mendes de Abreu
- Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Department of Rheumatology, Hospital Pró Cardíaco, United Health Group, Rua General Polidoro, Rio de Janeiro, RJ, Brazil
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3
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Freitas LF, Neto OLA, Maley JE, Shekhrajka N, Policeni BA. Tumefactive primary central nervous system vasculitis mimicking a brain metastasis in a patient with kidney cancer. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-2. [PMID: 38740022 PMCID: PMC11090646 DOI: 10.1055/s-0044-1786762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/25/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Leonardo Furtado Freitas
- University of Iowa Hospitals and Clinics, Radiology Department, Neuroradiology Division, Iowa City Iowa, United States.
| | - Osorio Lopes Abath Neto
- University of Iowa Hospitals and Clinics, Pathology Department, Iowa City Iowa, United States.
| | - Joan E. Maley
- University of Iowa Hospitals and Clinics, Radiology Department, Neuroradiology Division, Iowa City Iowa, United States.
| | - Nitesh Shekhrajka
- University of Iowa Hospitals and Clinics, Radiology Department, Neuroradiology Division, Iowa City Iowa, United States.
| | - Bruno A. Policeni
- University of Iowa Hospitals and Clinics, Radiology Department, Neuroradiology Division, Iowa City Iowa, United States.
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4
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Hoshina Y, Delic A, Wong KH, Lyden S, Kadish R, Smith TL, Wright MA, Shimura D, Clardy SL. Vasculitis in the Central Nervous System: Etiology, Characteristics, and Outcomes in a Large Single-Center Cohort. Neurohospitalist 2024; 14:129-139. [PMID: 38666288 PMCID: PMC11040621 DOI: 10.1177/19418744231223283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Background and Purpose For the management of central nervous system (CNS) vasculitis, it is crucial to differentiate between primary and secondary CNS vasculitis and to understand the respective etiologies. We assessed the etiology, characteristics, and outcomes of patients with CNS vasculitis. Methods A single-center retrospective chart review was conducted at the University of Utah, Department of Neurology, between February 2011 and October 2022. Results The median age of the 44 included patients at diagnosis was 54 years; 25.0% were men. Compared to primary CNS vasculitis, secondary CNS vasculitis exhibits higher fever incidence (observed in infectious and connective tissue disorder [CTD]-associated vasculitis), low glucose levels (mostly in infectious vasculitis) and unique cerebrospinal fluid oligoclonal bands (observed in infectious and CTD-associated vasculitis). Patients with inflammatory cerebral amyloid angiopathy (CAA) were older and more commonly had microhemorrhage than primary angiitis of the CNS (PACNS). All patients with CTD-associated vasculitis had a known history of CTD at presentation. Brain biopsies were performed on 10 of 17 PACNS patients and 4 of 8 inflammatory CAA patients, confirming vasculitis in 7 and 4 patients, respectively. Intravenous methylprednisolone was the predominant induction therapy (63.6%), and cyclophosphamide was the most used adjunctive therapy. Cyclophosphamide, rituximab, azathioprine, and mycophenolate mofetil were utilized as maintenance therapy, often with concurrent prednisone. Patients with inflammatory CAA had a higher tendency for relapse rates than PACNS. Conclusions This study highlights the variations in patients' characteristics, symptoms, and treatment for CNS vasculitis. Understanding these differences can lead to more efficient diagnostic and management strategies.
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Affiliation(s)
- Yoji Hoshina
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Alen Delic
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Ka-Ho Wong
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Stephanie Lyden
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Robert Kadish
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Tammy L. Smith
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Melissa A. Wright
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Daisuke Shimura
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - Stacey L. Clardy
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
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5
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Zamora CA, Mossa-Basha M, Castillo M. Usefulness of Different Imaging Methods in the Diagnosis of Cerebral Vasculopathy. Neuroimaging Clin N Am 2024; 34:39-52. [PMID: 37951704 DOI: 10.1016/j.nic.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Assessment of cerebral vasculopathies is challenging and requires understanding the utility of different imaging methods. Various techniques are available to image the vessel lumen, each with unique advantages and disadvantages. Bolus-based CT and MR angiography requires careful timing of a contrast bolus to provide optimal luminal enhancement. Non-contrast MRA techniques do not require a contrast agent and can provide images with little venous contamination. Digital subtraction angiography remains the gold standard but is invasive, while VW-MRI provides a non-invasive way of assessing vessel wall pathology. Conventional brain MRI has high sensitivity in the diagnosis of vasculitis but findings are nonspecific.
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Affiliation(s)
- Carlos A Zamora
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, CB 7510, Old Infirmary Building, 101 Manning Drive, Chapel Hill, NC 27599-7510, USA.
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, CB 7510, Old Infirmary Building, 101 Manning Drive, Chapel Hill, NC 27599-7510, USA
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Pascarella R, Antonenko K, Boulouis G, De Boysson H, Giannini C, Heldner MR, Kargiotis O, Nguyen TN, Rice CM, Salvarani C, Schmidt-Pogoda A, Strbian D, Hussain S, Zedde M. European Stroke Organisation (ESO) guidelines on Primary Angiitis of the Central Nervous System (PACNS). Eur Stroke J 2023; 8:842-879. [PMID: 37903069 PMCID: PMC10683718 DOI: 10.1177/23969873231190431] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/11/2023] [Indexed: 11/01/2023] Open
Abstract
The European Stroke Organisation (ESO) guideline on Primary Angiitis of the Central Nervous System (PACNS), developed according to ESO standard operating procedures (SOP) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, was elaborated to assist clinicians in the diagnostic and treatment pathway of patients with PACNS in their decision making. A working group involving vascular neurologists, neuroradiologists, rheumatologists, a neuropathologist and a methodologist identified 17 relevant clinical questions; these were addressed according to the patient/population, intervention, comparison and outcomes (PICO) framework and systematic literature reviews were performed. Notably, each PICO was addressed with respect to large vessel (LV)-PACNS and small vessel (SV)-PACNS. Data to answer many questions were scarce or lacking and the quality of evidence was very low overall, so, for some PICOs, the recommendations reflect the ongoing uncertainty. When the absence of sufficient evidence precluded recommendations, Expert Consensus Statements were formulated. In some cases, this applied to interventions in the diagnosis and treatment of PACNS which are embedded widely in clinical practice, for example patterns of cerebrospinal fluid (CSF) and Magnetic Resonance Imaging (MRI) abnormalities. CSF analysis for hyperproteinorrachia and pleocytosis does not have evidence supporting their use as diagnostic tools. The working group recommended that caution is employed in the interpretation of non-invasive vascular imaging due to lack of validation and the different sensitivities in comparison with digital subtraction angiography (DSA) and histopathological analyses. Moreover, there is not a neuroimaging pattern specific for PACNS and neurovascular issues are largely underreported in PACNS patients. The group's recommendations on induction and maintenance of treatment and for primary or secondary prevention of vascular events also reflect uncertainty due to lack of evidence. Being uncertain the role and practical usefulness of current diagnostic criteria and being not comparable the main treatment strategies, it is suggested to have a multidisciplinary team approach in an expert center during both work up and management of patients with suspected PACNS. Highlighting the limitations of the currently accepted diagnostic criteria, we hope to facilitate the design of multicenter, prospective clinical studies and trials. A standardization of neuroimaging techniques and reporting to improve the level of evidence underpinning interventions employed in the diagnosis and management of PACNS. We anticipate that this guideline, the first comprehensive European guideline on PACNS management using GRADE methodology, will assist clinicians to choose the most effective management strategy for PACNS.
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Affiliation(s)
- Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Katherina Antonenko
- Department of Neurology, University Hospital and University of Bern, Bern, Switzerland
| | - Grégoire Boulouis
- Neuroradiology - Diagnostic and Interventional Neuroradiology, CIC-IT 1415, INSERM 1253 iBrain, Tours University Hospital, Centre Val de Loire Region, France
| | - Hubert De Boysson
- Service de Médecine Interne, CHU de Caen, Avenue de la Côte de Nacre, Caen, France; Université Caen Normandie, Caen, France
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mirjam R Heldner
- Department of Neurology, University Hospital and University of Bern, Bern, Switzerland
| | - Odysseas Kargiotis
- Stroke Unit, Metropolitan Hospital, Ethnarchou Makariou 9, Piraeus, Greece
| | - Thanh N Nguyen
- Neurology, Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Claire M Rice
- Neurology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Carlo Salvarani
- Rheumatology, Rheumatology Unit, Azienda Ospedaliera-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Antje Schmidt-Pogoda
- Department of Neurology with Institute of Translational Neurology, Münster University Hospital, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Daniel Strbian
- Department of Neurology, Helsinki University Central Hospital HUCH, Helsinki, Finland
| | | | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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7
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Bou GA, El Sammak S, Chien LC, Cavanagh JJ, Hutto SK. Tumefactive brain parenchymal neurosarcoidosis. J Neurol 2023; 270:4368-4376. [PMID: 37219604 DOI: 10.1007/s00415-023-11782-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Enhancing brain parenchymal disease, and especially tumefactive lesions, are an uncommon manifestation of neurosarcoidosis. Little is known about the clinical features of tumefactive lesions and their impact on management and outcomes, which this study aims to characterize. METHODS Patients with pathologically-confirmed sarcoidosis were retrospectively reviewed and included if brain lesions were: (1) intraparenchymal, (2) larger than 1 cm in diameter, and (3) associated with edema and/or mass effect. RESULTS Nine patients (9/214, 4.2%) were included. Median onset age was 37 years. Diagnosis was confirmed by brain parenchymal biopsies in 5 (55.6%). Median modified Rankin scale (mRS) score was 2 (range 1-4) at initial presentation. Common manifestations included headache (77.8%), cognitive dysfunction (66.7%), and seizures (44.4%). Sixteen lesions were present in 9 patients. The frontal lobe (31.3%) was most affected, followed by the subinsular region (12.5%), basal ganglia (12.5%%), cerebellum (12.5%), and pons (12.5%). MRI characteristics of the dominant lesions included spherical morphology (77.8%), perilesional edema (100.0%), mass effect (55.6%), well-demarcated borders (66.7%), and contrast enhancement (100.0%; 55.6% heterogeneous). Leptomeningitis was frequently present (77.8%). All required corticosteroid-sparing treatments, and most (55.6%) needed at least a third line of treatment (infliximab used in 44.4%). All patients relapsed (median 3 relapses, range 1-9). Median last mRS was 1.0 after median follow-up of 86 months, with significant residual deficits in 55.6%. CONCLUSION Tumefactive brain parenchymal lesions are uncommon, usually affect the supratentorial brain along with leptomeningitis, and are refractory to initial treatments with a high risk of relapse. Significant sequelae were encountered despite a favorable median last mRS.
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Affiliation(s)
- Gabriela A Bou
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA, 30329, USA
| | - Sally El Sammak
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA, 30329, USA
| | - Ling-Chen Chien
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Julien J Cavanagh
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA, 30329, USA
| | - Spencer K Hutto
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive NE, Atlanta, GA, 30329, USA.
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8
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Application of susceptibility weighted imaging (SWI) in diagnostic imaging of brain pathologies – a practical approach. Clin Neurol Neurosurg 2022; 221:107368. [DOI: 10.1016/j.clineuro.2022.107368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/03/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022]
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9
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Primary angiitis of central nervous system – A challenging diagnosis. J Neuroimmunol 2022; 366:577844. [DOI: 10.1016/j.jneuroim.2022.577844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/26/2022] [Accepted: 03/06/2022] [Indexed: 12/14/2022]
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10
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Mansueto G, Lanza G, Fisicaro F, Alaouieh D, Hong E, Girolami S, Montella M, Feola A, Di Napoli M. Central and Peripheral Nervous System Complications of Vasculitis Syndromes From Pathology to Bedside: Part 1-Central Nervous System. Curr Neurol Neurosci Rep 2022; 22:47-69. [PMID: 35138587 PMCID: PMC9056593 DOI: 10.1007/s11910-022-01172-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide a comprehensive update on the clinical assessment, diagnosis, complications, and treatment of primary central nervous system vasculitis (PCNSV). RECENT FINDINGS The developments in neuroimaging, molecular testing, and cerebral biopsy have enhanced clinical assessment and decision making, providing novel insights to prevent misdiagnosis increasing diagnostic certainty. Advances in imaging techniques visualizing the wall of intracranial vessels have improved the possibility to distinguish inflammatory from non-inflammatory vascular lesions. Large recent studies have revealed a more varied histopathological pictures and disclosed an association with amyloid angiopathy. Unfortunately, therapy remains largely empiric. PCNSV is a heterogeneous group of disorders encompassing different clinical subsets that may differ in terms of prognosis and therapy. Recent evidence has described a more benign course, with good response to therapy. New diagnostic techniques will play soon a pivotal role in the appropriate diagnosis and prompt management of PCNSV.
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Affiliation(s)
- Gelsomina Mansueto
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
- grid.9841.40000 0001 2200 8888Clinical Department of Laboratory Services and Public Health—Legal Medicine Unit, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy
- grid.4691.a0000 0001 0790 385XPathology-Unit of Federico II University, via S. Pansini 3, 80131 Naples, Italy
| | - Giuseppe Lanza
- grid.8158.40000 0004 1757 1969Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
- grid.419843.30000 0001 1250 7659Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy
| | - Francesco Fisicaro
- grid.8158.40000 0004 1757 1969Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy
| | - Danielle Alaouieh
- grid.266832.b0000 0001 2188 8502School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - Emily Hong
- grid.266832.b0000 0001 2188 8502School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - Sara Girolami
- grid.413811.eNeurological Service, SS Annunziata Hospital, Viale Mazzini 100, 67039 Sulmona, L’Aquila, Italy
| | - Marco Montella
- grid.9841.40000 0001 2200 8888Mental and Physical Health and Preventive Medicine Department, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy
| | - Alessandro Feola
- Department Experimental Medicine, University of Campania, 80138 Naples, Italy
| | - Mario Di Napoli
- grid.413811.eNeurological Service, SS Annunziata Hospital, Viale Mazzini 100, 67039 Sulmona, L’Aquila, Italy
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Hsu CCT, Du L, Luong D, Suthiphosuwan S, Bharatha A, Krings T, Haacke EM, Osborn AG. More on Exploiting the T1 Shinethrough and T2* Effects Using Multiecho Susceptibility-Weighted Imaging. AJNR Am J Neuroradiol 2021; 42:E62-E63. [PMID: 34167958 DOI: 10.3174/ajnr.a7175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- C C-T Hsu
- Division of Neuroradiology, Department of Medical ImagingGold Coast University HospitalSouthport, Queensland, Australia
| | - L Du
- Division of Neuroradiology, Department of Medical ImagingGold Coast University HospitalSouthport, Queensland, Australia
| | - D Luong
- Division of Neuroradiology, Department of Medical ImagingGold Coast University HospitalSouthport, Queensland, Australia
| | - S Suthiphosuwan
- Division of Neuroradiology, Department of Medical ImagingSt Michael's HospitalToronto, Ontario, Canada
| | - A Bharatha
- Division of Neuroradiology, Department of Medical Imaging and Division Neurosurgery, Department of SurgerySt. Michael's HospitalToronto, Ontario, Canada
| | - T Krings
- Division of Neuroradiology, Department of Medical ImagingToronto Western HospitalToronto, Ontario, Canada
| | - E M Haacke
- Department of RadiologyWayne State UniversityDetroit, Michigan
| | - A G Osborn
- Departments of Pathology and Radiology and Imaging SciencesUniversity of UtahSalt Lake City, Utah
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12
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Su X, Han L, Li M, Wang Z, Gao J, Tian Y, Du C. Novel method using DW-MRI and ADC images to guide stereotactic biopsy for the diagnosis small primary angiitis of the central nervous system: a case report. Eur J Med Res 2021; 26:58. [PMID: 34162432 PMCID: PMC8220829 DOI: 10.1186/s40001-021-00529-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
Objective To determine the role of diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient (ADC) imaging to guide stereotactic biopsy for the diagnosis of intracranial angiitis. Case presentation In a 28-year-old woman who had experienced inactive headache and right limbs numbness for 4 days, preoperative magnetic resonance (MR) scanning, enhanced scanning, diffusion tensor imaging, magnetic resonance spectroscopy, diffusion-weighted imaging (DWI), and ADC image scanning were performed. Stereotactic biopsy was performed in one target where the area of edema detected with MR FLAIR, and two targets where the area shown as a high-value and a lower value area in the DWI/ADC image. Pathological examinations together with computed tomographic and enhanced MRI scans were conducted after surgery. A preoperative enhanced MRI scan showed a uniform low-intensity lesion in the patient’s left centrum semiovale, with a volume of 3.1 cm3. The DWI and ADC images showed uneven high-intensity signals and different ADC values in the lesion area, respectively. During surgery, tissues around the lesion and the lesion center were sampled at the three selected targets. The postoperative pathological diagnosis was primary angiitis of the central nervous system, and the patient was given anti-inflammatory medication and hormone therapy. The 3-year follow-up confirmed that the patient had recovered well, with a Glasgow Outcome Scale score of five. Conclusion DW-MRI and ADC images can be reliably used to determine the location of small intracranial lesions, and guide stereotactic biopsy to facilitate the diagnosis of primary vasculitis of the central nervous system.
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Affiliation(s)
- Xu Su
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China
| | - Liang Han
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Mengxing Li
- Beijing Neurosurgical Institute , Beijing, China
| | - Zhengming Wang
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China
| | - Jiadui Gao
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China
| | - Yu Tian
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China
| | - Chao Du
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China.
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13
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Fonseca APA, do Carmo RL, Pacheco FT, Nunes RH, da Rocha AJ. Primary Angiitis of the CNS with Unremarkable Vessel Wall MR Imaging: How the "T1 Shinethrough" Effect on SWI Adds to the Detection of Gadolinium Enhancement of Small Intraparenchymal Brain Vessels. AJNR Am J Neuroradiol 2021; 42:E24-E26. [PMID: 33574099 DOI: 10.3174/ajnr.a6973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- A P A Fonseca
- Division of NeuroradiologyDiagnosticos da America SASao Paulo, Brazil
- Division of NeuroradiologySanta Casa de Sao Paulo School of Medical SciencesSao Paulo, Brazil
- Division of NeuroradiologyUnited Health GroupSao Paulo, Brazil
| | - R L do Carmo
- Division of NeuroradiologyDiagnosticos da America SASao Paulo, Brazil
- Division of NeuroradiologySanta Casa de Sao Paulo School of Medical SciencesSao Paulo, Brazil
- Division of NeuroradiologyUnited Health GroupSao Paulo, Brazil
| | - F T Pacheco
- Division of NeuroradiologyDiagnosticos da America SASao Paulo, Brazil
- Division of NeuroradiologySanta Casa de Sao Paulo School of Medical SciencesSao Paulo, Brazil
- Division of NeuroradiologyUnited Health GroupSao Paulo, Brazil
| | - R H Nunes
- Division of NeuroradiologyDiagnosticos da America SASao Paulo, Brazil
- Division of NeuroradiologySanta Casa de Sao Paulo School of Medical SciencesSao Paulo, Brazil
- Division of NeuroradiologyUnited Health GroupSao Paulo, Brazil
| | - A J da Rocha
- Division of NeuroradiologyDiagnosticos da America SASao Paulo, Brazil
- Division of NeuroradiologySanta Casa de Sao Paulo School of Medical SciencesSao Paulo, Brazil
- Division of NeuroradiologyUnited Health GroupSao Paulo, Brazil
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