Morgagnian cataract simulating iris neoplasia : case report

Purpose: to describe a case in which the diagnosis of Morganian cataract required clinical and instrumental differentiation from iris pathologies, including iris melanoma. Methods: a 60-years-old Caucasian man referred to our institute for worsening of vision in last few months. Clinical evaluation consisted in complete ophthalmological assessment, ultrasound examination (biomicroscopy and 20MHz), and Magnetic Resonance Imaging (MRI) completed with Susceptibility Weighted Imaging (SWI). Results: traumatic corneal wound of the left eye (LE) had occurred 5 years before, and was treated with medical therapy alone. Best-corrected visual acuity (BCVA) was 3/10 in the right eye (RE) and finger count in the LE, with intraocular pressure at 13 and 20mmHg, respectively. Chronic central serous chorioretinopathy, accounted for the low visual acuity of the RE. Slit-lamp biomicroscopy of the LE was as in Figure 1; LE fundus was not clinically observable. Despite MRI was compatible with an iris solid formation, characterized by contrast enhancement and hyperintense signal in SWI, ultrasound indicated rather a mixed solid and liquid content (moderately echogenic external layer, hyporeflective internal content). Iris root and ciliary body were not significantly altered; the lens showed inhomogeneous content. We considered Morgagnian cataract the most probable diagnosis. Surgery confirmed the presence of a hypermature cataract with prior anterior capsule fissuring; the liquefied cortex infiltrated the iris without anterior chamber seeping. Post-operative BCVA was 3/10 and fundus examination disclosed an advanced macular chronic central serous chorioretinopathy. Conclusions: In the reported case a previous perforating trauma have probably damaged the lens capsule and started cataract progression. Curiously cataract developed percolating into the iris stroma, thus simulating an iris mass. At our knowledge, Morgagnian cataract has never been included in the differential diagnosis of iris mass.

Free-breathing black-blood coronary MR angiography: initial results

The authors developed a free-breathing black-blood coronary magnetic resonance (MR) angiographic technique with a potential for exclusive visualization of the coronary blood pool. Results with the MR angiographic technique were evaluated in eight healthy subjects and four patients with coronary disease identified at conventional angiography. This MR angiographic technique accurately depicted luminal disease in the patients and permitted visualization of extensive continuous segments of the native coronary tree in both the healthy subjects and the patients. Black-blood coronary MR angiography provides an alternative source of contrast enhancement.

Clinical management and outcome of histologically verified adult brainstem gliomas in Switzerland: a retrospective analysis of 21 patients.

Because of low incidence, mixed study populations and paucity of clinical and histological data, the management of adult brainstem gliomas (BSGs) remains non-standardized. We here describe characteristics, treatment and outcome of patients with exclusively histologically confirmed adult BSGs. A retrospective chart review of adults (age >18 years) was conducted. BSG was defined as a glial tumor located in the midbrain, pons or medulla. Characteristics, management and outcome were analyzed. Twenty one patients (17 males; median age 41 years) were diagnosed between 2004 and 2012 by biopsy (n = 15), partial (n = 4) or complete resection (n = 2). Diagnoses were glioblastoma (WHO grade IV, n = 6), anaplastic astrocytoma (WHO grade III, n = 7), diffuse astrocytoma (WHO grade II, n = 6) and pilocytic astrocytoma (WHO grade I, n = 2). Diffuse gliomas were mainly located in the pons and frequently showed MRI contrast enhancement. Endophytic growth was common (16 vs. 5). Postoperative therapy in low-grade (WHO grade I/II) and high-grade gliomas (WHO grade III/IV) consisted of radiotherapy alone (three in each group), radiochemotherapy (2 vs. 6), chemotherapy alone (0 vs. 2) or no postoperative therapy (3 vs. 1). Median PFS (24.1 vs. 5.8 months; log-rank, p = 0.009) and mOS (30.5 vs. 11.5 months; log-rank, p = 0.028) was significantly better in WHO grade II than in WHO grade III/IV tumors. Second-line therapy considerably varied. Histologically verification of adult BSGs is feasible and has an impact on postoperative treatment. Low-grade gliomas can simple be followed or treated with radiotherapy alone. Radiochemotherapy with temozolomide can safely be prescribed for high-grade gliomas without additional CNS toxicities.

Phase II study of imatinib in advanced chordoma.

PURPOSE: To explore the antitumor activity of imatinib in patients with advanced platelet-derived growth factor β (PDGFB)/PDGF receptor β (PDGFRB)-positive chordomas.¦PATIENTS AND METHODS: In a collaborative Italian-Swiss, prospective, phase II clinical study conducted from November 2004 through April 2006, 56 patients with advanced PDGFB and/or PDGFRB chordoma received 800 mg/d of imatinib until progression. The primary end point was the overall tumor response rate (ORR), defined by RECIST. Secondary, exploratory end points included tissue response (ie, changes in tumor density or signal intensity/contrast enhancement, and/or [18F]-fluorodeoxyglucose positron emission tomography [PET] uptake), overall survival, progression-free survival (PFS), and pain score.¦RESULTS: Among 50 patients evaluable by RECIST, the best response was one partial response (PR) obtained at 6 months (ORR, 2%). There were 35 patients with stable disease (SD, 70%) and a 64% clinical benefit rate (ie, RECIST complete response + PR + SD ≥ 6 months). A minor dimensional response (< 20%) was detected in nine patients. A maximum standard uptake value decrease ≥ 25% was observed in 10 (39%) of 26 patients evaluable for PET response at 3 months. Changes in the Brief Pain Inventory score were consistent with the response assessment. Median PFS (intention-to-treat population, 56 patients) was 9 months. No unexpected toxicities were observed.¦CONCLUSION: This is the largest phase II study in chordoma to date. It confirms anecdotal evidence that imatinib has antitumor activity in this orphan disease, and therefore, it is worth further investigation.

Local re-inversion coronary MR angiography: arterial spin-labeling without the need for subtraction.

PURPOSE: To implement a double-inversion bright-blood coronary MR angiography sequence using a cylindrical re-inversion prepulse for selective visualization of the coronary arteries. MATERIALS AND METHODS: Local re-inversion bright-blood magnetization preparation was implemented using a nonselective inversion followed by a cylindrical aortic re-inversion prepulse. After an inversion delay that allows for in-flow of the labeled blood-pool into the coronary arteries, three-dimensional radial steady-state free-precession (SSFP) imaging (repetition/echo time, 7.2/3.6 ms; flip angle, 120 degrees, 16 profiles per RR interval; field of view, 360 mm; matrix, 512, twelve 3-mm slices) is performed. Coronary MR angiography was performed in three healthy volunteers and in one patient on a commercial 1.5 Tesla whole-body MR System. RESULTS: In all subjects, coronary arteries were selectively visualized with positive contrast. In addition, a middle-grade stenosis of the proximal right coronary artery was seen in one patient. CONCLUSION: A novel T1 contrast-enhancement strategy is presented for selective visualization of the coronary arteries without extrinsic contrast medium application. In comparison to former arterial spin-labeling schemes, the proposed magnetization preparation obviates the need for a second data set and subtraction.

Skull base chordomas: presentation of six cases and review of the literature.

Chordomas are uncommon tumours occuring from remnants of the notochord. They are mainly localized in the sacrococcygium, the spine and the skull base. We focused our study on skull base chordomas and reviewed 531 published cases and 6 cases diagnosed in our institution. The six cases diagnosed at our hospital are described with a special mention of a unique case presenting with meningitis. Clinical features, radiology, histopathology and survival with different treatments are reviewed. Skull base chordomas can occur at any age and are slightly more frequent in males. Patients complain most often of diplopia and headaches. Abducens nerve palsy is the commonest neurological finding. Radiological examination should include both CT-scan which shows extensive osteolysis, calcifications and contrast enhancement and MRI for topographical definition. Metastases rarely occur. Treatment remains controversial but combined surgery and radiotherapy is the best treatment with a 5 year survival rate of 75%.

Addition of MR imaging features and genetic biomarkers strengthens glioblastoma survival prediction in TCGA patients.

PURPOSE: The purpose of our study was to assess whether a model combining clinical factors, MR imaging features, and genomics would better predict overall survival of patients with glioblastoma (GBM) than either individual data type. METHODS: The study was conducted leveraging The Cancer Genome Atlas (TCGA) effort supported by the National Institutes of Health. Six neuroradiologists reviewed MRI images from The Cancer Imaging Archive (http://cancerimagingarchive.net) of 102 GBM patients using the VASARI scoring system. The patients' clinical and genetic data were obtained from the TCGA website (http://www.cancergenome.nih.gov/). Patient outcome was measured in terms of overall survival time. The association between different categories of biomarkers and survival was evaluated using Cox analysis. RESULTS: The features that were significantly associated with survival were: (1) clinical factors: chemotherapy; (2) imaging: proportion of tumor contrast enhancement on MRI; and (3) genomics: HRAS copy number variation. The combination of these three biomarkers resulted in an incremental increase in the strength of prediction of survival, with the model that included clinical, imaging, and genetic variables having the highest predictive accuracy (area under the curve 0.679±0.068, Akaike's information criterion 566.7, P<0.001). CONCLUSION: A combination of clinical factors, imaging features, and HRAS copy number variation best predicts survival of patients with GBM.

Ultra-high Field (7 T) MRI and a Novel Robust Segmentation of Thalamic Nuclei on DWI for Gamma Knife Surgery Purposes: The Targeting of the Ventrointermediate Nucleus

Introduction: Gamma Knife surgery (GKS) is a noninvasive neurosurgical stereotactic procedure, increasingly used as an alternative to open functional procedures. This includes the targeting of the ventrointermediate nucleus of the thalamus (e.g., Vim) for tremor. Objective: To enhance anatomic imaging for Vim GKS using high-field (7 T) MRI and Diffusion Weighted Imaging (DWI). Methods: Five young healthy subjects and two patients were scanned both on 3 and 7 T MRI. The protocol was the same in all cases, and included: T1-weighted (T1w) and DWI at 3T; susceptibility weighted images (SWI) at 7T for the visualization of thalamic subparts. SWI was further integrated into the Gamma Plan Software® (LGP, Elekta Instruments, AB, Sweden) and co-registered with 3T images. A simulation of targeting of the Vim was done using the quadrilatere of Guyot. Furthermore, a correlation with the position of the found target on SWI and also on DWI (after clustering of the different thalamic nuclei) was performed. Results: For the 5 healthy subjects, there was a good correlation between the position of the Vim on SWI, DWI and the GKS targeting. For the patients, on the pretherapeutic acquisitions, SWI helped in positioning the target. For posttherapeutic sequences, SWI supposed position of the Vim matched the corresponding contrast enhancement seen at follow-up MRI. Additionally, on the patient's follow-up T1w images, we could observe a small area of contrast-enhancement corresponding to the target used in GKS (e.g., Vim), which belongs to the Ventral-Lateral-Ventral (VLV) nuclei group. Our clustering method resulted in seven thalamic groups. Conclusion: The use of SWI provided us with a superior resolution and an improved image contrast within the central gray matter, enabling us to directly visualize the Vim. We additionally propose a novel robust method for segmenting the thalamus in seven anatomical groups based on DWI. The localization of the GKS target on the follow-up T1w images, as well as the position of the Vim on 7 T, have been used as a gold standard for the validation of VLV cluster's emplacement. The contrast enhancement corresponding to the targeted area was always localized inside the expected cluster, providing strong evidence of the VLV segmentation accuracy. The anatomical correlation between the direct visualization on 7T and the current targeting methods on 3T (e.g., quadrilatere of Guyot, histological atlases, DWI) seems to show a very good anatomical matching.

Functional magnetic resonance imaging in oncology: state of the art

In the investigation of tumors with conventional magnetic resonance imaging, both quantitative characteristics, such as size, edema, necrosis, and presence of metastases, and qualitative characteristics, such as contrast enhancement degree, are taken into consideration. However, changes in cell metabolism and tissue physiology which precede morphological changes cannot be detected by the conventional technique. The development of new magnetic resonance imaging techniques has enabled the functional assessment of the structures in order to obtain information on the different physiological processes of the tumor microenvironment, such as oxygenation levels, cellularity and vascularity. The detailed morphological study in association with the new functional imaging techniques allows for an appropriate approach to cancer patients, including the phases of diagnosis, staging, response evaluation and follow-up, with a positive impact on their quality of life and survival rate.

Multiparametric magnetic resonance imaging of the prostate: current concepts

Multiparametric MR (mpMR) imaging is rapidly evolving into the mainstay in prostate cancer (PCa) imaging. Generally, the examination consists of T2-weighted sequences, diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) evaluation, and less often proton MR spectroscopy imaging (MRSI). Those functional techniques are related to biological properties of the tumor, so that DWI correlates to cellularity and Gleason scores, DCE correlates to angiogenesis, and MRSI correlates to cell membrane turnover. The combined use of those techniques enhances the diagnostic confidence and allows for better characterization of PCa. The present article reviews and illustrates the technical aspects and clinical applications of each component of mpMR imaging, in a practical approach from the urological standpoint.

High-Resolution Magnetic Resonance Imaging Can Reliably Detect Orbital Tumor Recurrence after Enucleation in Children with Retinoblastoma.

PURPOSE: Orbital tumor recurrence is a rare but serious complication in children with retinoblastoma, leading to a high risk of metastasis and death. Therefore, we assume that these recurrences have to be detected and treated as early as possible. Preliminary studies used magnetic resonance imaging (MRI) to evaluate postsurgical findings in the orbit. In this study, we assessed the diagnostic accuracy of high-resolution MRI to detect orbital tumor recurrence in children with retinoblastoma in a large study cohort. DESIGN: Consecutive retrospective study (2007-2013) assessing MRI findings after enucleation. PARTICIPANTS: A total of 103 MRI examinations of 55 orbits (50 children, 27 male/23 female, mean age 16.3±12.4 months) with a median time of 8 months (range, 0-93) after enucleation for retinoblastoma. METHODS: High-resolution MRI using orbital surface coils was performed on 1.5 Tesla MRI systems to assess abnormal orbital findings. MAIN OUTCOME MEASURES: Five European experts in retinoblastoma imaging evaluated the MRI examinations regarding the presence of abnormal orbital gadolinium enhancement and judged them as "definitive tumor," "suspicious of tumor," "postsurgical condition/scar formation," or "without pathologic findings." The findings were correlated to histopathology (if available), MRI, and clinical follow-up. RESULTS: Abnormal orbital enhancement was a common finding after enucleation (100% in the first 3 months after enucleation, 64.3% >3 years after enucleation). All histopathologically confirmed tumor recurrences (3 of 55 orbits, 5.5%) were correctly judged as "definitive tumor" in MRI. Two orbits from 2 children rated as "suspicious of tumor" received intravenous chemotherapy without histopathologic confirmation; further follow-up (67 and 47 months) revealed no sign of tumor recurrence. In 90.2%, no tumor was suspected on MRI, which was clinically confirmed during follow-up (median follow-up after enucleation, 45 months; range, 8-126). CONCLUSIONS: High-resolution MRI with orbital surface coils may reliably distinguish between common postsurgical contrast enhancement and orbital tumor recurrence, and therefore may be a useful tool to evaluate orbital tumor recurrence after enucleation in children with retinoblastoma. We recommend high-resolution MRI as a potential screening tool for the orbit in children with retinoblastoma to exclude tumor recurrence, especially in high-risk patients within the critical first 2 years after enucleation.

Recuperation and improvement of chromosome preparations stained with silver nitrate

Both periodic acid and photographic reagents have been used to remove the silver nitrate residues from cytological preparations. We used potassium ferricyanide to remove AgNO3 salts in cases of excessive chromosome impregnation. This method produced partial decolorization, with contrast enhancement. Counterstaining with Giemsa also promoted a better contrast between chromosome arms and NORs, which were preserved and retained a dark color. Application of this procedure to chromosome preparations treated sequentially for CBG banding/AgNO3 staining promoted complete decolorization of C+ regions, leading to "reverse" C-banding, generally with high contrast.

Strain induced anomalous red shift in mesoscopic iron oxide prepared by a novel technique

Nano magnetic oxides are promising candidates for high density magnetic storage and other applications. Nonspherical mesoscopic iron oxide particles are also candidate materials for studying the shape, size and strain induced modifications of various physical properties viz. optical, magnetic and structural. Spherical and nonspherical iron oxides having an aspect ratio, ~2, are synthesized by employing starch and ethylene glycol and starch and water, respectively by a novel technique. Their optical, structural, thermal and magnetic properties are evaluated. A red shift of 0⋅24 eV is observed in the case of nonspherical particles when compared to spherical ones. The red shift is attributed to strain induced changes in internal pressure inside the elongated iron oxide particles. Pressure induced effects are due to the increased overlap of wave functions. Magnetic measurements reveal that particles are superparamagnetic. The marked increase in coercivity in the case of elongated particles is a clear evidence for shape induced anisotropy. The decreased specific saturation magnetization of the samples is explained on the basis of weight percentage of starch, a nonmagnetic component and is verified by TGA and FTIR studies. This technique can be modified for tailoring the aspect ratio and these particles are promising candidates for drug delivery and contrast enhancement agents in magnetic resonance imaging

Angiorresonancia versus angiografía por sustracción digital en el seguimiento de aneurismas intracraneales embolizados. Comparación del desempeño diagnóstico

Introducción: La DSA es el método de elección para el seguimiento de pacientes con aneurismas intracraneales embolizados; esta se puede asociar a complicaciones incapacitantes o mortales. La MRA se ha propuesto como método alternativo por menor costo y menos morbi-mortalidad, aunque su desempeño diagnóstico permanece en discusión debido al desarrollo de nuevos protocolos, resonadores más potentes y nuevas aplicaciones de la DSA. Metodología: Exploramos la literatura hasta la actualidad y comparamos el desempeño diagnóstico de la MRA con la DSA para detectar flujo residual posterior a la embolización terapéutica de aneurismas intracraneales. Realizamos una revisión sistemática de la literatura y meta-análisis basados en 34 artículos detectados en la búsqueda que incluyó las bases de datos PubMed, Scopus, ScIELO y BVS. Resultados: La TOF-MRA demostró sensibilidad de 86.8% (84.3%-89.1%) y especificidad de 91.2% (89%-93.1%); la SROC para TOF-MRA demostró un AUC de 0.95. El desempeño de la CE-MRA demostró sensibilidad de 88.1% (84.6%-91.1%) y especificidad de 89.1% (85.7%-91.9%); la SROC presentó una AUC de 0.93. El análisis estratificado por potencia del resonador encontró que la TOF-MRA tiene mejor desempeño con el resonador de 3T, aunque no es estadísticamente significativo. La concordancia interobservador con TOF-MRA y CE-MRA fue moderada a muy buena. Discusión: El desempeño diagnóstico de la MRA en el seguimiento de aneurismas intracraneales embolizados demostró ser bueno, con sensibilidad mayor a 84%, siendo ligeramente mejor con TOF-MRA, sin lograr reemplazar la DSA. Sin embargo, los resultados deben ser evaluados con precaución por la heterogeneidad de los resultados de los estudios incluidos. (Abreviaturas: DSA: Angiografía por Sustracción Digital; MRA: Angiografía por Resonancia Magnética; TOF-MRA: Angiorresonancia por Tiempo de Vuelo; CE-MRA: Angiorresonancia contrastada).

Intermittent antegrade cardioplegia: isolated heart preservation with the Asporto heart preservation device

Background—A major problem in procurement of donor hearts is the limited time a donor heart remains viable. After cardiectomy, ischemic hypoxia is the main cause of donor heart degradation. The global myocardial ischemia causes a cascade of oxygen radical formation that cumulates in an elevation in hydrogen ions (decrease in pH), irreversible cellular injury, and potential microvascular changes in perfusion. Objective—To determine the changes of prolonged storage times on donor heart microvasculature and the effects of intermittent antegrade perfusion. Materials and Methods—Using porcine hearts flushed with a Ribosol-based cardioplegic solution, we examined how storage time affects microvascular myocardial perfusion by using contrast-enhanced magnetic resonance imaging at a mean (SD) of 6.1 (0.6) hours (n=13) or 15.6 (0.6) hours (n=11) after cardiectomy. Finally, to determine if administration of cardioplegic solution affects pH and microvascular perfusion, isolated hearts (group 1, n=9) given a single antegrade dose, were compared with hearts (group 2, n=8) given intermittent antegrade cardioplegia (150 mL, every 30 min, 150 mL/min) by a heart preservation device. Khuri pH probes in left and right ventricular tissue continuously measured hydrogen ion levels, and perfusion intensity on magnetic resonance images was plotted against time. Results—Myocardial perfusion measured via magnetic resonance imaging at 6.1 hours was significantly greater than at 15.6 hours (67% vs 30%, P= .00008). In group 1 hearts, the mean (SD) for pH at the end of 6 hours decreased to 6.2 (0.2). In group 2, hearts that received intermittent antegrade cardioplegia, pH at the end of 6 hours was higher at 6.7 (0.3) (P=.0005). Magnetic resonance imaging showed no significant differences between the 2 groups in contrast enhancement (group 1, 62%; group 2, 40%) or in the wet/dry weight ratio. Conclusion—Intermittent perfusion maintains a significantly higher myocardial pH than does a conventional single antegrade dose. This difference may translate into an improved quality of donor hearts procured for transplantation, allowing longer distance procurement, tissue matching, improved outcomes for transplant recipients, and ideally a decrease in transplant-related costs.