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Magnetic resonance imaging (MRI) in therapy-naïve intracranial glioma is paramount for neuro-oncological diagnostics, and it provides images that are helpful for surgery planning and intraoperative guidance during tumor resection, including assessment of the involvement of functionally eloquent brain structures. This study reviews emerging MRI techniques to depict structural information, diffusion characteristics, perfusion alterations, and metabolism changes for advanced neuro-oncological imaging. In addition, it reflects current methods to map brain function close to a tumor, including functional MRI and navigated transcranial magnetic stimulation with derived function-based tractography of subcortical white matter pathways. We conclude that modern preoperative MRI in neuro-oncology offers a multitude of possibilities tailored to clinical needs, and advancements in scanner technology (e. g., parallel imaging for acceleration of acquisitions) make multi-sequence protocols increasingly feasible. Specifically, advanced MRI using a multi-sequence protocol enables noninvasive, image-based tumor grading and phenotyping in patients with glioma. Furthermore, the add-on use of preoperatively acquired MRI data in combination with functional mapping and tractography facilitates risk stratification and helps to avoid perioperative functional decline by providing individual information about the spatial location of functionally eloquent tissue in relation to the tumor mass. Key Points: Citation Format

Zusammenfassung Einleitung Bei Leberzirrhose mit Pfortaderhochdruck kann es zu lebensbedrohlichen gastrointestinalen Blutungen kommen. Fallvorstellung Wir berichten über einen 67-jährigen Patienten mit äthyltoxischer Leberzirrhose und endoskopisch nicht kontrollierbaren Rektalvarizenblutungen. Beschrieben wird eine im interdisziplinären Konsens getroffene Entscheidung eines Therapieversuchs mittels perkutaner paraumbilikaler Embolisation. Diskussion Bei gastrointestinalen Blutungen bei Pfortaderhochdruck stehen als Therapiemöglichkeiten die endoskopische oder chirurgische Intervention, medikamentöse Therapie oder die TIPS (transjugulärer intrahepatischer portosystemischer Shunt)-Anlage im Vordergrund. Sollten diese Optionen nicht infrage kommen oder frustran verlaufen sein, besteht die Möglichkeit einer radiologischen Intervention mit perkutaner transumbilikaler Embolisation des die Blutung speisenden Pfortaderumgehungskreislaufs. Sowohl in unserem Fall als auch bei den in der Literatur beschriebenen Embolisationen von Ösophagusvarizen kam es zu einem Sistieren der Blutungen, ohne dass für den jeweiligen Patienten ein großer Eingriff nötig gewesen war.

Background There has been long-standing clinical and electrophysiological evidence that in patients with albinism the visual pathways cross atypically: most fibres from one eye cross to the contralateral visual cortex. Purpose of the study to determine whether the size and configuration of the optic chiasm in human albinos is different from normally pigmented controls. Patients and methods 17 patients (11 female, mean age 35.8 years) with oculocutaneous albinism underwent a standardised graded morphological and functional evaluation. Magnetic resonance images were reformatted to the region of the optic chiasm and analysed using observer-independent morphometry. In addition, fMRI of the visual cortex was performed during VEP analysis (1.5 Tesla Siemens Vision). Morphological and fMRT results were compared to an age-correlated group of n = 16 normally pigmented healthy volunteers with normal visual acuity and stereopsis. Results 65 % of the patients (n = 10) showed signs of dysplasia of the optic nerve head. Statistical morphometry showed distinct differences in chiasmal morphology between albinos and normally pigmented probands (smaller optic nerves, different angles of optical entry into the chiasm and of the beginning of the Tractus optici leaving the chiasm, overall chiasmal width and height). Conclusions Optic nerve head anomalies are frequent in albinism and influence visual outcome. Size and configuration of the optic chiasm in human albinos is distinctly different from normally pigmented control persons and reflects the atypical crossing of optic fibres.