INTRAMEDULLARY THORACIC MENINGIOMA: A RARE CASE REPORT AND REVIEW OF THE LITERATURE

Only a few cases of intramedullary meningiomas in the cervical and thoracic region have been reported in the literature. We present a rare case of intramedullary meningioma in the lower thoracic region. A 68-year-old woman with complaints of back pain, gait disturbance, and paresthesias in both lower extremities for 4 months was admitted to our institution. Initially, she presented with weakness in her legs that gradually deteriorated over time. The patient had been operated on for breast cancer 2 years prior to the onset of current complaints. The neurological examination revealed spastic inferior paraparesis (McCormick grade IV), hypoesthesia below Th10 dermatome, bowel and bladder disturbances. Magnetic resonance imaging of the thoracic spine demonstrated intramedullary tumor that was hypointense on T1 and T2-weighted images but showed homogenous enhancement after gadolinium administration. After gross total resection, the histopathological examination confirmed the diagnosis of atypical intramedullary meningioma. CONCLUSION: The intramedullary meningiomas are extremely rare, but they should not be excluded from the differential diagnosis, especially in cases of intramedullary tumors with homogenous enhancement on magnetic resonance imaging. The best treatment strategy is gross total removal of the tumor.

Hirayama disease: the importance of flexion imaging

Hirayama disease is a rare cervical myelopathy characterised by asymmetrical upper limb weakness and muscle atrophy in the forearm and hand. MRI of the cervical spine plays an essential role in diagnosis, however, the characteristic findings are often only seen when the patient is imaged with the neck in flexion. We present a case of a 15-year-old male who presented with left forearm and hand weakness with muscle wasting. An MRI of the cervical spine with the neck in a neutral position demonstrated atrophy of the spinal cord with intrinsic signal abnormality between C5 and C7. Further imaging with the patient’s neck in flexion demonstrated the hallmark features of Hirayama disease. There was anterior displacement of the thecal sac and spinal cord, and an enlarged, crescent-shaped dorsal epidural space which enhanced following i.v. gadolinium administration. The atrophic segment of cord contacted the posterior vertebral bodies when the neck was in full flexion. This case highlights the importance of imaging patients suspected of having this entity with the neck in full flexion in order to make a diagnosis.

Use of the new Lake Louise Criteria improves CMR detection of atypical forms of acute myocarditis

The purpose of our study was to compare diagnostic performance of old and new Lake Louise Criteria (oLLC and nLLC) among different clinical presentations: infarct-like (IL), cardiomyopathic (CM) and arrhythmic (AR). 102 patients with clinical suspicion of acute myocarditis underwent cardiac magnetic resonance (CMR) on a 1.5 T scanner. Protocol included cine-SSFP, T2-weighted STIR, T2 mapping, early and late gadolinium enhancement and T1 mapping acquired before and after gadolinium administration. The degree of agreement has been calculated with Cohen’s K test. 42 patients also underwent endomyocardial biopsy (EMB). IL onset was present in 54/102 patients, CM in 28/102 and AR in 20/102. nLLC were positive in 58.3% of the patients, while oLLC in 37.9%, k = 0.57 (IC: 0.428–0.713). The degree of agreement between nLLC and oLLC was 0.49 (IC: 0.111–0.876) for AR onset (nLLC positive in 35% vs oLLC in 15%), 0.25 (IC: 0.035–0.459) for CM pattern (nLLC positive in 60.7% vs oLLC 17.9%) and 0.73 (IC: 0.543–0.912) for IL presentation (nLLC positive in 66.7% vs oLLC in 57.4%). Diagnostic accuracy was 75% for both nLLC and oLLC among IL onset, and 41.6% for oLLC vs 66.7% for nLLC, as regards CM clinical presentation. nLLC have improved diagnostic performance of CMR for the diagnosis of acute myocarditis, in particular for atypical clinical presentation.

P5287Influence of contrast and spatial resolution on myocardial strain results using feature tracking MRI

Background Feature tracking is a new post-processing algorithm for calculating myocardial strain from cardiac magnetic resonance (CMR) cine images. Quantification of myocardial deformation promises to detect myocardial abnormalities early in the course of disease. However, no uniform standards for image acquisition and processing are available. Purpose Analysing the influence of spatial resolution and contrast agent on quantitative myocardial strain results. Methods Seventy-five patients in sinus rhythm were prospectively enrolled and underwent a standardised CMR exam using a 1.5 Tesla scanner. For feature tracking analysis, steady-state free-precession (SSFP) cine images in long and short axes were acquired in 3 variants: 1. Native standard cine (spatial resolution 1.4x1.4x8mm3). 2. Native cine with lower spatial resolution (2.0x2.0x8mm3). 3. Standard cine equal to variant 1 but acquired 5 minutes after i.v.-administration of 0.2mmol/kg body weight gadoteracid. Group A consisted of 50 patients with normal left ventricular ejection fraction, no regional wall motion abnormality and no evidence of fibrosis based on Late Gadolinium Enhancement. Group B comprised 25 patients with evidence of infarct-like myocardial scar in the analyzed planes. Using dedicated feature tracking software, circumferential, longitudinal and radial strain were calculated as mean of the six midventricular myocardial segments for group A. For group B, the analysis focused on the infarcted segments. Results Figure 1 summarises the strain results, given as mean standard deviation. (The p-values stem from paired t-tests (group A) and Wilcoxon tests (group B), respectively. Significance is highlighted by *). In group A, circumferential and radial strain decreased significantly after Gadolinium administration, while longitudinal strain increased significantly with lower spatial resolution. In group B, circumferential, longitudinal and radial strain results of the infarcted segments increased significantly with lower spatial resolution, while Gadolinium had no statistically significant influence on strain results. Figure 1 Conclusion Quantitative myocardial strain results obtained by CMR feature tracking are significantly influenced by spatial resolution and Gadolinium administration. Standardised image acquisition seems fundamental for reliable and comparable CMR strain analysis.

Endolymphatic Hydrops, Evaluated Using 3T MRI in Patients with Clinically Confirmed Meniere Disease

Ménière’s disease (MD) is characterized by intermittent episodes of vertigo with fluctuating sensorineural hearing loss, tinnitus, and aural fullness. Despite numerous studies, the etiology of this disorder remains poorly understood and thus diagnostic criteria are mainly clinical. Development and progress in magnetic resonance imaging (MRI) techniques, in 2007, has enabled visualization of endolymphatic hydrops, which was the milestone achievement. We present two cases of patients with clinically confirmed MD with a set of audiological, otoneurological examinations and MRI performed. Structures of the inner ear were visualized using contrast-enhanced MR imaging after a 4-hour delayed intravenous gadolinium administration. The cochlea and vestibule were evaluated separately and classified using Barath grading scale. Endolymphatic hydrops in the clinically affected ears was confirmed using MRI. Due to disabling and intractable MD, a decision about vestibular neurectomy was made.