T2 Relaxometry Secrets in Epilepsy Protocol

Hippocampal structural damage is equivocally depicted by spectroscopy. For diagnostic and pre-operative evaluation, hippocampal volumetry and T2-relaxometry provide maximal accuracy. Amygdala quantifications are irrelevant in the pre-operative evaluation but may be useful for diagnostic purposes. Of the three qMRI modalities tested, T2-relaxometry provided the best balance between diagnosis accuracy and time-efficiency to lateralize a sclerotic lesion on the majority of the patients. The salient points to rememberare:
- independent of magnetic strength, age, sex or side
- can be done not only in hippocampus but also in anterior temporal lobe, parietooccipiatal lobe, amgdela etc.
- complete symmetry exists between both sides (< 7 ms)
- normally should not exceed 90 to 97 ms
- if volume calculations and T2 values do not match believe the T2 values
- epileptogenic focus is the key to treatment

Submitted by Dr MGK Murthy (Elbit Medical Diagnostics)

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TB Meningitis

Multiple conglomerate ring enhancing lesions in the basal cisterns extending along tentorium predominantly on left side with lipid lactate peaks on MRS and dilated ventricular system.
The incidence of CNS TB is related to the prevalence of TB in the community, and it is still the most common type of chronic CNS infection in developing countries.
In an immunocompetent individual, CNS TB usually takes the form of meningitis that causes an acute-to-subacute illness characterized by fever, headache, drowsiness, meningism, and confusion over a period of approximately 2-3 weeks.
Two rare forms of TBM are serous TB meningitis and TB encephalopathy. Serous TB meningitis is characterized by signs and symptoms of a mild meningitis with spontaneous recovery. TB encephalopathy usually occurs in a young child with progressive primary TB; the presentation is that of reduced levels of consciousness with few focal signs and minimal meningism.

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Arteriovenous Malformation

Large AVM in right mid and superior perietal region with arterial feeders from right middle cerebral and part of anterior cerebral arteries and draining into superior sagital sinus and adjacent cortical veins.
An arteriovenous malformation (AVM) is a tangled cluster of vessels, typically located supratentorially, in which arteries connect directly to veins with no intervening capillary bed. A 1988 study of more than 500 patients showed that the core, or nidus, of a compact AVM was from 2-6 cm in diameter in 77%.AVMs account for approximately 11% of cerebrovascular malformations. AVMs are more likely than other types of vascular malformations to be clinically symptomatic. AVMs are categorized by their blood supply. Pial or parenchymal AVMs are supplied by the internal carotid or vertebral circulation; dural AVMs, by the external carotid circulation; and mixed AVMs, by both. A pediatric variant of AVM is the vein-of-Galen aneurysm, in which an AVM drains to and dilates the great vein of Galen.
The Spetzler and Martin grading system attempts to predict risk of surgical morbidity and mortality by assigning points to an AVM on the basis of its size, the eloquence of the adjacent brain, and the pattern of venous drainage.

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Digital Breast Tomosynthesis

Tubulolobular adenocarcinoma seen on conventional digital mammogram (left) and in a slice from a tomosynthesis dataset (right).

Digital breast tomosynthesis boosts radiologists' cancer detection rates compared to digital mammography alone. The researchers conducted a multicenter, multi-reader study to evaluate reader performance with tomosynthesis.
It's done like a regular mammogram and still involves compressing the breast. But it takes a 3-D view with a CT scan in an arc around the breast. The machines are expensive, and as with many new techniques, testing will be expensive too. It only takes a few seconds to do the tomosynthesis part of the exam, but then the machine will also take a regular mammogram.

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Neurological Manifestations in Sjogren's Syndrome

Known case of Sjogren's Syndrome with hypothyroidism and hypertension.
Fairly large, symmetrical hyperintensities in periventricular frontal, parietal and parietooccipital white matter regions with similar smaller lesions in brainstem, cerebellum, bilateral thalamic and capsuloganglionic regions.
Possible cause is autoimmune pathology with vascular involvement. Corticosteroid therapy results in rapid and nearly complete resolution of the cortical lesions with marked improvement of the clinical manifestations. Memory disturbance is a rare initial manifestation in meningoencephalitis associated with SjS.

Ref: Journal of the Neurological Sciences, Volume 232, Issue 1-2, Pages 111-113

Submitted by Dr MGK Murthy (Elbit Medical Diagnostics)

Carcinoma Tongue

The most common type of cancer of the tongue is Squamous Cell Carcinoma. The oral tongue and the base of the tongue comprise the whole tongue but it is important to know that they develop from different embryonic tissue and really are somewhat dissimilar. Most importantly, this explains why the treatment for squamous cell carcinoma for the oral tongue is usually quite different from the treatment for squamous cell carcinoma of the base of tongue.
Unlike oral tongue cancers, base of tongue squamous cell cancer is usually larger when diagnosed because in the early stages it can not be seen and it creates few, if any, symptoms. Later however, base of tongue cancer may create pain, a sense of fullness, changes in what the voice sounds like, and perhaps even some difficulty in swallowing. Also, because the diagnosis often comes a bit later, a greater number of patients with this disease will already have neck metastasis in the lymph nodes of the neck, by the time they are seen by the Head and Neck Surgeon.

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Submitted by Dr Kiran David (Elbit Medical Diagnostics)

Cistern of Great Cerebral Vein

This patient presented with recurrent seizures.
The cistern of great cerebral vein occupies the interval between the splenium of the corpus callosum and the superior surface of the cerebellum; it extends between the layers of the tela chorioidea of the third ventricle and contains the great cerebral vein.Synonyms of cistern of great cerebral vein include: ambient cistern, Bichat's canal, Bichat's foramen, superior cistern.