To evaluate the possibility of preoperatively obtaining an index of aggressiveness for intracranial meningiomas, we prospectively studied 22 patients with computed tomographic or magnetic resonance imaging evidence of meningeal tumour, using single-photon emission tomography (SPET) of the brain and thallium-201 (201Tl). On a brain-dedicated SPET scanner, a rapid acquisition protocol with early, short scans was started simultaneously with the intravenous administration of 111 MBq 201Tl, covering the initial intratumoral distribution of the tracer. Twenty minutes post injection, a delayed SPET scan was also obtained. On the reconstructed and attenuation-corrected images we calculated the 201Tl concentration in tumour and normal contralateral brain tissue, and compared intratumoral tracer concentration in the initial and the final part of the rapid acquisition protocol. Benign and malignant meningiomas were classified as such based on histological examination. In malignant lesions, the ratio of the 201Tl concentration at 2-4 min post injection to that at 14-16 min was found to be significantly higher than in non-aggressive neoplasms (mean+/-1 SD: 1.14+/-0.31 and 0.56+/-0.13, respectively, P <0.01). Conversely, in the delayed scan, most lesions showed high tracer concentration, and the two groups could not be distinguished. In addition, three recurrent meningiomas displayed the same imaging behaviour as the malignant group, i.e. had similar 201Tl concentration values at 2-4 and at 14-16 min. Our findings suggest that the comparative assessment of intratumoral 201Tl concentration at 2-4 and at 14-16 min post injection could provide a fast, simple method to differentiate preoperatively intracranial meningiomas with different biological behaviour.
Carpal tunnel syndrome is the most common peripheral neuropathy. Conventional carpal tunnel surgery has been performed as a primary procedure for the decompression of the median nerve at the wrist in patients who have idiopathic carpal tunnel syndrome. While the results have been excellent, this surgical procedure has been reported to be related to high postoperative morbidity and extended length of recovery time. Over the past decade, endoscopic release of the transverse carpal ligament has been developed as a new, alternative method to the open procedures. Endoscopic carpal tunnel release has been reported to ensure less postoperative morbidity, more rapid recovery of strength, with earlier return to work, reduced disability time and a better cosmetic result. The authors present a surgical series of 200 hands in 164 patients (36 bilaterals) with idiopathic carpal tunnel syndrome, who underwent a single-portal endoscopic carpal tunnel release (Agee technique), with regards to the clinical outcome and complications occurred after 4-months follow-up.
Parole chiave: compressione midollare, mielopatia, risonanza magnetica RIASSUNTO -Le compressioni midollari di lunga durata possono determinare un danno parenchimale che, nelle immagini RM T2 dipendenti, si manifesta come un'area di segnale iperintenso. Gli autori, in un precedente lavoro, hanno ipotizzato che tale danno sia in parte dovuto a processi di demielinizzazione e di gliosi. Questa ipotesi e avvalorata dal presente studio che si basa sui confronto tra evoluzione clinica e segnale RM in cinque pazienti controllati nel tempo, dopo intervento chirurgico di decompressione del midollo cervicale.SUMMARY -The cases of five patients with cervical myelopathy due to herniated disk or diskarthrosis treated surgically are reported. They were studied clinically and by Magnetic Resonance Imaging (M RI). A localized increased signal intensity within the cervical cord was observed in preoperative M R T2 images of four patients (Cases 1, 2, 3 and 5). Postoperatively, such high signal intensity showed no change in two patients ( Cases 2 and 3) , whereas it partially decreased in the other two patients ( Cases 1 and 5) . From the clinical point of view, three of these patients (Cases 1, 2 and 5) partially improved after surgery , whereas the fourth (Case 3) remained unchanged. Finally in one patient ( Case 4) preoperative and postoperative MR images did not reveal any intraparenchymal high intensity area, and the clinical evolution was quite favourable. Both reversible ( edema, inflammation and ischemia) and irreversible (demyelinization and cord gliosis) pathologic changes seem to be represented in the high signal intensity lesion on T2 weighted images. IntroduzioneUn interesse particolare e stato recentemente rivolto al fatto che il midollo, nella patologia compressiva cronica, puo mostrare, nelle immagini RM T2 dipendenti, un'area di elevato segnale ritenuta espressione di sofferenza parenchimale 1 • 4 • 5 • 7 • Le basi patogenetiche e cliniche di tale fenomeno non sono completamente note e costituiscono ancora argomento di studio e di discussione.E, comunque, verosimile che processi di demielinizzazione e di gliosi siano responsabili delle alterazioni del segnale. Nel presente lavoro, proponiamo una prima valutazione del ruolo e del significato prognostico dello studio RM nella cervicodiscoartrosi, allo scopo di selezionare i casi che possono trarre reali vantaggi dal trattamento chirurgico.Pazienti e metodi I pazienti sono stati studiati con un apparecchio superconduttivo da 0,5 Tesla ed antenna di superficie a geometria piana. Sono state utilizzate sequenze Spin-Echo (SE) a singolo echo e con tempi brevi di ripetizione e di echo (TR 500; TE 28 msec.), nonche sequenze SE a 4 echi simmetrici e tempi lunghi (TR 1500; TE 40 msec.), per meglio valutare il segnale dipendente dal T2. Sono state effettuate 6-7 sezioni contigue di 5 mm di spessore 3.177
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