Contribution of advanced MRI to the diagnosis of giant tumefactive perivascular spaces

Background Giant tumefactive perivascular spaces (PVSs) are uncommon benign cystic lesions. They can imitate cystic neoplasms. Purpose To evaluate the contribution of advanced neuro magnetic resonance imaging (MRI) techniques in the diagnosis of giant tumefactive PVSs and to further characterize these unusual cerebral lesions. Material and Methods The MRI scans of patients with tumefactive PVS diagnosed between 2010 and 2019 were retrospectively reviewed. All imaging studies included three plane conventional cerebral MRI sequences as well as precontrast 3D T1 MPRAGE, post-gadolinium 3D T1 acquisitions, sagittal plane 3D T2 SPACE, diffusion-weighted imaging, and time-of-flight (TOF) angiography. Some patients received perfusion MR, MR spectroscopy, diffusion tensor imaging (DTI), and contrast-enhanced TOF MR angiography. Results A perforating vessel was demonstrated in 16 patients (66.7%) by TOF imaging. In four patients, there were intracystic vascular collaterals on contrast-enhanced TOF MR angiography. Septal blooming was observed in four patients in susceptibility-weighted imaging. On perfusion MR, central hyperperfusion was observed in four patients, and peripheral hyperperfusion was observed in one patient. On MR spectroscopy, choline increase was observed in two patients, and there was a lactate peak in three patients, and both a choline increase and lactate peak in one patient. On DTI, there was fiber distortion in five patients and fiber deformation in one patient. Conclusion Advanced MRI techniques and 3D volumetric high-resolution MRI sequences can provide a valuable contribution to the diagnosis and can be successfully used in the management of these lesions.

Tumefactive demyelinating CNS lesion in a 60-year-old woman with familial Mediterranean fever

SummaryWe here report on a 60-year-old woman with familial Mediterranean fever (FMF) who developed cognitive impairment 16 years after initial diagnosis. On MRI, a new extensive white matter lesion in the right frontal lobe with mild local mass effect but without contrast enhancement was detectable and classified as a tumefactive lesion. Additional MR spectroscopy showed markedly increased choline levels accompanied by a significant lactate peak, highly suggestive of a low-florid demyelinating process. Although diffuse central nervous system (CNS) lesions have been described in single FMF cases, tumefactive lesions have not been observed in FMF patients without concomitant multiple sclerosis. In summary, this case highlights rare differential diagnoses of atypical, inflammatory CNS lesions and the clinical utility of MR spectroscopy.

The Effect of Sports Rules Amendments on Exercise Intensity during Taekwondo-Specific Workouts

We aimed to compare the change in exercise response to taekwondo-specific circuit workouts before and after competition rule amendments. A total of 240 workouts in 15 elite athletes were analyzed over two years. Physiological and kinematic data were gathered with the wireless Bioharness system along with capillary blood samples for lactate concentration. Progressive exercise tests until exhaustion were periodically performed to obtain reference data. The rule changes resulted in significant increases (mainly medium or large effects) in the physiological (2.9–14.4%) and kinematic (4.8–10.1%) response to taekwondo-specific workouts. The largest increases were for peak breathing rate (12.0%), energy expenditure (6.6%), blood lactate immediately after exercise (10.2%) and at the 30th min of recovery (14.4%), and peak kinematic activity (10.1%). Significant differences between taekwondo-specific workouts and tournament combats persisted after the shift from old to new rules, ranging from 2.4 to 38.5% for physiological and from 2.9 to 15.5% for kinematic variables. The largest workout–combat differences were revealed for post-exercise (15.9%) and recovery (38.5%) blood lactate, peak (−15.8%) and relative (−15.0%) breathing rate, and mechanical (13.5%) and physiological (14.2%) intensity. Our study suggests that the rule amendments significantly modify the exercise response to discipline-specific workouts and that taekwondo-specific training sessions do not fully recreate the tournament demands in terms of physiological and kinematic load.

Radiological and Immunostaining Characteristics of H3.3 G34R-Mutant Glioma: A Report of 3 Cases and Review of the Literature

<b><i>Introduction:</i></b> H3.3 G34R/V mutation is predominantly identified in the supratentorial nonmidline tumors. However, this tumor is not yet categorized as an entity in 2016 WHO CNS classification. More information is necessary to further determine the characteristics of this tumor. <b><i>Case Presentation:</i></b> Three cases of adolescent hemispheric glioma were treated in our institution. All tumors showed the characteristics of huge tumor size with mild peritumoral edema on T2WI/FLAIR, hyperintense on DWI, and slight partial enhancement by gadolinium. The single-voxel proton MR spectroscopy revealed characteristics of high choline peak, marked decrease in N-acetyl aspartate peak, and small lactate peak. The histopathological diagnosis, based on 2007 WHO CNS classification, was high-grade glioma in 2 cases and a PNET. Immuno­staining revealed that the tumor cells were positive against H3.3 G34R, H3K27me3, and p53 antibodies and negative against H3K27M, IDH1-R132H, ATRX, and Olig2 antibodies. Pyrosequencing analysis confirmed H3.3 G34R mutation, IDH-wildtype, and BRAF-wildtype. <b><i>Conclusion:</i></b> Radiological and immunostaining findings are characteristic in our 3 cases of H3.3 G34-mutant glioma. It is essential to consider H3.3 G34-mutant glioma as a differential diagnosis particularly in pediatric and adolescents and young adult hemispheric tumors.