MR cisternography after intrathecal Gd-DTPA application

The purpose of this study was to establish and to evaluate MR cisternography after intrathecal Gd-DTPA administration to detect rhinobasal cerebrospinal fluid (CSF) fistulae in patients with suspected CSF rhinorrhoea. Ten patients with suspected CSF rhinorrhoea were examined. The MR cisternography included the following investigation steps: acquisition of nonenhanced fat-suppressed T1-weighted spin-echo (SE) scans of the skull base and the paranasal sinuses, lumbar puncture with administration of 1 ml Gd-DTPA solute with 4 ml NaCl and performance of MR cisternography with the same fat-suppressed T1-weighted sequences as used initially. In 10 patients with suspected CSF rhinorrhoea Gd-DTPA enhanced MR cisternography detected 5 CSF fistulae. In 3 of 5 CSF leaks were located in the cribriform plate and in 2 of 5 sphenoidal. Whereas 4 of these depicted leaks were confirmed surgically, in 1 case the CSF fistula closed spontaneously. In another case, CSF leakage after severe head injury was clinically highly suspected but ceased prior to MR cisternography with inability to detect the temporary fistula. In the remaining 4 patients with serous rhinorrhoea MR cisternography did not provide any evidences for CSF fistulae. Intrathecal Gd-DTPA injection was tolerated excellently. Clinical and EEG examinations showed no gross behavioural or neurological disturbances and no seizure activity, respectively. The MR cisternography after intrathecal administration of Gd-DTPA represents a safe, promising and minimally invasive method for detection of CSF fistulae. This MR investigation provides excellent depiction of CSF spaces and pinpoints CSF fistulae

Patients with High-Grade Gliomas Harboring Deletions of Chromosomes 9p and 10q Benefit from Temozolomide Treatment

Surgical cure of glioblastomas is virtually impossible and their clinical course is mainly determined by the biologic behavior of the tumor cells and their response to radiation and chemotherapy. We investigated whether response to temozolomide (TMZ) chemotherapy differs in subsets of malignant glioblastomas defined by genetic lesions. Eighty patients with newly diagnosed glioblastoma were analyzed with comparative genomic hybridization and loss of heterozygosity. All patients underwent radical resection. Fifty patients received TMZ after radiotherapy (TMZ group) and 30 patients received radiotherapy alone (RT group). The most common aberrations detected were gains of parts of chromosome 7 and losses of 10q, 9p, or 13q. The spectrum of genetic aberrations did not differ between the TMZ and RT groups. Patients treated with TMZ showed significantly better survival than patients treated with radiotherapy alone (19.5 vs 9.3 months). Genomic deletions on chromosomes 9 and 10 are typical for glioblastoma and associated with poor prognosis. However, patients with these aberrations benefited significantly from TMZ in univariate analysis. In multivariate analysis, this effect was pronounced for 9p deletion and for elderly patients with 10q deletions, respectively. This study demonstrates that molecular genetic and cytogenetic analyses potentially predict responses to chemotherapy in patients with newly diagnosed glioblastomas