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Historical Article 2008; 29(Suppl 1): 105-122 PubMed PMID: 19029873 Citation  Keywords:  Brain:anatomy & histology, History, 20th Century, Humans, Magnetic Resonance Imaging, Mental Disorders:surgery, Neurosurgical Procedures:methods, Obsessive-Compulsive Disorder:therapy, Poland, Psychosurgery:history,.   

: Surgical intervention to the brain has a long history, but contemporary psychosurgery started in the mid-1930s. The first psychosurgical operation was a prefrontal leucotomy. In this chapter, a history of psychosurgery is described with a special focus on so-called "ablation" procedures such as anterior cingulotomy, anterior capsulotomy, subcaudate tractotomy, and limbic leucotomy. The expectations that psychiatrists linked to the surgical intervention have grown along with the progress of diagnostic neuroimaging procedures used in brain research. In recent years, the introduction of neuromodulation techniques seemed to produce a qualitative progress in modern psychosurgery. However, the controversies about these surgical interventions to the brain among psychiatrists still restrict the indications for psychosurgery to highly selected cases....

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Case Reports 2008; 29(4): 428-430 PubMed PMID: 18766149 Citation  Keywords:  Child, Diffusion Magnetic Resonance Imaging, Humans, Leukodystrophy, Metachromatic:diagnosis,.   

: Ten years old patient with juvenile form of metachromatic leukodystrophy (MDL) is presented. Apart from standard magnetic resonance (MR) protocol, the diffusion weighted sequence was performed and apparent diffusion coefficient (ADC) map was constructed. The cause of restricted diffusion is considered to be the deposits of metachromatic substance in the intercellular space, apparently similar reason for decrease of speed of diffusion in other storage diseases....

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Journal Article 2008; 29(4): 461-466 PubMed PMID: 18766142 Citation  Keywords:  Adult, Atrophy:pathology, Brain:pathology, Disability Evaluation, Disease Progression, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis, Chronic Progressive:pathology, Multiple Sclerosis, Relapsing-Remitting:pathology, Sta.   

OBJECTIVES: To monitor the interaction between the clinical manifestation of the secondary progressive form of multiple sclerosis (SPMS) expressed in the Expanded Disability Status Scale (EDSS) and abnormal findings in magnetic resonance imaging (MRI) of the brain. To compare a time line of brain atrophy in patients with SPMS, patients with relapsing-remitting multiple sclerosis (RRMS) and the healthy population.

METHODS: Brain atrophy, volume of increased signal lesions on Fluid Attenuated Inversion Recovery Sequence (FLAIR) sequence (s.c.lesion load) and decreased signal lesions on T1 weighted sequence (s.c. black holes) were measured semi-automatically and correlated with EDSS in 12 patients. Further, we compared a time line of brain parenchyma fraction (BPF) loss in patients with SPMS, patients with RRMS and the healthy population.

RESULTS: In patients with SPMS, no statistical correlation was found between lesion load in FLAIR and EDSS and there was also no significant statistical correlation (p=0.1134) between the volume of "black holes" and EDSS. However, we did confirm a significant correlation between increase in brain atrophy and clinical status (p=0.0093). Comparison of patients with SPMS or RRMS and the healthy population revealed that brain atrophy progressed most rapidly in patients with SPMS.

CONCLUSIONS: The presence of a statistically significant difference in BPF loss between patients with SPMS or RRMS and the healthy population merits further study despite the small size of our sample. We postulate that the measurement of brain atrophy could be helpful in determining the transition of RRMS to SPMS and thereby predict the progression of the disease in the future....

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Journal Article 2008; 29(3): 281-286 PubMed PMID: 18580841 Citation  Keywords:  Autistic Disorder:pathology, Brain:pathology, Child, Diagnostic Imaging, Humans, Magnetic Resonance Imaging,.   

: Structural neuroimaging studies done by means of magnetic resonance imaging (MRI) have provided important insights into the neurobiological basis for autism. The aim of this article is to review the current state of knowledge regarding structural brain abnormalities in autism. Results of MRI studies dealing with total brain volume, the volume of the cerebellum, caudate nucleus, thalamus, amygdala, hippocampus and the area of the corpus callosum are summarized. Existing research suggests that autistic individuals have larger total brain, cerebellar and caudate nucleus volumes; however, the area of the corpus callosum is reduced. Results of studies involving the amygdala and hippocampus volume in autistic subjects remain inconsistent and no changes have been detected in thalamic volume....

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Comparative Study 2007; 28(6): 789-800 PubMed PMID: 18063942 Citation  Keywords:  3-Iodobenzylguanidine, Adult, Aged, Aged, 80 and over, Carcinoma, Neuroendocrine:classification, Diagnostic Imaging:instrumentation, Female, Humans, Indium Radioisotopes, Intestinal Neoplasms:diagnosis, Iodine Radioisotopes, Magnetic Resonance Imaging, Ma.   

AIM: The aim of the study was to review the current diagnostic approach, based on the experience of one center performed during a 4-year period, according to WHO criteria of GEP - NET.

MATERIAL AND METHODS: The study group comprised case records of 134 patients with confirmed GEP-NET carcinomas (WHO groups 2-4). All patients were subjected to clinical, biochemical and imaging examinations performed as routine clinical work-up. The imaging techniques consisted of anatomical (CT, EUS) and functional approaches (SRS, mIBG and FDG PET).

RESULTS: The clinical classification considered the primary origin of the tumor as follows: 49% - foregut tumors, 44% - midgut, and 7% of tumors of unknown origin. Group of patients with WHO 2 consisted of 98 (73%) subjects. Considering those with foregut tumors EUS followed by CT and SRS were used in each case. SRS and CT imaging was used to assess the extent of the tumor. Patients with midgut tumors had CT and SRS as routine diagnostic imaging examinations. Considering the above-mentioned patients, CT and SRS were used to localize the primary tumor, and assess tumor extent. Overall sensitivity of CT considering the active disease amounted to 96%, while specificity - 75%. Sensitivity of SRS was 97%, while specificity- 85%. WHO 3-29 patients, 17 foregut and 9 midgut tumors, and 3 of unknown origin. Diagnostic imaging examinations consisted of CT. Standard SRS (sst2) was negative in most cases. The aggressive behaviour of this type of tumors was detected by means of FDG-PET. Sensitivity of CT amounted to 100%, and that of SRS - 44%. Specificity of CT amounted to 67% and that of SRS - 100%. WHO 4-7 patients, including 4 foregut and 3 midgut neoplasms. The imaging approach consisted of CT/MR and in 5 cases FDG-PET. Sensitivity of CT amounted to 100%. Only one patient presented with a SRS positive study. FDG-PET sensitivity amounted to 100%.

CONCLUSION: Diagnostic imaging of GEP-NET, consider anatomical and functional techniques, which should be read together. The diagnostic value of CT and SRS were similar in case of WHO 2, while in case of WHO 3 CT had a higher diagnostic accuracy. FDG-PET seems to be a very attractive imaging functional modality in case of patients with WHO 3 and WHO 4....

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Journal Article 2007; 28(6): 841-845 PubMed PMID: 18063932 Citation  Keywords:  Adult, Dopamine Agonists:adverse effects, Female, Follow-Up Studies, Humans, Intracranial Hemorrhages:etiology, Magnetic Resonance Imaging, Male, Pituitary Neoplasms:blood, Prolactin:blood, Prolactinoma:blood, Radiography, Receptors, Dopamine D2:agonists,.   

OBJECTIVES: Retrospective follow-up study on patients suffering from macroprolactinomas which were treated with agonists of D2 receptors; the MRI results were correlated with the clinical symptomatology and with the level of prolactin in the blood.

METHODS: From 1996 to 2006 we followed 38 patients diagnosed with macroprolactinoma. All patients underwent MRI in same protocol two times. The indication for MRI was based on the clinical symptomatology (signs of hormonal dysfunction, visual fields impairment) or increased blood level of prolactin.

RESULTS: The first predominant clinical signs in males were local manifestations of expansive process and in women hormonal dysfunction. Intratumorous haemorrhage in patients undergoing the treatment with the agonists of D2 receptors is common, it was encountered in 25 cases, but only in two cases it was followed by a more serious clinical symptomatology, which had to be referred to the department of the neurosurgery. Even when there were pronounced regressions or near complete disappearance of the tumour and normalisation of the blood level of prolactin, withdrawal of the treatment with agonists of D2 receptors caused increase in size of the adenoma and increase of level of prolactinaemia.

CONCLUSION: Only two patients presented with serious clinical symptomatology associated with intratumoral hemorrhage. The hemorrhages are more common during the first weeks of therapy, but can happen at any time thought out the treatment with D2 receptor agonists. Our hypothesis: the prolactinomas with higher level of prolactin have greater tendency for larger hemorrhages....

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Case Reports 2007; 28(5): 560-564 PubMed PMID: 17984954 Citation  Keywords:  Adenoma:pathology, Adult, Antineoplastic Agents, Hormonal:therapeutic use, Choristoma:pathology, Growth Hormone-Secreting Pituitary Adenoma:pathology, Humans, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Male, Peptides, Cyclic:therapeutic .   

: MR spectroscopy (MRS) of hormonally active pituitary adenomas has not been published in literature. We report MR imaging and spectroscopy findings in a 41-year-old man with extrapituitary growth hormone-secreting adenoma. Application of the single voxel proton MRS, SE 135 technique, with voxel size 11x11x11 mm, revealed the elevated choline peak (resonance at 3.2 ppm) in the paramedial aspect of the tumor, while no metabolic activity in the mentioned region was noted using the same method 11 months after Lanreotide treatment. Elevation of choline peak in functional pituitary adenomas could represent an active marker of cellular proliferation, compatible with increased hormonal activity....

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Journal Article 2007; 28(4): 438-444 PubMed PMID: 17693972 Citation  Keywords:  ACTH-Secreting Pituitary Adenoma:pathology, Adenoma:pathology, Adolescent, Adult, Aged, Child, Endoscopy:adverse effects, Female, Growth Hormone-Secreting Pituitary Adenoma:pathology, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Minimally Invasi.   

AIM OF THE STUDY: The paper presents endoscopic surgical technique used in the treatment of hormonally active pituitary adenomas and assessment of the method in terms of its effectiveness and safety.

MATERIAL AND METHODS: In 217 cases the surgery was performed due to pituitary adenomas applying the technique developed by Jho and Carrau, with our own modifications. 70 patients were treated for hormonally active adenomas. The group consisted of 36 somatotrophic adenomas, 21 prolactinomas and 13 corticotrophic adenomas. There were 51 females and 19 males with mean age of 42.6 years (range 11-77 years). The follow-up period was between 7 and 56 months (mean - 34 months). The effectiveness and occurrence of complications were confirmed on the basis of neurosurgical, laryngological, endocrinological, ophthalmological examinations and neuroimaging.

RESULTS: Biochemical and neurosurgical criteria for complete resection were obtained in 21 (58.3%) of 36 patients with all somatotrophic adenomas. In the group of prolactinomas complete resection was achieved in 17 (80.9%) of 21 patients. Of the 13 patients with Cushing's disease 11 (84.6%) were cured. In the studied group there were no deaths. In the postoperative course only 2 (2.8%) patients suffered liquorrhoeas and new anterior lobe pituitary insufficiency was noted in 8 (11.4%) cases. Meningitis was noted in 1 (1.4%) case and another 1 (1.4%) patient had epistaxis which required repeated endoscopic surgery.

CONCLUSIONS: Endoscopic technique is an effective method of treatment of hormonally active pituitary adenomas. It is characterised as being minimal invasive and has a low severe complication rate....

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