Background Susceptibility-weighted imaging (SWI) is occasionally performed with intravenous gadolinium (Gd). It was reported that SWI can be performed after Gd injection without information loss or signal change. Purpose To investigate the diagnostic value of contrast-enhanced SWI (CE-SWI) in the assessment of intracranial brain neoplasm. Material and Methods After obtaining the approval of the local ethics committee, 35 brain neoplasm patients (24 with metastasis and 11 with glioblastoma multiforme [GBM]) were enrolled. In order to investigate the value of using CE-SWI, two neuroradiologists performed an evaluation of the frequency of the intratumoral susceptibility signals (ITSS) in SWI and CE-SWI with visual assessment using 5-grade scales. We evaluated the visibility of the tumor margins and the internal architecture of tumors on T1-weighted imaging (T1WI), contrast-enhanced T1 (CE-T1), SWI, and CE-SWI. Results The contrast-enhanced scans (CE-T1 and CE-SWI) showed statistically significant higher scores compared to non-enhanced scans (T1WI and SWI) for the analysis of the tumor margin in GBM and metastasis ( P < 0.05, Wilcoxon signed rank test). Statistically significant higher scores are noted in GBMs compared to metastases in the visibility of the internal architecture of tumors on CE-SWI and the visibility of the tumor margin on CE-T1 ( P < 0.05, Mann–Whitney test). Conclusion Based on our results, SWI can be performed after gadolinium injection without information loss or signal change. CE-SWI is useful in evaluating intracranial neoplasm due to its ability to simultaneously demonstrate both ITSS that are not visible with conventional magnetic resonance sequences and contrast enhancement.
true for our patient who had undergone several prior resections without lasting effect. Total resection can have increased risk of complications such as intraoperative blood loss and death. This case highlights the advantages of combining CAD-CAM planning and intraoperative neuronavigation to mitigate the potential risks of total resection by increasing surgical precision, decreasing intraoperative time, and limiting surgical blood loss. 12 Reconstruction options can be autologous or alloplastic. Autologous reconstruction includes split rib grafts, split cranial bone grafts, or reimplanting the involved bone after autoclaving and recontouring. However, the viability of such bone is unpredictable and has potential for resorption. Prosthetic implants can be made of titanium mesh, hydroxyapatite, methyl methacrylate, or a natural polymer such as polyetheretherketone (used in this case). Preoperative manufacturing of custom implants eliminates donor site morbidity, obliterates dead space significantly, expedites cranial closure, and improves the aesthetic outcome considerably. 12,16 In the seminal article by Berli et al, the authors report their experience using customized craniofacial implants for single-stage cranioplasty following benign and malignant tumor resection. 16 PEEK implants were utilized for large defects of the fronto-orbital and orbitozygomatic regions and did not require any additional materials to cover the predicted defect, similar to our study. However, instead of using a cutting guide, Berli et al use the actual implant to mark out the resection lines. In an up to 16-month followup period, no implant-related complications were identified.Together, CAD-CAM, neuronavigation, and prefabrication of custom prostheses improves overall safety, efficacy, and cosmetic outcomes for the surgical treatment of extensive craniomaxillofacial fibrous dysplasia.
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