Comparison of CSF cytology and spinal magnetic resonance imaging in the detection of leptomeningeal disease in pediatric medulloblastoma or primitive neuroectodermal tumor.
(17/402)
PURPOSE: Leptomeningeal disease (LMD) significantly affects the prognosis and treatment of pediatric patients with medulloblastoma or primitive neuroectodermal tumor (PNET). Examination of CSF for malignant cells, detection of LMD on spinal magnetic resonance imaging (MRI), or both are the methods routinely used to diagnose LMD. A recent study suggested 100% correlation between CSF and MRI findings in children with medulloblastoma. To determine the validity of this hypothesis, we compared the rate of detection of LMD between concurrent lumbar CSF cytology and spinal MRI performed at diagnosis in patients with medulloblastoma or PNET. PATIENTS AND METHODS: As a part of diagnostic staging, 106 consecutive patients newly diagnosed with medulloblastoma or PNET were evaluated with concurrent lumbar CSF cytology and spinal MRI. CSF cytology was examined for the presence of malignant cells and spinal MRI was reviewed independently for the presence of LMD. RESULTS: Thirty-four patients (32%) were diagnosed with LMD based on CSF cytology, spinal MRI, or both. There were 21 discordant results. Nine patients (8.5%) with positive MRI had negative CSF cytology. Twelve patients (11.3%) with positive CSF cytology had negative MRIs. The exact 95% upper bounds on the proportion of patients with LMD whose disease would have gone undetected using either CSF cytology or MRI as the only diagnostic modality were calculated at 14.4% and 17.7%, respectively. CONCLUSION: With the use of either CSF cytology or spinal MRI alone, LMD would be missed in up to 14% to 18% of patients with medulloblastoma or PNET. Thus, both CSF cytology and spinal MRI should routinely be used to diagnose LMD in patients with medulloblastoma or PNET. (+info)
Drug therapy against a transplantable guinea pig leukemia.
(18/402)
The effects of six clinically active drugs were tested against a ttansplantable leukemia in inbred strain 2 guinea pigs. Cytoxan and 6-mercaptopurine were found to elicit a therqeutic response against this leukemia based on complete tumor regression of the established tumor as well as a substantial increase in survival time. Animals dying in the untreated control and drug-treated groups revealed typical generalized lymphoblastic leukemia. However, only Cytoxan-treated animals that had relapsed exhibited central nervous system involvement originating from the arachnoid membrane. A tow-drug combination of Cytoxan and 1-(2-chloroethyl)-3(trans-4-methylcyclohexyl)-1-nitrosourea was found not only to prevent meningeal leukemia development but also to result in "curing" all animals from their leukemia. This observation was based on a complete clinical, hematological, and histopathological "remission" period up to 176 days. The administration of 1-(2-chloroethyl)-3-(trans-4-methylcyclohexyl)-1-nitrosourea alone was observed not only to control the systemic leukemia but also to prevent central nervous system involvement. No relapses occurred after the first "remission" period was achieved in the groups of animals that received 1-(2-chloroethyl)-3-(trans-4-methylcyclohexyl)-1-nitrosourea. (+info)
"Ivy sign" on fluid-attenuated inversion-recovery images in childhood moyamoya disease.
(19/402)
We report on MR studies of a 15-year-old girl with moyamoya disease in whom diffuse leptomeningeal enhancement ("ivy sign") was revealed by fluid-attenuated inversion-recovery (FLAIR) and contrast-enhanced imaging. We speculate that the mechanism behind this enhancement is caused by a retrograde slow flow of engorged pial vasculature via leptomeningeal anastomosis. Nevertheless, it remains unknown whether the precise source of a high signal on FLAIR images is attributable to pial vessels themselves or congested thickening of the leptomeninges or both. (+info)
Efficacy of trisacryl gelatin microspheres versus polyvinyl alcohol particles in the preoperative embolization of meningiomas.
(20/402)
BACKGROUND AND PURPOSE: Trisacryl gelatin microspheres are a new, commercially available nonabsorbable embolic agent. The purpose of this study was to evaluate their efficacy in the preoperative embolization of meningiomas as compared with polyvinyl alcohol (PVA) particles of various sizes. METHODS: In 30 consecutive patients, trisacryl gelatin microspheres (150-300 microm) were used for the preoperative superselective embolization of meningiomas (group 1). Thirty other consecutive patients had embolization with PVA particles of 45 to 150 microm (n = 15, group 2) and of 150 to 250 microm (n = 15, group 3). Extent of devascularization, intraoperative blood loss, blood transfusion, and hemostasis at the time of surgery were recorded for every patient. The inflammatory reaction, the extent of necrotic areas, and the most distal intravascular location of the embolic agent (arterial, arteriolar, precapillary, capillary) were recorded. RESULTS: There was no significant difference in the extent of angiographic devascularization among the groups. Intraoperative blood loss differed significantly between groups 1 and 2 and groups 1 and 3, but not between groups 2 and 3. The trisacryl gelatin microspheres were located more distally in tumor vessels than were the PVA particles of either size. The extent of intratumoral necrosis was not significantly different between the two embolic agents. In all groups there was a mild inflammatory tissue reaction in the vicinity of the embolic agent. CONCLUSION: Trisacryl gelatin microspheres may be effective in the preoperative embolization of meningiomas, producing significantly less blood loss at surgery than seen with PVA particles of either size, possibly because of the significantly more distal vascular penetration of the microspheres. (+info)
Antibodies to the junctional adhesion molecule cause disruption of endothelial cells and do not prevent leukocyte influx into the meninges after viral or bacterial infection.
(21/402)
A hallmark of infectious meningitis is the invasion of leukocytes into the subarachnoid space. In experimental meningitis triggered by tumor necrosis factor-alpha and interleukin-1beta, the interaction of leukocytes with endothelial cells and the subsequent migration of the cells through the vessel wall can be inhibited by an antibody to the junctional adhesion molecule (JAM). In contrast to the cytokine-induced meningitis model, anti-JAM antibodies failed to prevent leukocyte influx into the central nervous system after infection of mice with Listeria monocytogenes or lymphocytic choriomeningitis virus. Furthermore, in bacterial meningitis, anti-JAM IgG antibodies, but not Fab fragments, caused disruption of the endothelium. Likewise complement-dependent antibody-mediated cytotoxicity was observed in cultured brain endothelial cells treated with anti-JAM IgG but not with its Fab fragment. (+info)
Intracranial and intraspinal meningeal melanocytosis.
(22/402)
We describe a 35-year-old man with a history of remote closed head injury who presented with new neurologic deficits. A noncontrast head CT scan showed hyperattenuation involving both temporal lobes, frontal lobes, basal meninges, and cerebellum. A subsequent contrast-enhanced MR examination of the brain showed enhancement in the basal cisterns extending into the upper cervical spine and throughout the spinal canal. Gross, histologic, and immunohistochemical analysis revealed meningeal melanocytoma. (+info)
Diffuse cerebrospinal gliomatosis with extensive leptomeningeal spread.
(23/402)
A case of diffuse cerebrospinal gliomatosis with extensive leptomeningeal spread is presented. The patient, an 18-year-old girl, was admitted due to progressive weakness and paresthesia of both legs, following rapid neuropsychiatric deterioration. An initial magnetic resonance imaging (MRI) study of the T-spine showed diffuse high signal intensities from T9 to T12 spinal cords on a T2 sagittal image and diffuse cord bulging at T1WI. This suggested an inflammatory lesion such as tuberculosis or fungal meningoencephalitis. A limited autopsy was performed. A microscopic examination revealed multifocal GFAP-positive astrocytic proliferations that were low grade astrocytoma in the cerebral leptomeninges, parietal, occipital and temporal lobes and anaplastic astrocytoma in the spinal cord and spinal leptomeninges. The high proliferative indices of the spinal lesion and aneuploidy correspond to a diagnosis of malignant astrocytoma and a rapid fatal clinical course. (+info)
Radiolabeled leucocyte imaging in diffuse granulomatous involvement of the meninges in Wegener's granulomatosis: scintigraphic findings and their role in monitoring treatment response to specific immunotherapy (humanized monoclonal antilymphocyte antibodies).
(24/402)
BACKGROUND AND PURPOSE: Diffuse involvement of the meninges by remote granulomas in Wegener's granulomatosis is rare. This study reports the radiolabeled leucocyte imaging findings in five such patients. The diagnosis was made by MR imaging in five patients and confirmed in four by findings at meningeal biopsy. The potential role of serial radiolabeled leucocyte examinations in assessing treatment response is discussed. METHODS: Three of the five patients underwent whole-body planar 111In-labeled leucocyte imaging. Two of these patients had serial imaging and one had, in addition, a 99mTc-HMPAO-labeled leucocyte single-photon emission CT brain examination. Two of the five patients had whole-body planar 99mTc-HMPAO-labeled leucocyte imaging. Of these, one patient had serial imaging. The radiolabeled leucocyte imaging findings were correlated with MR findings and with the patients' clinical course. RESULTS: In four patients there was a midline linear area of increased tracer uptake in the brain, and in one of these, tracer uptake also extended laterally over the brain convexity. In two patients linear tracer uptake extended in an inferolateral direction from the midline. These abnormalities correlated with meningeal thickening in the falx, over the brain convexity, and in the tentorium cerebelli on MR images. Serial imaging in three patients revealed a reduction or disappearance in tracer uptake after treatment with anti-CD52, which correlated with clinical improvement. CONCLUSION: In patients with Wegener's granulomatosis, abnormal uptake corresponding to meningeal thickening can be seen on planar radiolabeled leucocyte images. Leucocyte imaging may be useful for monitoring treatment response. (+info)