Tag Archives: magnetic resonance imaging

Non-surgical approach to a paediatric pilocytic astrocytoma with MRI follow-up. Case report and brief literature review

DOI: 10.2478/amma-2022-0022

Introduction: Pilocytic astrocytoma is a common tumour in paediatric patients. A low-grade glioma, it is most commonly treated by surgery, with various post-surgical side effects. New methods of treatment and follow-up are constantly evolving to offer alternative options to paediatric patients whose nerve structures are developing.
Case presentation: A 9-year-old patient diagnosed with a pilocytic astrocytoma by MRI and histopathological examination underwent a biopsy and evacuation procedure of the cystic component after which the patient’s condition improved significantly. The ‘wait-and-see’ approach using MRI instead of total surgical excision of the tumour was preferred, and the patient had favourable results on control imaging.
Conclusions: Paediatric patients suffering from pilocytic astrocytoma with favourable imaging and histopathological features may consider MRI follow-up instead of surgical excision until the character of the tumour changes or until the brain has reached full development.

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Development of a low-grade glioma in an ischemic brain territory that evolved into a glioblastoma. A case report and brief literature review

DOI: 10.2478/amma-2022-0015

Introduction: Glioblastoma is one of the most common and aggressive brain tumours with a very high mortality rate. It often evolves from a late or misdiagnosed astrocytoma. Stroke is one of the most common pathologies of the brain, affecting approximately 1.1 million Europeans each year. This article presents the sequential development of a low-grade astrocytoma in an ischemic brain territory into a high-grade glioblastoma.
Case presentation: A 59-year-old patient presented to our hospital with severe headache and transient loss of balance and vision. Clinical findings and control imaging revealed the presence of an ischemic brain area in the left temporal lobe of the brain. Monthly brain magnetic resonance imaging (MRI) follow-up revealed the development of a low-grade astrocytoma in the ischemic territory, which later evolved into a glioblastoma.
Conclusions: Patients who suffer from a stroke should be closely monitored via MRI to prevent the rare development of tumour pathology in the affected territory.

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Multiple Sclerosis Brain Lesions: Is Short Tau Inversion Recovery Sequence Suitable in Magnetic Resonance Imaging Evaluation?

Purpose: To compare the sensitivity of Short Tau Inversion Recovery magnetic resonance sequence with Fast Spin-Echo T2-weighted and Fluid-Attenuated Inversion Recovery magnetic resonance sequences in detection and evaluation of multiple sclerosis brain lesions.
Material and method: Fast Spin-Echo T2-weighted, Fluid-Attenuated Inversion Recovery and Short Tau Inversion Recovery sequences were performed in 7 patients with relapsing remitting multiple sclerosis. Qualitative assessment, regarding the number of lesions detected, conspicuity and lesion location was performed on all images in each sequence by two radiologists. Consensus was reached by agreement.
Results: When comparing Short Tau Inversion Recovery sequences with Fast Spin-Echo sequences, Short Tau Inversion Recovery showed 51 lesions more than Fast Spin-Echo sequences and increased the number of lesions detected by 38% in posterior fossa and by 27% in juxtacortical locations. When comparing Short Tau Inversion Recovery sequences with Fluid-Attenuated Inversion Recovery sequences, Short Tau Inversion Recovery sequences showed 72 lesions more than Fluid-Attenuated Inversion Recovery sequences and increased the number of lesion detected by 86% in posterior fossa and by 24% in periventricular areas.
Conclusions: By increasing the sensitivity Short Tau Inversion Recovery sequence might be suitable as an additional sequence in routine magnetic resonance brain examinations in patients with multiple sclerosis. Although Short Tau Inversion Recovery provides essential supplementary information to conventional imaging for the visualization brain lesions in multiple sclerosis, especially in posterior fossa, it is not a substitute for other sequences.

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Multiple Sclerosis of the Spinal Cord: is Gadolinium Irreplaceable in Assessing Lesion Activity?

DOI: 10.2478/amma-2013-0037

Purpose: To evaluate the relationship between the T2 patterns of spinal cord multiple sclerosis lesions and their contrast uptake.
Material and method: We retrospectively reviewed the appearance of spinal cord lesions in 29 patients (with relapsing-remitting multiple sclerosis) who had signs and symptoms of myelopathy on neurologic examination and at least one active lesion visualized on magnetic resonance examinations performed between 2004 and 2011. We correlated the T2 patterns of lesions with contrast enhancement and calculated sensitivity and specificity in predicting gadolinium enhancement.
Results: Only focal patterns consisting of a lesion’s center homogenously brighter than its periphery on T2-weighed images (type I) correlated significantly with the presence of contrast enhancement (p = 0.004). Sensitivity was 0.307 and specificity 0.929. In contrast, enhancement was not significantly related to uniformly hyperintense T2 focal lesions (type II) or diffuse (type III) pattern defined as poorly delineated areas of multiple small, confluent, subtle hyperintense T2 lesions (p >0.5 for both).
Conclusions: We believe that information about the activity of multiple sclerosis spinal cord lesions in patients with myelopathy may be extracted not only from contrast enhanced, but also from non-enhanced magnetic resonance images.

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