Hunt, Christopher H.

This paper reviews a case of metastatic 1p/19q codeleted oligodendrioglioma causing diffuse osteosclerosis and pain. Primary central nervous system (CNS) tumors rarely metastasize outside the CNS, and metastatic oligodendroglioma is rarer still. The patient in this study had relief of pain after being treated with temozolomide. We discuss this rare presentation and potential treatment options, and review the literature in regards to metastatic oligodendrogliomas.

ABSTRACTPURPOSEInvestigate the relative frequency of nonlesional versus lesional hypertrophic olivary degeneration (HOD) and potential explanations for nonlesional HOD.METHODSOur radiology report database was queried for “HOD” in all head MRI reports between 7/1/2002 and 7/1/2013 and identified 138 patients. Specific absence of HOD or cases with lesions within the dento‐rubro‐olivary pathway (DROP) or extending into the inferior olivary nuclei (ION) were excluded (22 in total). For included patients, 19 locations with the anatomic potential to connect to the ION or DROP were reviewed and grouped into embryological categories, along with the use of the drug metronidazole.RESULTSA total of 51 of 116 (44%) HOD patients did not have a causative lesion in the DROP. The 27/51 (53%) of these patients had progressive ataxia with palatal tremor (PAPT). The 28/51 (55%) patients had one or more lesions outside of the DROP and one of these 28 patients used metronidazole. The remaining 23/51 (45%; 19% of total HOD cohort) patients had no additional lesions in the brain and 6 of these 23 patients did not have a clinical diagnosis of PAPT.CONCLUSIONForty‐four percent of patients with HOD did not demonstrate an MRI‐identifiable lesion in the DROP, and 45% of those patients did not have identifiable brain lesions outside of the DROP. Thus, nearly a fifth of HOD cases may be truly idiopathic. A majority of patients without a DROP lesion had bilateral HOD and two‐thirds were male.

Cervical pseudomeningocele is a rare complication of trauma. It develops when an extradural collection of cerebrospinal fluid (CSF) develops after a dural breach. The authors present the unusual case of a 33-year-old man with progressive headache, neck pain, mental status changes, and cardiopulmonary instability after polytrauma sustained from a motorcycle-versus-deer collision, without improvement during a 5-day hospitalization. Magnetic resonance imaging revealed a collection of CSF anterior to the cervical thecal sac compatible with an anterior cervical pseudomeningocele. A nontargeted epidural blood patch was performed with subsequent resolution of the patient's symptoms. Anterior cervical pseudomeningoceles are usually asymptomatic; however, these lesions can cause orthostatic headaches, neck pain, and cardiopulmonary compromise, as it did in the featured patient. Pseudomeningoceles should be included in the differential diagnosis for posttrauma patients with progressive neurological decline or postural headache, and blood patch may be an effective minimally invasive treatment.

ABSTRACTBACKGROUND AND PURPOSERequests for after‐hours emergent spine MR imaging seem to be increasing. We sought to review the trend in after hours spine MRI utilization at our institution and to determine how these results impacted therapeutic intervention.METHODSFollowing Institutional Review Board approval, reports from 179 after hours spinal MRI's performed over the past 13 years were obtained and the relevant electronic medical records were reviewed.RESULTSEmergent after hours spine MRI utilization increased from 7 per year to 23 over 13 years. Fifty‐eight percent (104/179) had significant findings. Twenty‐nine percent (52/179) of all patients imaged underwent surgery to treat pathologies identified on MR. Surgery was performed in only 2% (4/179) of these patients within 3 hours and 6% (10/179) within 6 hours of MRI completion. Five percent (8/179) had findings that were treated with radiation therapy and in 78% of these it was performed within 6–12 hours. Of those in whom steroids or antibiotics were initiated, 41% and 50% were treated within 3 hours of MR scanning, respectively.DISCUSSIONClinical use of emergent after hours spine MRI is steadily increasing at our institution. While MR imaging often discerned significant pathologies, performing these emergent studies rarely resulted in immediate surgical or radiotherapeutic intervention.

ABSTRACTBACKGROUND AND PURPOSEHypertrophic olivary degeneration (HOD) is an uncommon type of transneuronal degeneration. Case reports and case series described in the literature provide a foundation of our current knowledge of HOD. These reports have described HOD most frequently to be unilateral and occurring in association with lesions in the dentato‐rubro‐olivary pathway. Our purpose was to evaluate the rate of bilateral versus unilateral HOD in a large case series.METHODSA retrospective review was performed to identify patients in which the phrase “hypertrophic olivary degeneration” occurred in the radiology report. A diagnosis of HOD was confirmed on imaging if there was focal hyperintensity on T2‐weighted images confined to either or both inferior olivary nuclei.RESULTSA total of 102 patients had findings consistent with HOD. Of these, 76% had findings bilaterally. In 44%, a lesion could not be identified to explain HOD. Bilateral HOD was common in both lesional and nonlesional group, though more common in the nonlesional group.CONCLUSIONThis study demonstrates that HOD is frequently bilateral. In slightly over 50% of patients with HOD, a lesion can be identified. In just under 50% patients with HOD, a lesion could not be identified and in these cases HOD was present bilaterally in the majority.

ABSTRACTTwo valuable confirmatory MRI findings of acute spinal cord infarct are highlighted and discussed: concomitant vertebral body infarct and ventral cauda equina nerve root enhancement.

AbstractBackground and AimsPositron emission tomography with computed tomography (PET/CT) has been used to detect metastasis in the diagnosis of esophageal adenocarcinoma (EAC). However, the utility of PET/CT to assess primary tumor for endoscopic resectability and prognosis in early EAC remains unclear. We conducted a retrospective study to determine the association of PET/CT findings with histopathological tumor invasion depth and survival outcomes.MethodsEAC patients who underwent PET/CT followed by endoscopic mucosal resection (EMR) were included. Pathology on EMR and survival outcomes from a prospectively maintained database was retrieved. Two radiologists independently reviewed the PET/CT using the following parameters: detection of malignancy, fluorodeoxyglucose (FDG) uptake intensity, FDG focality, FDG eccentricity, esophageal thickness, maximal standard uptake value (SUVmax), and SUVmax ratio (lesion/liver).ResultsThere were 72 eligible patients: 42 (58.3%) had T1a lesions, and 30 (41.7%) had ≥ T1b. Only SUVmax ratio was associated with tumor invasion depth (odds ratio = 2.77, 95% confidence interval 1.26–7.73, P = 0.0075). Using a cut‐off of 1.48, the sensitivity and specificity of SUVmax ratio for identification of T1a lesions were 43.3% and 80.9%, respectively. Adjusting the SUVmax ratio to 2.14, 16.7% (5/30) of ≥ T1b patients were identified without any false‐positive cases. Multivariate analysis showed SUVmax ratio, Charlson comorbidity index, and esophagectomy were independent predictors for survival.ConclusionsSUVmax ratio (lesion/liver) is more accurate in predicting endoscopic resectability and mortality for EAC than other PET/CT parameters and appears promising as a useful adjunct to the current diagnostic work‐up.