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ABSTRACT: Augmentation of the cerebral blood supply to correct cerebral hemodynamic insufficiency by extracranial-intracranial bypass may be an appropriate method to reduce the risk of ischemic stroke. Eighty-five patients with ischemic symptoms, decreased regional cerebral blood flow, and decreased regional cerebrovascular reactivity were recruited for surgery. The post-bypass mean regional blood flow increased by 35.8% compared to the pre-bypass value (p<0.001). Only minor re-establishment of vasculature after anastomosis was detected in three of four patients with middle cerebral artery stenosis, which suggests that there are fewer benefits of bypass surgery in this situation. Cerebral infarction occurred immediately post-operation in one patient who was predisposed to stroke due to a bilateral carotid occlusion. Hyperperfusion injury was infrequent in this series; only one patient developed intracerebral hemorrhage three weeks after the bypass. One ischemic and one hemorrhagic stroke occurred during the 90 months following surgery.
Journal of Clinical Neuroscience 04/2012; 19(6):814-9. · 1.25 Impact Factor
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ABSTRACT: A 62-year-old man with locally advanced squamous cell carcinoma of the right retromolar trigone, pT4bN0M0, had surgery and postoperative concurrent chemoradiation therapy for 4 months. Right otalgia developed and facial magnetic resonance imaging revealed lesions which corresponded to postirradiation inflammation. F-18 FDG PET/CT showed recurrent lesions in the right buccal region and along the route of the mandibular division of the trigeminal nerve. This report indicates that F-18 FDG PET/CT could detect occult perineural tumor spread before identification on MRI especially in postoperative and postirradiation patients and effect intensity-modulated radiation therapy planning.
Clinical nuclear medicine 03/2010; 35(3):189-91. · 3.92 Impact Factor
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ABSTRACT: Characterization of WM alteration using MR imaging is important in the pre- and intraoperative assessment of brain tumors. This study characterizes the extent and severity of WM tract alterations near brain tumors using DTI in an effort to determine preoperative viability or resectability of the adjacent WM tracts. Fractional anisotropy is an important DTI-derived metric of MR imaging.
Twenty-one patients underwent MR DTI. Eighty-six WM tracts composed of 43 WM lesions paired with 43 contralateral WM hemispheric controls were categorized using FA. Neuroradiologists categorized the WM tracts as edematous, displaced, disrupted, or infiltrated with tumor using directionally encoded color maps. A mixed model analysis was used to compare FA.
Of the lesioned tracts, 5 were scored as edema, 9 as infiltration, 18 as displacement, and 11 as disruption. A significant DeltaFA(%) was found between the lesioned and contralateral hemispheres only in WM disruption (P = .0056). Both edema FA and disruption FA are significantly less than displacement FA (P < .05). The FA change (DeltaFA(%) = [FA(lesion) - FA(normal)]/FA(normal) x 100%) on the lesioned side was calculated. A DeltaFA% less than -30% is likely to be associated with WM disruption. A positive DeltaFA% is likely to be associated with edema or displacement, and a DeltaFA% between 0% and -30% is likely to be associated with WM displacement or infiltration.
Quantitative analysis of DTI data may provide insight as to whether WM tracts are salvageable preoperatively.
Surgical Neurology 07/2009; 72(5):464-9; discussion 469. · 1.67 Impact Factor
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ABSTRACT: To determine the association between fluid sign and clinical prognosis following percutaneous vertebroplasty (PV).
Institutional review board approval and informed consent were obtained for this prospective study. Fifty-two patients (41 women, 11 men; mean age, 75.9 years; range, 56-95 years) were enrolled from August 2006 to August 2007. All patients underwent preoperative magnetic resonance (MR) imaging and assessment of mobility and pain scores. PV was performed and patients underwent 1-, 3-, and 6-month follow-up examinations. MR findings of fluid sign (a focal, linear, or triangular area of strong hyperintensity, which is isointense relative to cerebrospinal fluid on T2-weighted sagittal images) and vacuum cleft were analyzed with respect to clinical outcome. Data were analyzed by using a combination of independent Student t test, chi(2) test, analysis of variance, and Fisher exact test.
Thirty-four (65%) patients showed vacuum cleft; 14 (27%) showed fluid sign at the bone-cement interface. Patients without fluid sign in the treated vertebral bodies had better mobility and pain improvement compared with patients with fluid sign at 1- and 3-month follow-up (P < .05). The adjacent fracture percentage (seven of 14, 50%) was higher in patients with fluid sign in the treated vertebral bodies than in those without (three of 38, 8%) (P = .002). Pain was similar in groups with and without fluid sign at 6-month follow-up.
The fluid sign in the treated vertebral bodies had a high negative predictive value of 92% and a positive predictive value of 50% to develop a new adjacent compression fracture.
Radiology 03/2009; 251(3):866-72. · 5.73 Impact Factor
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ABSTRACT: Six patients (three females and three males) were referred from their clinicians for evaluation with complaints of recurrent pain. A followup MRI showed fluid at the cemented vertebral bodies. Repeat percutaneous vertebroplasty (PV) was performed in these six patients at the cemented vertebrae. Pain scores, mobility scores, and spine MRIs before the 1st PV, prior to the repeat PV, and 1 and 3 months after the repeat PV were obtained. One month after the repeat PV, the six patients had a mean pain score reduction of 6.2 points and a mean postoperative pain level reduction of 2.8 points. Four of the six patients demonstrated an improvement in mobility with a 1.7 point mean decrease one month after the repeat PV. There was decreased fluid and bone marrow edema in four of the six patients on the follow-up MRIs one and three months after the repeat PV. Repeat PV at cemented vertebrae with fluid signs may offer therapeutic benefits for recurrent pain.
Interventional Neuroradiology 11/2008; 14 Suppl 2:85-90. · 0.56 Impact Factor
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Gastroenterology 08/2006; 131(1):13, 337. · 11.68 Impact Factor
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ABSTRACT: Hemangioendothelioma is believed to be a neoplasm of borderline malignancy. We present a 3-year-old boy with bilateral lower leg pain and walking with limping gait. Plain radiographs showed multiple osteolytic, expansile lesions in humerus, femur, tibia, ribs and mandible. MRI showed these lesions with mixed signal intensity and heterogenous enhancement after contrast medium administration. Pathological studies revealed malignant hemangioendothelioma.
European Journal of Radiology Extra.
