✓ Tissue samples from 20 patients with various intracranial tumors and one case of cerebral contusion were analyzed for the cytosolic glucocorticoid-receptor concentration using isoelectric focusing in slabs of polyacrylamide gel. It is pointed out that the clinical response to dexamethasone in brain edema associated with various intracranial lesions is, to some extent, parallel to the glucocorticoid-receptor concentration in these tumors. The findings in this investigation suggest that the cytosolic glucocorticoid receptor might be responsible for the initiation of a series of biochemical effects of steroids affecting brain edema. It is possible that the first step in eliciting a beneficial clinical response to dexamethasone in patients with brain tumors is the formation of a steroid-receptor complex in the peripheral parts of the tumor.
Zhao-Ying Yu, Örjan Wrange, Jörgen Boëthius, Ahmad Hatam, Lars Granholm and Jan-Åke Gustafsson
Matthew J. Kuhn, Piero Picozzi, Joseph A. Maldjian, Ilona M. Schmalfuss, Kenneth R. Maravilla, Brian C. Bowen, Franz J. Wippold II, Val M. Runge, Michael V. Knopp, Leo J. Wolansky, Lars Gustafsson, Marco Essig and Nicoletta Anzalone
The goal in this article was to compare 0.1 mmol/kg doses of gadobenate dimeglumine (Gd-BOPTA) and gadopentetate dimeglumine, also known as gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA), for enhanced magnetic resonance (MR) imaging of intraaxial brain tumors.
Eighty-four patients with either intraaxial glioma (47 patients) or metastasis (37 patients) underwent two MR imaging examinations at 1.5 tesla, one with Gd-BOPTA as the contrast agent and the other with Gd-DTPA. The interval between fully randomized contrast medium administrations was 2 to 7 days. The T1-weighted spin echo and T2-weighted fast spin echo images were acquired before administration of contrast agents and T1-weighted spin echo images were obtained after the agents were administered. Acquisition parameters and postinjection acquisition times were identical for the two examinations in each patient. Three experienced readers working in a fully blinded fashion independently evaluated all images for degree and quality of available information (lesion contrast enhancement, lesion border delineation, definition of disease extent, visualization of the lesion's internal structures, global diagnostic preference) and quantitative enhancement (that is, the extent of lesion enhancement after contrast agent administration compared with that seen before its administration [hereafter referred to as percent enhancement], lesion/brain ratio, and contrast/noise ratio). Differences were tested with the Wilcoxon signed-rank test. Reader agreement was assessed using kappa statistics.
Significantly better diagnostic information/imaging performance (p < 0.0001, all readers) was obtained with Gd-BOPTA for all visualization end points. Global preference for images obtained with Gd-BOPTA was expressed for 42 (50%), 52 (61.9%), and 56 (66.7%) of 84 patients (readers 1, 2, and 3, respectively) compared with images obtained with Gd-DTPA contrast in four (4.8%), six (7.1%), and three (3.6%) of 84 patients. Similar differences were noted for all other visualization end points. Significantly greater quantitative contrast enhancement (p < 0.04) was noted after administration of Gd-BOPTA. Reader agreement was good (κ > 0.4).
Lesion visualization, delineation, definition, and contrast enhancement are significantly better after administration of 0.1 mmol/kg Gd-BOPTA, potentially allowing better surgical planning and follow up and improved disease management.