Bilateral posterior RION after concomitant radiochemotherapy with temozolomide in a patient with glioblastoma multiforme: a case report

<p>Abstract</p> <p>Background</p> <p>Radiation induced optic neuropathy (RION) is a rare but severe consequence of radiation therapy that is associated with adjuvant chemotherapy, specifically therapy with vincristine or nitrosoureas. However, there is very little evidence regarding the occurrence of RION after concomitant radiochemotherapy with temozolomide.</p> <p>Case Presentation</p> <p>The case of a 63 year old woman with glioblastoma multiforme and concomitant radiochemotherapy with temozolomide is described. Due to a slight depressive episode the patient also took hypericum perforatum. Five months after cessation of fractionated radiation and adjuvant chemotherapy with temozolomide (cumulative dose of 11040 mg) the patient developed bilateral amaurosis due to RION. Tumor regrowth was excluded by magnetic resonance imaging. After the application of gadolinium a pathognomonic contrast enhancement of both prechiasmatic optic nerves could be observed.</p> <p>Conclusions</p> <p>In this patient, the occurrence of RION may have been the result of radiosensitization by temozolomide, which could have been strengthened by hypericin. Consequently, physicians should avoid a concomitant application of hypericum perforatum and radiochemotherapy.</p

A comparison of angiographic CT and multisection CT in lumbar myelographic imaging

BACKGROUND AND PURPOSE: The purpose of this work was to provide an intraindividual comparison of angiographic CT (ACT) and multisection CT (MSCT) in lumbar myelographic imaging and to evaluate possible benefits of ACT, which is a further development of rotational angiography providing image data of high spatial and CT-like contrast resolution. MATERIALS AND METHODS: In 26 patients with degenerative lumbar spine disease a lumbar ACT was performed in combination with conventional lumbar myelography and followed by postmyelographic. MSCT. Conventional lumbar myelography and lumbar ACT were performed with a flat panel detector-equipped angiographic device. Postmyelographic MSCT was performed with a 16-section CT scanner. Three experienced neuroradiologists rated anonymized sets of multiplanar reformatted CT and ACT images regarding diagnostic and technical parameters. The ratings were repeated after 2 months. Weighted K Statistics were calculated to describe the levels of intraobserver and interobserver agreement. RESULTS: The analysis shows that MSCT achieves higher ratings than ACT in all of the parameters asked. An adequate diagnostic quality was only assigned to 80% of the ACT acquisitions compared with 97% of the MSCT acquisitions. All of the mean K values were above 0.60, demonstrating a substantial intraobserver and interobserver agreement for MSCT, as well as for ACT. CONCLUSION: Using ACT, radiographic myelography and myelographic CT can be performed at the same imaging system. However, the results of our study show that the current myelographic ACT image quality fails to apply diagnostic standards. We, therefore, cannot recommend ACT as a general alternative to postmyelographic MSCT