Osseous metaplasia has recently been described in several cases of nephrogenic systemic fibrosis,... more Osseous metaplasia has recently been described in several cases of nephrogenic systemic fibrosis, sometimes in association with unusual clinical features such as painful hyperkeratotic spicules, palpable bony masses, and disease regression. Some authors have suggested that it may mainly occur late in the disease course or even be a marker for involuting nephrogenic systemic fibrosis. Here, we present a 27-year-old woman with a 7-year history of nephrogenic systemic fibrosis, who developed cutaneous osseous metaplasia.
Objective: Assessment of radiographic findings, surgical management, histopathology, and clinical... more Objective: Assessment of radiographic findings, surgical management, histopathology, and clinical outcomes of patients with spheno-orbital meningiomas. Methods: Retrospective analysis of radiographic findings, surgical techniques, histopathology, neurological, and ophthalmalogical function for patients with spheno-orbital meningiomas. Fifteen patients were identified, 12 without prior treatment, and 3 with recurrent tumors after prior surgery. Twelve patients were female, 3 male with a mean age of 45.6 years (range 15–65 y). Mean follow-up was 22 months (range 2–55 mo). Results: At 6 months postoperatively functional status was equivalent to or better than preoperative functional status for 14 of 15 patients and there was 1 perioperative death. Visual acuity was improved in 5, stable in 7, worsened in 2, and unknown in 1 (early postoperative death). There was 1 cerebellar infarction. World Health Organization (WHO) meningioma pathology grade was I for 11 patients and II for 4 patients (1 with neurofibromatosis type II-NF2). Bone involvement with hyperostosis with tumor invasion was shown in 13, and bone destruction in 1. Four patients received postoperative fractionated radiation. There have been no cases of meningioma progression during follow-up. Conclusion: Patients with spheno-orbital meningiomas present with proptosis and variable degrees of vision loss. These tumors have a characteristic appearance on radiographic imaging. Optimal surgical treatment includes aggressive removal of hyperostotic and tumor-infiltrated bone in addition to soft tumor. Reconstructive techniques reduce risks of enophthalamous or other cosmetic deformity. Long-term follow-up is necessary to monitor for recurrence, and radiation is advisable in cases with greater risk for recurrence.
OBJECTIVE Colloid cysts are rare, histologically benign lesions that may result in obstructive hy... more OBJECTIVE Colloid cysts are rare, histologically benign lesions that may result in obstructive hydrocephalus and death. Understanding the natural history of colloid cysts has been challenging given their low incidence and the small number of cases in most reported series. This has complicated efforts to establish reliable prognostic factors and surgical indications, particularly for asymptomatic patients with incidental lesions. Risk factors for obstructive hydrocephalus in the setting of colloid cysts remain poorly defined, and there are no grading scales on which to develop standard management strategies. METHODS The authors performed a single-center retrospective review of all cases of colloid cysts of the third ventricle treated over nearly 2 decades at Washington University. Univariate analysis was used to identify clinical, imaging, and anatomical factors associated with 2 outcome variables: symptomatic clinical status and presentation with obstructive hydrocephalus. A risk-pr...
High-resolution computed tomography (CT) slices of the temporal bone of the Macaca mulatta monkey... more High-resolution computed tomography (CT) slices of the temporal bone of the Macaca mulatta monkey were performed and key anatomical landmarks were identified and labelled. The scans provided detailed anatomical definition of the monkey temporal bone and were considered a useful basis for studying the anatomy of a primate model.
Charts from 1,074 consecutive emergency department patients who underwent cranial computed tomogr... more Charts from 1,074 consecutive emergency department patients who underwent cranial computed tomography (CT) were reviewed for predictors of a CT abnormality. Twenty-six clinical variables and the results of neurologic examination were compared with cranial CT findings. Patients with focal neurologic deficit, unresponsiveness, and hypertension had an increased risk of a CT abnormality. Blurred vision, trauma, loss of consciousness, headache, and dizziness were each associated with a lower risk of a CT abnormality. Multivariate analysis showed that only focal neurologic deficit and unresponsiveness effectively helped predict a CT abnormality. In patients with negative neurologic findings, only intoxication and amnesia were associated with greater than 10% positive scans and an increased risk for a CT abnormality. The data indicate that positive neurologic findings coupled with intoxication and amnesia would have helped detect 90.7% of the positive scans and provide an effective initial approximation strategy for selecting patients to undergo CT. Although 15 patients with positive scans (1.4%) would have been missed, this strategy would have yielded a negative predictive value of 97.3% and eliminated 53.9% of the CT scans obtained.
We describe neural foraminal enlargement as a radiologic sign indicating bilateral interfacetal d... more We describe neural foraminal enlargement as a radiologic sign indicating bilateral interfacetal dislocation or subluxation injuries (BID/S) of the lower cervical spine on axial images. Axial neural foraminal width was measured by computed tomography or magnetic resonance imaging in 10 patients with BID/S and compared with measurements in 20 control patients. In both the BID/S patients and controls, the size of the foramina at the injured level was compared with the foramina at levels immediately above and below the injury.
The purpose of this study was to describe the “open” exit foramen as a new sign associated with u... more The purpose of this study was to describe the “open” exit foramen as a new sign associated with unilateral interfacetal dislocation or subluxation (UID/S) of the cervical spine. Three blinded observers evaluated 20 randomly ordered axial imaging examinations (9 with UID/S and 11 traumatized control patients) assessing for presence or absence of the open exit foramen sign at the level of injury. The clinical observations were then quantified by measuring the width of the involved cervical exit foramen at the level of injury on axial computed tomography or magnetic resonance imaging in nine patients with UID/S. These measurements were also compared to the width of contralateral uninvolved exit foramen at the level of UID/S and to ipsi- and contralateral exit foramen measurements of 20 control patients with acute cervical spine injuries but no UID/S. Measurements were analyzed using Student’st-test. Calculated sensitivity and specificity for blinded reviewer detection of the open exit foramen sign in cases of UID/S vs. traumatized controls were 78% and 79%, respectively. Quantitative measurements indicate the involved exit foramen was enlarged by an average of 3.9 mm compared to the contralateral exit foramen at the levels of UID/S, whereas controls demonstrated only 0.9 mm of foraminal asymmetry (P<0.01). In cases of UID/S, asymmetric widening of the exit foramen occurs in the axial plane, resulting in the open exit foramen sign. Blinded review confirms that this sign is clinically helpful in identifying the level and side of UID/S on axial imaging studies.
We studied clinical predictors of cranial computed tomography (CT) abnormalities in patients with... more We studied clinical predictors of cranial computed tomography (CT) abnormalities in patients with acute or acutely worsened headache. Data were collected from chart review of 333 consecutive patients presenting to an emergency department and who were clinically selected for cranial CT. Patients with a positive neurologic examination were at 10.7 times greater risk for a positive CT than the rest of the sample (p < 1.5-104°). Using only neurologic examination to select patients for CT would have missed 30.3% of the positive scans. The amnesia, depressed sensorium, and hypertension variables had CT yields approximating 10% or greater even in the presence of a negative neurologic examination. Together with a positive neurologic examination, these variables detected 87.9% of the patients in this sample with positive scans; their absence had a negative predictive value of 98.0%. Of the four patients with positive scans who would have been missed using this strategy, one was discharged directly from the emergency department anyway
The purpose of this study was to determine the incidence of nephrogenic systemic fibrosis (NSF) i... more The purpose of this study was to determine the incidence of nephrogenic systemic fibrosis (NSF) in patients with chronic kidney disease (CKD) and moderate-to-severe impairment of kidney function who had not previously been exposed to gadolinium-based contrast agents (GBCAs) or referred to undergo contrast-enhanced MRI with gadobenate dimeglumine or gadoteridol. Two multicenter prospective cohort studies evaluated the incidence of unconfounded NSF in patients with stage 3 CKD (estimated glomerular filtration rate [eGFR] in cohort 1, 30-59 mL/min/1.73 m(2)) or stage 4 or 5 CKD (eGFR in cohort 2, < 30 mL/min/1.73 m(2)) after injection of gadobenate dimeglumine (study A) or gadoteridol (study B). A third study (study C) determined the incidence of NSF in patients with stage 4 or 5 CKD who had not received a GBCA in the 10 years before enrollment. Monitoring for signs and symptoms suggestive of NSF was performed via telephone at 1, 3, 6, and 18 months, with clinic visits occurring at ...
C o n d u c t i v e hear ing loss is a c o m m o n affliction typically associated with chronic m... more C o n d u c t i v e hear ing loss is a c o m m o n affliction typically associated with chronic middle or external ear inf lammation or obstruction, as in chronic otitis media, choles tea toma, external otitis, or ce rumen impaction. Pr imary ossicular d y s f u n c t i o n s u c h as otosclerosis, t rauma, congenital malformations, and Paget ' s d i s e a s e a l s o contr ibutes to impaired ossicular sound transmission. Familial expansile osteolysis ( F E O ) is a rare autosomal -dominan t bone dysplasia character ized by early-onset conduct ive hear ing loss caused by resorpt ion of ossicular bone. Genera l ized skeletal changes similar to Paget ' s disease progress throughout adult life. Focal osteoclastic resorpt ion leads to pain, deformity, loss o f denti t ion, and pathologic fractures. The appendicular s k e l e t o n p a r t i c u l a r l y the tibia, fibula, and h u m e r u s i s most frequently affected. Serum alkaline phospha tase and urinary hydroxyprol ine levels are usually elevated. The original descr ipt ion of F E O is based on a previously repor ted single-family pedigree in Nor thern Ireland. 1,2 W e present a pat ient with conductive hearing loss caused by spontaneous ossicular necrosis. By use of family history, radiographic evidence, and surgical exploration, F E O was diagnosed.
THE DIAGNOSIS OF CEREBRAL CYSTICERCOSIS is often quite challengingt both clinically and radiograp... more THE DIAGNOSIS OF CEREBRAL CYSTICERCOSIS is often quite challengingt both clinically and radiographically. Until recently, computed tomography (CT) was undoubtedly the imaging modality of choice for detecting these lesions. In this report, we describe the magnetic resonance (MR) findings in two patients with biopsy-proved cysticercosis and compare the results with those of CT. Methods Two patients were studied with a 0.5-tesla superconductive magnetic resonance imaging device manufactured by Picker International. Scans were generated in the sagittal, coronal and transaxial planes in both patients, and both T 1and T2-weighted sequences were used. The T2-weighted sequence comprised a repetition time (TR) of 2,200 ms and an echo-delay time (TE) of 80 ms, and the TI-weighted images were obtained using a TR of 850 ms and a TE of 40 ms. CT scans were available for review and comparison on both patients. In both cases, these were done on a GE 8800 CT scanner using 1-cm slice thickness. Reports of Cases Case I A 42-year-old Bolivian physician had her first generalized seizure in 1983. CT and angiography at that time were interpreted as normal. In August 1984, subcutaneous nodules developed on the patient's scalp, oral mucosa, neck and groin. A biopsy of the scalp and oral lesions was interpreted as being consistent with cysticercosis. Additional seizures
Osseous metaplasia has recently been described in several cases of nephrogenic systemic fibrosis,... more Osseous metaplasia has recently been described in several cases of nephrogenic systemic fibrosis, sometimes in association with unusual clinical features such as painful hyperkeratotic spicules, palpable bony masses, and disease regression. Some authors have suggested that it may mainly occur late in the disease course or even be a marker for involuting nephrogenic systemic fibrosis. Here, we present a 27-year-old woman with a 7-year history of nephrogenic systemic fibrosis, who developed cutaneous osseous metaplasia.
Objective: Assessment of radiographic findings, surgical management, histopathology, and clinical... more Objective: Assessment of radiographic findings, surgical management, histopathology, and clinical outcomes of patients with spheno-orbital meningiomas. Methods: Retrospective analysis of radiographic findings, surgical techniques, histopathology, neurological, and ophthalmalogical function for patients with spheno-orbital meningiomas. Fifteen patients were identified, 12 without prior treatment, and 3 with recurrent tumors after prior surgery. Twelve patients were female, 3 male with a mean age of 45.6 years (range 15–65 y). Mean follow-up was 22 months (range 2–55 mo). Results: At 6 months postoperatively functional status was equivalent to or better than preoperative functional status for 14 of 15 patients and there was 1 perioperative death. Visual acuity was improved in 5, stable in 7, worsened in 2, and unknown in 1 (early postoperative death). There was 1 cerebellar infarction. World Health Organization (WHO) meningioma pathology grade was I for 11 patients and II for 4 patients (1 with neurofibromatosis type II-NF2). Bone involvement with hyperostosis with tumor invasion was shown in 13, and bone destruction in 1. Four patients received postoperative fractionated radiation. There have been no cases of meningioma progression during follow-up. Conclusion: Patients with spheno-orbital meningiomas present with proptosis and variable degrees of vision loss. These tumors have a characteristic appearance on radiographic imaging. Optimal surgical treatment includes aggressive removal of hyperostotic and tumor-infiltrated bone in addition to soft tumor. Reconstructive techniques reduce risks of enophthalamous or other cosmetic deformity. Long-term follow-up is necessary to monitor for recurrence, and radiation is advisable in cases with greater risk for recurrence.
OBJECTIVE Colloid cysts are rare, histologically benign lesions that may result in obstructive hy... more OBJECTIVE Colloid cysts are rare, histologically benign lesions that may result in obstructive hydrocephalus and death. Understanding the natural history of colloid cysts has been challenging given their low incidence and the small number of cases in most reported series. This has complicated efforts to establish reliable prognostic factors and surgical indications, particularly for asymptomatic patients with incidental lesions. Risk factors for obstructive hydrocephalus in the setting of colloid cysts remain poorly defined, and there are no grading scales on which to develop standard management strategies. METHODS The authors performed a single-center retrospective review of all cases of colloid cysts of the third ventricle treated over nearly 2 decades at Washington University. Univariate analysis was used to identify clinical, imaging, and anatomical factors associated with 2 outcome variables: symptomatic clinical status and presentation with obstructive hydrocephalus. A risk-pr...
High-resolution computed tomography (CT) slices of the temporal bone of the Macaca mulatta monkey... more High-resolution computed tomography (CT) slices of the temporal bone of the Macaca mulatta monkey were performed and key anatomical landmarks were identified and labelled. The scans provided detailed anatomical definition of the monkey temporal bone and were considered a useful basis for studying the anatomy of a primate model.
Charts from 1,074 consecutive emergency department patients who underwent cranial computed tomogr... more Charts from 1,074 consecutive emergency department patients who underwent cranial computed tomography (CT) were reviewed for predictors of a CT abnormality. Twenty-six clinical variables and the results of neurologic examination were compared with cranial CT findings. Patients with focal neurologic deficit, unresponsiveness, and hypertension had an increased risk of a CT abnormality. Blurred vision, trauma, loss of consciousness, headache, and dizziness were each associated with a lower risk of a CT abnormality. Multivariate analysis showed that only focal neurologic deficit and unresponsiveness effectively helped predict a CT abnormality. In patients with negative neurologic findings, only intoxication and amnesia were associated with greater than 10% positive scans and an increased risk for a CT abnormality. The data indicate that positive neurologic findings coupled with intoxication and amnesia would have helped detect 90.7% of the positive scans and provide an effective initial approximation strategy for selecting patients to undergo CT. Although 15 patients with positive scans (1.4%) would have been missed, this strategy would have yielded a negative predictive value of 97.3% and eliminated 53.9% of the CT scans obtained.
We describe neural foraminal enlargement as a radiologic sign indicating bilateral interfacetal d... more We describe neural foraminal enlargement as a radiologic sign indicating bilateral interfacetal dislocation or subluxation injuries (BID/S) of the lower cervical spine on axial images. Axial neural foraminal width was measured by computed tomography or magnetic resonance imaging in 10 patients with BID/S and compared with measurements in 20 control patients. In both the BID/S patients and controls, the size of the foramina at the injured level was compared with the foramina at levels immediately above and below the injury.
The purpose of this study was to describe the “open” exit foramen as a new sign associated with u... more The purpose of this study was to describe the “open” exit foramen as a new sign associated with unilateral interfacetal dislocation or subluxation (UID/S) of the cervical spine. Three blinded observers evaluated 20 randomly ordered axial imaging examinations (9 with UID/S and 11 traumatized control patients) assessing for presence or absence of the open exit foramen sign at the level of injury. The clinical observations were then quantified by measuring the width of the involved cervical exit foramen at the level of injury on axial computed tomography or magnetic resonance imaging in nine patients with UID/S. These measurements were also compared to the width of contralateral uninvolved exit foramen at the level of UID/S and to ipsi- and contralateral exit foramen measurements of 20 control patients with acute cervical spine injuries but no UID/S. Measurements were analyzed using Student’st-test. Calculated sensitivity and specificity for blinded reviewer detection of the open exit foramen sign in cases of UID/S vs. traumatized controls were 78% and 79%, respectively. Quantitative measurements indicate the involved exit foramen was enlarged by an average of 3.9 mm compared to the contralateral exit foramen at the levels of UID/S, whereas controls demonstrated only 0.9 mm of foraminal asymmetry (P&lt;0.01). In cases of UID/S, asymmetric widening of the exit foramen occurs in the axial plane, resulting in the open exit foramen sign. Blinded review confirms that this sign is clinically helpful in identifying the level and side of UID/S on axial imaging studies.
We studied clinical predictors of cranial computed tomography (CT) abnormalities in patients with... more We studied clinical predictors of cranial computed tomography (CT) abnormalities in patients with acute or acutely worsened headache. Data were collected from chart review of 333 consecutive patients presenting to an emergency department and who were clinically selected for cranial CT. Patients with a positive neurologic examination were at 10.7 times greater risk for a positive CT than the rest of the sample (p < 1.5-104°). Using only neurologic examination to select patients for CT would have missed 30.3% of the positive scans. The amnesia, depressed sensorium, and hypertension variables had CT yields approximating 10% or greater even in the presence of a negative neurologic examination. Together with a positive neurologic examination, these variables detected 87.9% of the patients in this sample with positive scans; their absence had a negative predictive value of 98.0%. Of the four patients with positive scans who would have been missed using this strategy, one was discharged directly from the emergency department anyway
The purpose of this study was to determine the incidence of nephrogenic systemic fibrosis (NSF) i... more The purpose of this study was to determine the incidence of nephrogenic systemic fibrosis (NSF) in patients with chronic kidney disease (CKD) and moderate-to-severe impairment of kidney function who had not previously been exposed to gadolinium-based contrast agents (GBCAs) or referred to undergo contrast-enhanced MRI with gadobenate dimeglumine or gadoteridol. Two multicenter prospective cohort studies evaluated the incidence of unconfounded NSF in patients with stage 3 CKD (estimated glomerular filtration rate [eGFR] in cohort 1, 30-59 mL/min/1.73 m(2)) or stage 4 or 5 CKD (eGFR in cohort 2, < 30 mL/min/1.73 m(2)) after injection of gadobenate dimeglumine (study A) or gadoteridol (study B). A third study (study C) determined the incidence of NSF in patients with stage 4 or 5 CKD who had not received a GBCA in the 10 years before enrollment. Monitoring for signs and symptoms suggestive of NSF was performed via telephone at 1, 3, 6, and 18 months, with clinic visits occurring at ...
C o n d u c t i v e hear ing loss is a c o m m o n affliction typically associated with chronic m... more C o n d u c t i v e hear ing loss is a c o m m o n affliction typically associated with chronic middle or external ear inf lammation or obstruction, as in chronic otitis media, choles tea toma, external otitis, or ce rumen impaction. Pr imary ossicular d y s f u n c t i o n s u c h as otosclerosis, t rauma, congenital malformations, and Paget ' s d i s e a s e a l s o contr ibutes to impaired ossicular sound transmission. Familial expansile osteolysis ( F E O ) is a rare autosomal -dominan t bone dysplasia character ized by early-onset conduct ive hear ing loss caused by resorpt ion of ossicular bone. Genera l ized skeletal changes similar to Paget ' s disease progress throughout adult life. Focal osteoclastic resorpt ion leads to pain, deformity, loss o f denti t ion, and pathologic fractures. The appendicular s k e l e t o n p a r t i c u l a r l y the tibia, fibula, and h u m e r u s i s most frequently affected. Serum alkaline phospha tase and urinary hydroxyprol ine levels are usually elevated. The original descr ipt ion of F E O is based on a previously repor ted single-family pedigree in Nor thern Ireland. 1,2 W e present a pat ient with conductive hearing loss caused by spontaneous ossicular necrosis. By use of family history, radiographic evidence, and surgical exploration, F E O was diagnosed.
THE DIAGNOSIS OF CEREBRAL CYSTICERCOSIS is often quite challengingt both clinically and radiograp... more THE DIAGNOSIS OF CEREBRAL CYSTICERCOSIS is often quite challengingt both clinically and radiographically. Until recently, computed tomography (CT) was undoubtedly the imaging modality of choice for detecting these lesions. In this report, we describe the magnetic resonance (MR) findings in two patients with biopsy-proved cysticercosis and compare the results with those of CT. Methods Two patients were studied with a 0.5-tesla superconductive magnetic resonance imaging device manufactured by Picker International. Scans were generated in the sagittal, coronal and transaxial planes in both patients, and both T 1and T2-weighted sequences were used. The T2-weighted sequence comprised a repetition time (TR) of 2,200 ms and an echo-delay time (TE) of 80 ms, and the TI-weighted images were obtained using a TR of 850 ms and a TE of 40 ms. CT scans were available for review and comparison on both patients. In both cases, these were done on a GE 8800 CT scanner using 1-cm slice thickness. Reports of Cases Case I A 42-year-old Bolivian physician had her first generalized seizure in 1983. CT and angiography at that time were interpreted as normal. In August 1984, subcutaneous nodules developed on the patient's scalp, oral mucosa, neck and groin. A biopsy of the scalp and oral lesions was interpreted as being consistent with cysticercosis. Additional seizures
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Papers by Franz Wippold