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Tumoren der Pinealisregion machen insgesamt nur etwa 0,5% aller Hirntumoren aus. Pinealiszysten werden inzidentiell bei 1,3–2,6% der Kernspintomographien beim Erwachsenen gefunden. In absteigender Häufigkeit finden sich in der Pinealisregion Pinealiszysten, Germinome, Teratome, Pineozytome, Pineoblastome, Gliome, Meningeome und andere seltene Tumoren. Die Differentialdiagnose der pinealen Tumoren ergibt sich aus mehreren Kriterien: 1. Erkrankungsalter: Teratome/Pineoblastome/niedriggradige Astrozytome treten im Kindesalter unter 20 Jahren, Germinome bis etwa 30 Jahre, Pineozytome zwischen 25 und 35 Jahren, Meningeome über 35 Jahre und Pinealiszysten in jedem Alter auf. 2. Geschlechterprädisposition: Germinome und Teratome haben eine männliche Prädominanz, 3. Lokalisation: Bis auf die niedriggradigen Astrozytome und Meningeome, die auch parapineal vorkommen können, sind alle Tumoren pineal lokalisiert. 4. Signalgebung: Die Tumoren sind meist hypo- bis isointens zum umgebenden Hirngewebe auf T1-gewichteten Aufnahmen und hyperintens auf T2-gewichteten Aufnahmen, weisen jedoch starke Variationen und Besonderheiten auf. 5. Kontrastaufnahme: Bis auf die Teratome und die niedriggradigen Astrozytome, die ein variables Kontrastverhalten zeigen, weisen alle pinealen Tumoren eine kräftige Kontrastaufnahme auf. Die Pinealiszysten zeigen allenfalls eine randständige Anreicherung, die durch normales, z. T. komprimiertes Pinealisgewebe vorgetäuscht wird.

Identification of country-specific demographic, medical, lifestyle, and geoenvironmental risk factors for cerebral aneurysm rupture in the developing Asian country of Mongolia. First-time estimation of the crude national incidence of aneurysmal subarachnoid hemorrhage (aSAH). A retrospective analysis of all intracranial digital subtraction angiographies (DSA) acquired in Mongolia during the 2‑year period 2016–2017 (1714 examinations) was performed. During this period, DSA was used as primary diagnostic imaging modality for acute severe neurological symptoms in the sole hospital nationwide dedicated to neurological patients. The catchment area of the hospital included the whole country. Patients with incidental and ruptured aneurysms were reviewed with respect to their medical history and living conditions. The data was used to install a Mongolian aneurysm registry. The estimated annual crude incidence of cerebral aneurysm rupture was 6.71 for the country of Mongolia and 14.53 per 100,000 persons for the capital region of Ulaanbaatar. Risk factors common in developed countries also applied for the Mongolian population: A medical history of hypertension, smoking or the presence of multiple aneurysms led to a higher relative risk of rupture. In contrast, female gender was not associated with a higher risk in this national cohort. Males pursuing a traditional nomadic living may exhibit a specifically high risk of rupture. Disease management of over 200 individuals/year with aSAH constitutes a socioeconomic burden in Mongolia. Efforts to raise awareness of the risk factors hypertension and smoking among the Mongolian population are desirable. Measures to improve the nationwide availability of modern neurovascular treatment options are currently under consideration.

Diagnostic cerebral catheter angiography is used to assess a variety of neurovascular pathologies especially in patients before and after endovascular neurointerventional treatment. In many centers diagnostic cerebral angiographies are performed with the patient staying for one night in the hospital because there are not yet sufficient data on the safety of ambulatory cerebral angiography. At the same time hospitals face a growing demand to perform ambulatory medical procedures. A total of 426 ambulatory diagnostic cerebral angiographies were retrospectively analyzed. Technical details of the angiographies were analyzed to identify procedural risk factors. Out of 426 patients 14 (3.3%) had some form of complication, 3 developed minor transient neurological symptoms, 1 patient developed Quincke’s edema probably as an adverse reaction to contrast agent, 1 patient had an asymptomatic carotid dissection and 1 had a fall of unknown etiology. Of the 14 complications 8 were puncture site complications with 1 re-bleeding, 1 dissection, and 6 minor complications, 421 punctures were femoral, 3 radial and 2 brachial. Out of 333 patients with magnetic resonance imaging (MRI) after angiography 21 showed focal diffusion-weighted imaging (DWI) lesions but none of these lesions were symptomatic. The rate of DWI lesions was significantly higher in selectively angiography territories than in other territories. The use of a Simmons 2 catheter significantly increased the rate of DWI lesions (p = 0.047), whereas 3D rotational angiography did not (p = 0.55). The rate of DWI lesions per selectively accessed vessel was 4.6% with a higher rate in the anterior than in the posterior circulation. Diagnostic cerebral catheter angiography can be safely performed in an ambulatory setting.

Based on histopathology, Edinburgh diagnostic criteria were proposed to consider a nontraumatic intracerebral lobar hemorrhage (ICH) as related to cerebral amyloid angiopathy (CAA) using the initial computed tomography (CT) scan and the APOE genetic status. We aimed to externally validate the Edinburgh prediction model, excluding the APOE genotyping and based on the modified Boston criteria on the MRI for CAA diagnosis We included patients admitted for spontaneous lobar ICH in the emergency department between 2016 and 2019 who underwent noncontrast CT scan and MRI. According to the MRI, patients were classified into the CAA group or into the non-CAA group in the case of other causes of ICH. Two neuroradiologists, blinded to the final retained diagnosis, rated each radiological feature on initial CT scan described in the Edinburgh study on initial CT scan A total of 102 patients were included, of whom 36 were classified in the CAA group, 46 in the non-CAA causes group and 20 of undetermined cause (excluded from the primary analysis). The Edinburgh prediction model, including finger-like projections and subarachnoid extension showed an area under receiver operating characteristic curves (AUC) of 0.760 (95% confidence interval, CI: 0.660–0.859) for the diagnosis of CAA. The AUC reached 0.808 (95% CI: 0.714–0.901) in a new prediction model integrating a third radiologic variable: the ICH cortical involvement. Using the Boston MRI criteria as a final assessment, we provided a new external confirmation of the radiological Edinburgh CT criteria, which are directly applicable in acute settings of spontaneous lobar ICH and further proposed an original 3‑set model considering finger-like projections, subarachnoid extension, and cortical involvement that may achieve a high discrimination performance.

Eine progrediente Querschnittslähmung wird heute mittels der Magnetresonanztomographie (MRT) abgeklärt. Neben den häufigen Ursachen dieser Symptomatik, wie Metastasen, Tumoren und Entzündungen, muß differentialdiagnostisch auch an eine spinale Blutung gedacht werden. Obwohl insgesamt selten und vor allem bei Patienten mit einer Gerinnungsstörung beobachtet, sind epidurale Hämatome gelegentlich beschrieben worden. Spinale subdurale Blutungen sind dagegen sehr viel seltener und nur vereinzelt beobachtet worden. Wir demonstrieren die MRT-Zeichen eines akuten, spontanen, operativ gesicherten Subduralhämatoms, das insbesondere in den T2-gewichteten Turbospinechosequenzen nur schwer zu erkennen war. Neben der protonengewichteten Sequenz erwies sich hier die FLAIR-Sequenz als besonders geeignet, die Ausdehnung der Blutung zu dokumentieren.

Dieser Beitrag fasst kurz die Entwicklung der Magnetresonanztomographie (MRT) zur bevorzugten Bildgebung beim akuten Schlaganfall zusammen. Dabei werden die unterschiedlichen Aspekte der Pathophysiologie der Ischämie, die sich aus der MRT ableiten lassen, beleuchtet und vor dem Hintergrund der aktuellen Literatur sowie eigener Erfahrungen in der Lysetherapie diskutiert.