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Investigations of remote effect by IMP-SPECT
584
Imaging in Neurosurgery
low perfusion at the bottom of the left frontal and temporal cortex, but normal perfusion in the right cerebral hemisphere. All of these patients recovered clear consciousness after intravenous injection of 50% glucose. In a later SPECT study in the comatose patients, the low perfusion of the whole cerebral cortex improved with clear consciousness. Discussion and Conclusion: Disturbance of consciousness, focal neurologicdeficitsandalsoconvulsions werewell knowninthe hypoglycemic patients. But the mechanisms of these symptoms have not been elucidated. This study, showedthat the neurologicsymptoms including disturbance of consciousness wereassociated with low perfusion of the brain.Thesefindings suggestthatthe neurologic symptoms of hypoglycemia are caused by the selectiveinhibition of metabolism or blood flow in the brain.
I P-2-224!
Investigations of remote effect by IMP-SPECT
Takayuki Kitamura, Akira Teramoto. Department of Neurosurgery, Nippon MedicalSchool, Tokyo, Japan Introduction: We report the findings we have obtained from our investigations on remote effects (RE) in patients with hemorrhagic cerebrovascular disease(hypertensive intracerebral hemorrhage, ruptured cerebral aneurysm, etc.) which were relatively localized. Materials and Methods: Of the localized lesions for which IMP-SPECT was conducted, no abnormalities were recognized when examined by CT. The subjects who exhibited RE had a hypertensive intracerebral hemorrhage in 15 of 24 cases (62.5%), a cerebral aneurysm in 25 of 10 cases (59.5%) and a cerebral arteriovenous malformation in 14 of 18 cases (77.8%). Those who showed RE were classified as Group A and those who did not show RE as Group B. We studied each groupfor 1) affectedregion, 2) classification of RE, 3) ABRISEP findings and 4) the correlations, between redistribution, prognosis and RE on IMP-SPECT. Conclusion: 1)The REsuggested the participation ofthe cortico-pontocerebellar and thalamo-cortical tracts, depending on the regions wherethe lesions had frequentlydeveloped. 2) Crossedcerebellar diaschisis (CCD) wasthe most popular RE which we recognized on IMP-SPECT. 3) Although the correlation between the redistributed imagesand the prognosis was recognized, the correlationbetweenthe redistributed images, the occurrence of REandthe prognosis had yet to be clarified.
IP-2-225!
The use of OctreoScan® in the preoperative diagnosis and postoperative follow up of meningiomas
Ali F.Krisht, Kevin Yoo,W. BruceCherny, OssamaAI-Metty. University of Arkansasfor MedicalSciences, Little Rock, Arkansas, USA The preoperative diagnosisand the postoperative follow-up of meningiomas depends on radiological studies which may not always be correct. A reliable way of obtaining an accuratepreoperative diagnosisand postoperative follow-up is by relying on the biological properties of the tumor. Meningioma cells are rich with high density of high affinity somatostatin receptors. Using this information, we studied patients with different intracranial lesions with a radiolabeled somatostatin analog. Multiplanar nuclearscansand SinglePhoton Emission Computerized Tomograms(SPECT)wereobtained preoperatively and postoperatively in 24 patients after intravenous injections of a somatostatin analoglabeledwith radioactive indium (OctreoScan®) were given. Sixteenpatientshad meningiomas which was confirmed with histological studies. Fourteen of 16 (87.5%) meningiomas had increased uptake of radioactive tracer. Seven patients with meningiomas had postoperative scans which accurately depictedthe extentof surgical resection. One patientwith meningioma showedrecurrent disease4 monthsaftergross total resection that was not seen on postoperative MRI. The non-meningiomatous tumors included chordomas (2), pituitaryadenomas (2), metastatic tumor (1), cholesterol granuloma (1), and non-operated tumorsof unknown identities (2).
The scans of these tumors showednormaluptakeof radioactive tracer. The use of preoperative Octreoscan" can help in the accurate preoperative diagnosis of meningiomas and can have significant impacton the preoperative and postoperative treatment planning. Furthermore, the use of postoperative Oetreoscan" can reliably determinethe extent of surgical resection of meningiomasand ensureearly detectionprogression or recurrence of tumor. Supported by: Am. Cancer Soc. Instit. grant IRG-t87 (A.F.K.). Nat. Sci. Found. EPSCoRProg. RII8922108 (A.F.K.).
Monday, 7 July 1997
IP-2-226I
Correlation of intraoperative ultrasound, computed tomography, magnetic resonance imaging and histopathological findings
A. Melada, K. Rotim,M. Marciki6. Department of Neurosurgery, Schoolof Medicine, Zagreb, Yugoslavia In the last five years intraoperative US was carriedout in more than a thousand operations, mostlyin tumours. Wetry to determinewhetherthis methodprovides additional information about the extentof a solid tumour, its differentiation from surrounding oedema, its tissue components and defining borders. All gliomas wereechogenic compared to surrounding brain. The centre of the tumoursmay consistof necrosis or cyst which is not alwaysvisible in CT or MRI scans. Comparison of US, CT images and histOlogical findings revealed that the vast majority of contrastenhancing areason CT were hyperechogenic and contained tumourtissue. Hyperechogenic areas always represented solid tumour even whenthe CT showed lowdensity, histologyconsistently revealed necrotic tumour. US improved intraoperative delineation of tumour margins, as depicted by CT and MRI, thus maximising the extent of resection. However, with recurrent tumours, US tendsto overestimate the tumourvolume. Gliosis may accountfor this difference. Despite the highspecificityof US in the differentiation of tumour components, its sensitivity to tumour was inferior to that of CT and MRI, but allowsidentification of tumourtissue and its extent.
IP-2-227I neurosurgery Clinical usefulness of echo planar imaging in Masayuki Sumida, Sinichiro Takeshita, Tomohide Akimitsu, KeisukeMigita, Kazunori Arita, Kaoru Kurisu. Department of Neurosurgery, Hiroshima University Schoolof Medicine, Hiroshima, Japan Purpose: To evaluate the usefulness of echo planar imaging (EPI), a new ultra high speed MR method, for diagnosis and preoperative examination of neurosurgical cases. Methods and Materials: t05 patientswith various neuronal diseaseswere examined by EPl.ln all cases, a 1.5TMR unitwas used.T2WI,FLAIR,functional MRI(fMRI), diffusion weighted image(OWl)and perfusion imagewere obtained usingthe EPI method. Results: 1) T2WI were obtained within 30 seconds and hematomas were clearly demonstrated. 2) Lesions around CSF spaces were clearly seen on FLAIR. 3) The relationship between motor cortex and tumor was more clearly demonstrated beforesurgeryon fMRI.4) The ultra-early stageof infarction was seenonly by OWl. Epidermoids couldbe differentiated from other cysts by OWl. 5) Relative rCBFcould be evaluated with perfusion imaging. Conclusion: Variable new MR methods can be obtained using EPI. EPI can provide useful information for diagnosis and preoperative evaluation for neurosurgery.
IP-2-22SI The role of somatostatin receptor studies in the diagnosis and treatment of pituitary adenomas
Jerzy Bldziriski, Wiestaw Bonicki, Boguslaw Sk6rka, Leszek Kr6licki. Department of Neurosurgery Schoolof Medicine, Warsaw, Poland Human somatostatin is a 14-amino acid peptide. Most endocrinetumourshave somatostatin receptors, whichcan be visualised with the help of scintigraphy. This paper presentsthe resultsof somatostatin receptorstudies in patients with pituitaryadenomas. In the diagnosis Ind-111 radiolabelled DTPA-octreotid, the radio-pharmaceutical Octreo-Scan produced by Mallinckrodt Medical was usedusingSiemens ZLCGammakamera. 4-5 m Ci radioactive dosewas given. Theexamination wasperformed at 2,4 and24 hoursafterOctreo-Scan injection. Planarprojections were taken, in some cases SPECTwas used.The resulted scintigrams were qualitatively estimated. 25 patients with endocrine active pituitaryadenomas underwent the examination.Thepresence of somatostatin receptors wasobservedin 20 patientswith acromegaly, one patientwith mixted endocrine pituitary adenoma and two patients with ectopicACTH hypersecretion. It was not observedin two cases with with hyperprolactinoma. In the group examined, the presence of somatostatin receptors confirmed the indication for surgeryin 15 cases and the indication for reoperation in 5. The surgeryfollowed somatostatin analoguptakein 10 patients with a largenumberof somatostatin receptors on scintigraphy. One patientwith acromegaly, who wasoperated twice for a pitultaryadenomainfiltrating the cavernoussinuseswasqualifiedfor radiotherapy. in three patientswithacromegaiy, in whicha greatnumberof somatostatin receptors wasobservedbeforesurgery, followup studieswereconducted the scintigraphic picturesof the pituitarygland indicated the achieved endocrine normalisation. Octreo-Scan scintigraphy provedits high usefulness in the diagnosisof both primary and recurrent endocrine active pituitarytumors.
Imaging in Neurosurgery
low perfusion at the bottom of the left frontal and temporal cortex, but normal perfusion in the right cerebral hemisphere. All of these patients recovered clear consciousness after intravenous injection of 50% glucose. In a later SPECT study in the comatose patients, the low perfusion of the whole cerebral cortex improved with clear consciousness. Discussion and Conclusion: Disturbance of consciousness, focal neurologicdeficitsandalsoconvulsions werewell knowninthe hypoglycemic patients. But the mechanisms of these symptoms have not been elucidated. This study, showedthat the neurologicsymptoms including disturbance of consciousness wereassociated with low perfusion of the brain.Thesefindings suggestthatthe neurologic symptoms of hypoglycemia are caused by the selectiveinhibition of metabolism or blood flow in the brain.
I P-2-224!
Investigations of remote effect by IMP-SPECT
Takayuki Kitamura, Akira Teramoto. Department of Neurosurgery, Nippon MedicalSchool, Tokyo, Japan Introduction: We report the findings we have obtained from our investigations on remote effects (RE) in patients with hemorrhagic cerebrovascular disease(hypertensive intracerebral hemorrhage, ruptured cerebral aneurysm, etc.) which were relatively localized. Materials and Methods: Of the localized lesions for which IMP-SPECT was conducted, no abnormalities were recognized when examined by CT. The subjects who exhibited RE had a hypertensive intracerebral hemorrhage in 15 of 24 cases (62.5%), a cerebral aneurysm in 25 of 10 cases (59.5%) and a cerebral arteriovenous malformation in 14 of 18 cases (77.8%). Those who showed RE were classified as Group A and those who did not show RE as Group B. We studied each groupfor 1) affectedregion, 2) classification of RE, 3) ABRISEP findings and 4) the correlations, between redistribution, prognosis and RE on IMP-SPECT. Conclusion: 1)The REsuggested the participation ofthe cortico-pontocerebellar and thalamo-cortical tracts, depending on the regions wherethe lesions had frequentlydeveloped. 2) Crossedcerebellar diaschisis (CCD) wasthe most popular RE which we recognized on IMP-SPECT. 3) Although the correlation between the redistributed imagesand the prognosis was recognized, the correlationbetweenthe redistributed images, the occurrence of REandthe prognosis had yet to be clarified.
IP-2-225!
The use of OctreoScan® in the preoperative diagnosis and postoperative follow up of meningiomas
Ali F.Krisht, Kevin Yoo,W. BruceCherny, OssamaAI-Metty. University of Arkansasfor MedicalSciences, Little Rock, Arkansas, USA The preoperative diagnosisand the postoperative follow-up of meningiomas depends on radiological studies which may not always be correct. A reliable way of obtaining an accuratepreoperative diagnosisand postoperative follow-up is by relying on the biological properties of the tumor. Meningioma cells are rich with high density of high affinity somatostatin receptors. Using this information, we studied patients with different intracranial lesions with a radiolabeled somatostatin analog. Multiplanar nuclearscansand SinglePhoton Emission Computerized Tomograms(SPECT)wereobtained preoperatively and postoperatively in 24 patients after intravenous injections of a somatostatin analoglabeledwith radioactive indium (OctreoScan®) were given. Sixteenpatientshad meningiomas which was confirmed with histological studies. Fourteen of 16 (87.5%) meningiomas had increased uptake of radioactive tracer. Seven patients with meningiomas had postoperative scans which accurately depictedthe extentof surgical resection. One patientwith meningioma showedrecurrent disease4 monthsaftergross total resection that was not seen on postoperative MRI. The non-meningiomatous tumors included chordomas (2), pituitaryadenomas (2), metastatic tumor (1), cholesterol granuloma (1), and non-operated tumorsof unknown identities (2).
The scans of these tumors showednormaluptakeof radioactive tracer. The use of preoperative Octreoscan" can help in the accurate preoperative diagnosis of meningiomas and can have significant impacton the preoperative and postoperative treatment planning. Furthermore, the use of postoperative Oetreoscan" can reliably determinethe extent of surgical resection of meningiomasand ensureearly detectionprogression or recurrence of tumor. Supported by: Am. Cancer Soc. Instit. grant IRG-t87 (A.F.K.). Nat. Sci. Found. EPSCoRProg. RII8922108 (A.F.K.).
Monday, 7 July 1997
IP-2-226I
Correlation of intraoperative ultrasound, computed tomography, magnetic resonance imaging and histopathological findings
A. Melada, K. Rotim,M. Marciki6. Department of Neurosurgery, Schoolof Medicine, Zagreb, Yugoslavia In the last five years intraoperative US was carriedout in more than a thousand operations, mostlyin tumours. Wetry to determinewhetherthis methodprovides additional information about the extentof a solid tumour, its differentiation from surrounding oedema, its tissue components and defining borders. All gliomas wereechogenic compared to surrounding brain. The centre of the tumoursmay consistof necrosis or cyst which is not alwaysvisible in CT or MRI scans. Comparison of US, CT images and histOlogical findings revealed that the vast majority of contrastenhancing areason CT were hyperechogenic and contained tumourtissue. Hyperechogenic areas always represented solid tumour even whenthe CT showed lowdensity, histologyconsistently revealed necrotic tumour. US improved intraoperative delineation of tumour margins, as depicted by CT and MRI, thus maximising the extent of resection. However, with recurrent tumours, US tendsto overestimate the tumourvolume. Gliosis may accountfor this difference. Despite the highspecificityof US in the differentiation of tumour components, its sensitivity to tumour was inferior to that of CT and MRI, but allowsidentification of tumourtissue and its extent.
IP-2-227I neurosurgery Clinical usefulness of echo planar imaging in Masayuki Sumida, Sinichiro Takeshita, Tomohide Akimitsu, KeisukeMigita, Kazunori Arita, Kaoru Kurisu. Department of Neurosurgery, Hiroshima University Schoolof Medicine, Hiroshima, Japan Purpose: To evaluate the usefulness of echo planar imaging (EPI), a new ultra high speed MR method, for diagnosis and preoperative examination of neurosurgical cases. Methods and Materials: t05 patientswith various neuronal diseaseswere examined by EPl.ln all cases, a 1.5TMR unitwas used.T2WI,FLAIR,functional MRI(fMRI), diffusion weighted image(OWl)and perfusion imagewere obtained usingthe EPI method. Results: 1) T2WI were obtained within 30 seconds and hematomas were clearly demonstrated. 2) Lesions around CSF spaces were clearly seen on FLAIR. 3) The relationship between motor cortex and tumor was more clearly demonstrated beforesurgeryon fMRI.4) The ultra-early stageof infarction was seenonly by OWl. Epidermoids couldbe differentiated from other cysts by OWl. 5) Relative rCBFcould be evaluated with perfusion imaging. Conclusion: Variable new MR methods can be obtained using EPI. EPI can provide useful information for diagnosis and preoperative evaluation for neurosurgery.
IP-2-22SI The role of somatostatin receptor studies in the diagnosis and treatment of pituitary adenomas
Jerzy Bldziriski, Wiestaw Bonicki, Boguslaw Sk6rka, Leszek Kr6licki. Department of Neurosurgery Schoolof Medicine, Warsaw, Poland Human somatostatin is a 14-amino acid peptide. Most endocrinetumourshave somatostatin receptors, whichcan be visualised with the help of scintigraphy. This paper presentsthe resultsof somatostatin receptorstudies in patients with pituitaryadenomas. In the diagnosis Ind-111 radiolabelled DTPA-octreotid, the radio-pharmaceutical Octreo-Scan produced by Mallinckrodt Medical was usedusingSiemens ZLCGammakamera. 4-5 m Ci radioactive dosewas given. Theexamination wasperformed at 2,4 and24 hoursafterOctreo-Scan injection. Planarprojections were taken, in some cases SPECTwas used.The resulted scintigrams were qualitatively estimated. 25 patients with endocrine active pituitaryadenomas underwent the examination.Thepresence of somatostatin receptors wasobservedin 20 patientswith acromegaly, one patientwith mixted endocrine pituitary adenoma and two patients with ectopicACTH hypersecretion. It was not observedin two cases with with hyperprolactinoma. In the group examined, the presence of somatostatin receptors confirmed the indication for surgeryin 15 cases and the indication for reoperation in 5. The surgeryfollowed somatostatin analoguptakein 10 patients with a largenumberof somatostatin receptors on scintigraphy. One patientwith acromegaly, who wasoperated twice for a pitultaryadenomainfiltrating the cavernoussinuseswasqualifiedfor radiotherapy. in three patientswithacromegaiy, in whicha greatnumberof somatostatin receptors wasobservedbeforesurgery, followup studieswereconducted the scintigraphic picturesof the pituitarygland indicated the achieved endocrine normalisation. Octreo-Scan scintigraphy provedits high usefulness in the diagnosisof both primary and recurrent endocrine active pituitarytumors.