SUMMARY -This study explored the neurologic vascular complications of varicella zoster virus (VZV). We describe four patients presenting at our institution with neurologic involvement by VZV. MR and MRA studies of the intracranial arterial circulation in the head were read by board-certified radiologists using standard clinical procedures. On MRI, three patients had acute infarcts and in two instances irregularities and narrowings of vessels were visible. Many of these complications are recognized to be due to a vasculopathy affecting small or large vessels and resulting in cerebral infarctions and rarely hemorrhages. The pattern of cerebral infarction and vascular abnormalities is not specific and resembles those of vasculitis/vasculopathy from other causes. The central nervous system (CNS) vascular complications of VZV should be considered in the patients with simultaneous primary or prior VZV infection whose imaging studies show cerebral infarction and/ or vasculitic appearing intracranial arteries.
Purpose The aim of this study was to depict the signal intensity pattern of the normal oculomotor nerve demonstrated on contrast-enhanced three-dimensional fluid-attenuated inversion recovery images. Materials and methods Eighty-one patients were included in the study. Contrast-enhanced three-dimensional fluid-attenuated inversion recovery images with magnetisation-prepared rapid acquisition were reconstructed and evaluated in the coronal plane. The signal intensity of the cisternal segment of the oculomotor nerve was graded into a visual scale of 1 to 5 as compared to the white matter, grey matter and the pituitary stalk. The signal intensity ratio of the oculomotor nerve was consequently measured. Results By using the visual scale, more than half of the oculomotor nerves showed higher signal intensity than the grey matter signal on contrast-enhanced three-dimensional fluid-attenuated inversion recovery images (59.3–80.2%). It can demonstrate a signal intensity similar to the pituitary stalk (14.8%) by visualisation. None of them showed signal intensity equal to the normal white matter signal. By signal intensity measurement, the mean signal intensity ratio of oculomotor nerves to white matter equals 1.54±0.20 (95% confidence interval (CI) 1.51–1.57); mean signal intensity ratio to grey matter equals 1.16±0.15 (95% CI 1.14–1.18); mean signal intensity ratio to the pituitary stalk equals 0.68±0.10 (95% CI 0.64–0.70). Conclusions The normal oculomotor nerve visualised on contrast-enhanced three-dimensional fluid-attenuated inversion recovery images has a higher signal intensity than the white matter and may have a signal intensity similar to the grey matter or the pituitary stalk. The high signal intensity of the oculomotor nerve in contrast-enhanced three-dimensional fluid-attenuated inversion recovery should not be misinterpreted as a pathology.
Objective The aim of this study was to differentiate suprasellar germinomas from chiasmatic/hypothalamic gliomas (CHGs) using apparent diffusion coefficient (ADC) values and magnetic resonance imaging (MRI) characteristics. Materials and methods A cross-sectional study was conducted on 11 patients with suprasellar germinomas and 11 patients with CHGs who underwent pretreatment MRI. The ADC values (minimum and average ADC values) of the tumors were measured and the MRI characteristics were evaluated. Results The average and minimum ADC values of suprasellar germinomas were significantly lower than those of CHGs ( p = 0.016 and 0.004 respectively). The selection of 941.15 × 10−6 mm2/s as a cutoff value of the minimum ADC value was used to differentiate suprasellar germinomas and CHGs; the best results were obtained with area under the curve of 0.889, sensitivity of 87.5%, specificity of 77.8% and accuracy of 82.4%. MRI characteristics suggested the diagnosis of suprasellar germinomas were T2W hypointensity and involvement of pituitary gland and/or stalk. MRI characteristics suggested the diagnosis of CHGs was higher degree of contrast enhancement and presence of macrocysts. Conclusion ADC values have a role in differentiating suprasellar germinomas and CHGs, especially when imaging findings on conventional MRI are inconclusive. Furthermore, some MRI features are in favor of differentiation between these tumor entities including tumor location, cyst pattern, T2W hypointensity, degree of contrast enhancement, stalk and pituitary gland involvement.
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