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Transforming growth factor-beta2 (TGF-beta2) is known to suppress the immune response to cancer cells and plays a pivotal role in tumor progression by regulating key mechanisms including proliferation, metastasis, and angiogenesis. For targeted protein suppression the TGF-beta2-specific antisense oligodeoxynucleotide AP 12009 was developed. In vitro experiments have been performed to prove specificity and efficacy of the TGF-beta2 inhibitor AP 12009 employing patient-derived malignant glioma cells as well as peripheral blood mononuclear cells (PBMCs) from patients. Clinically, the antisense compound AP 12009 was assessed in three Phase I/II-studies for the treatment of patients with recurrent or refractory malignant (high-grade) glioma WHO grade III or IV. Although the study was not primarily designed as an efficacy evaluation, prolonged survival compared to literature data and response data were observed, which are very rarely seen in this tumor indication. Two patients experienced long-lasting complete tumor remissions. These results implicate targeted TGF-beta2-suppression using AP 12009 as a promising novel approach for malignant gliomas and other highly aggressive, TGF-beta-2-overexpressing tumors.

The anterior optic pathways are rarely affected by vascular malformations. In a meticulous literature review, 42 published cases of patients with vascular malformations within optic nerves, chiasma and/or optic tract were found, 30 of them being diagnosed as cavernous haemangiomas. All of them suffered from visual disturbances; in 38.1% previous symptoms had occurred. Surgical treatment resulted in major improvement in most patients. We include a further patient with a cavernous haemangioma of the optic chiasma and left optic tract who presented with an acute defect of the right visual field and severe retro-orbital pain. We succeeded in total excision of the malformation via a neuronavigationally guided approach. In the postoperative course, vision of our patient improved immediately and was found to be completely normal three months after the surgical intervention. Considering our patient and the published cases in the literature, we are of the opinion that microsurgical excision is a safe and efficient treatment for these rare pathologies.

Background: Various supratentorial pathological conditions can mimic neoplastic cerebral lesions clinically as well as radiologically. Analysis of the neuroradiological findings, the clinical history, laboratory and other paraclinical data mostly help to narrow down the diagnosis of cerebral pathologies. Sometimes, however, histopathological analysis of the operative specimen after surgery reveals unexpected findings., Patients and Findings: In a series of 197 operative procedures performed for glioma surgery between August 2000 and August 2002 we found six distinct cases mimicking supratentorial tumours. Clinicoradiological findings had suggested a neoplastic gliomatous process in all cases. But histopathological examination revealed that in reality one patient had been affected by a stroke, two by hypertensive encephalopathy, and one by radiation necrosis; multiple sclerosis was the underlying pathology in two patients., Interpretation: Conditions which show features similar to those of neoplastic cerebral lesions require advanced magnetic resonance imaging (MRI). The benefit of such sophisticated imaging in relation to the costs is an important issue in this context. Further research in the field of modern image modalities is necessary to evaluate these noninvasive techniques for specification of intracerebral lesions.

The purpose of this study was to compare functional magnetic resonance (MR) imaging of the motor cortex in healthy volunteers and patients with brain tumours. Functional MR imaging was performed in 14 healthy volunteers and 14 patients with tumours in or near the primary motor cortex with groups being matched for age, sex, and handedness. Functional images were acquired during motion of the right and left hand. Time courses of signal intensity within the contralateral, ipsilateral, and supplementary motor cortex as well as z-maps were calculated, their quality being assessed visually. Mean signal increase between activation and rest were evaluated within the contralateral, ipsilateral, and supplementary motor cortex, the activated area in those regions of interest was measured using z-maps. The quality of functional MR experiments was generally lower in patients than in volunteers. The quantitative results showed a trend towards increased ipsilateral activation in volunteers during left hand compared to right hand motion and in patients during motion of the affected compared to the non-affected hand. Considering quantitative and qualitative results, significantly increased ipsilateral activation was found in patients compared to healthy volunteers. In conclusion, functional MR imaging quality was significantly reduced in patient studies compared to healthy volunteers, even if influences of age, sex, and handedness were excluded. Increased ipsilateral activation was found in patients with brain tumours which can be interpreted by an improved connectivity between both hemispheres.

29 patients suffering from brain metastases were studied with a single (0.1 mmol/kg body weight) and triple dose (0.3 mmol/kg) of gadodiamide, a non-ionic MR contrast agent. The study was performed using an extended imaging protocol with application of T1-weighted images in three orientations. Number of definite and suspected metastases, lesion contrast, edema delineation, and flow artefacts were evaluated. Most of the definite metastases were found in triple dose images. However, the total lesion number could only be determined by looking on all sequences as a whole. Furthermore, the number of suspected metastases could be significantly reduced with triple dose images, but once more all sequences were needed to do so. Flow artefacts were significantly increased by triple dose, whereby lesion contrast and edema delineation was considerably improved. The conclusion is that the combination of high dose application of the contrast agent and an optimized imaging protocol facilitates sufficient imaging of brain metastases. This is important for therapeutical considerations, because patients with more than 1-2 metastases will be treated primarily with radiation therapy instead of neurosurgery.

Purpose: To determine the value of the gradient- and spin-echo (GRASE) technique as compared with the fast spin-echo and conventional spin-echo techniques in MR imaging of the brain., Methods: Sixty-six patients with ischemic and neoplastic brain lesions were examined with T2-weighted spin-echo, fast spin-echo, and GRASE sequences. Three independent observers evaluated the contrast characteristics of anatomic and pathologic structures and of artifacts. Quantitative image analysis included region-of-interest measurements of anatomic structures and lesions., Results: The contrast of anatomic structures was superior in images obtained with conventional and fast spin-echo techniques as compared with those obtained with the GRASE technique. Extended lesions, such as tumors and territorial infarcts, were identified equally with all techniques. For delineation of small ischemic lesions, GRASE was slightly inferior to fast and conventional spin-echo sequences. Flow artifacts were considerably reduced with fast spin-echo and GRASE sequences. Chemical-shift artifacts were significantly reduced, but ringing artifacts were more pronounced with GRASE., Conclusion: Fast spin-echo remains the standard technique in MR imaging of the brain. However, GRASE might be useful in special cases, such as with uncooperative patients whose conventional or fast spin-echo images show severe motion artifacts.

Our purpose was to determine the value of a T1-weighted rapid three-dimensional gradient-echo technique in preoperative MRI of brain tumours. We examined 30 patients with intracranial tumours who underwent neurosurgery, using T1-weighted magnetisation-prepared rapid gradient-echo (MP-RAGE) and axial T1-weighted spin-echo (SE) sequences, both before and after contrast medium (Gd-DTPA). Signal and contrast behaviour of anatomical and pathological structures were assessed with regions-of-interest (ROI) and visual inspection. Imaging results were compared with operative results. In 5 cases tumours and anatomical structures were segmented in MP-RAGE data sets. The MP-RAGE sequence considerably improved delineation of grey and white matter and small anatomical structures (vessels, cranial nerves), and significantly reduced flow artefacts. Contrast behaviour of tumours was similar with both techniques. Correlation of imaging with the operative results confirmed the reliability of the MP-RAGE sequence. Segmentation of MP-RAGE data sets allows three-dimensional display, which enables one to document the relevant information on a few images in selected cases.

Toxoplasmosis is a common infection with increased incidence in patients suffering from AIDS. In this paper we report a rare case of toxoplasmosis without evidence of AIDS: The patient had a singular tumor-like lesion in the right parietal lobe in CT and MRI. In neurosurgical intervention no tumor was found. Finally, different histopathological examinations led to the diagnosis of toxoplasmosis. Diagnostic and therapeutic regimes in patients with suspect tumor-like lesions should be discussed.