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Peter Yat-Ming Woo,Jennifer Hiu-Fung Chiu,Kar-Ming Leung,Kwong-Yau Chan 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.5
A 44-year-old woman with progressive cervical myelopathy and central cord syndrome was noted to have an extensive cervical intramedullary contrast-enhancing lesion on magnetic resonance imaging (MRI). The lesion resembled a spinal astrocytoma or ependymoma that required surgical intervention. She was subsequently diagnosed to have neuromyelitis optica (NMO), a rare idiopathic inflammatory demyelinating disorder, when the clinical examination revealed left optic atrophy. This was confirmed by a test showing seropositivity for NMO-immunoglobulin (IgG). Disease control was achieved with corticosteroids and immunosuppressive therapy. We report a rare case of a patient with NMO who had MRI features that could have easily led to the condition being misdiagnosed as a spinal cord tumor. The importance of careful history taking, awareness of typical radiological findings and the usefulness of serum NMO-IgG as a diagnostic tool are emphasized.
Siang-Hua Victor Chan,Kai-Sing Alain Wong,Yat-Ming Peter Woo,Kwong-Yau Chan,Kar-Ming Leung 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.4
Objective : Several modalities are available for volumetric measurement ofthe intracranial aneurysm. We discuss the challenges involved in manualsegmentation, and analyze the application of alternative methods usingautomatic segmentation and geometric formulae in measurement of aneurysmvolumes and coil packing density. Methods : The volumes and morphology of 38 aneurysms treated withendovascular coiling at a single center were measured using three-dimensionalrotational angiography (3DRA) reconstruction software using automaticsegmentation. Aneurysm volumes were also calculated from theirheight, width, depth, size of neck, and assumed shape in 3DRA imagesusing simple geometric formulae. The aneurysm volumes were dichotomizedas "small" or "large" using the median volume of the studied population(54 mm3) measured by automatic segmentation as the cut-off valuefor further statistical analysis. Results : A greater proportion of aneurysms were categorized as being"small" when geometric formulae were applied. The median aneurysm volumesobtained were 54.5 mm3 by 3DRA software, and 30.6 mm3 usingmathematical equations. An underestimation of aneurysm volume with aresultant overestimation in the calculated coil packing density (p = 0.002)was observed. Conclusion : Caution must be exercised in the application of simple geometricformulae in the management of intracranial aneurysms as volumesmay potentially be underestimated and packing densities falsely elevated. Future research should focus on validation of automatic segmentation involumetric measurement and improving its accuracy to enhance its applicationin clinical practice.