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Abstract

Osmotic Blood-Brain Barrier Modification: Clinical Documentation by Enhanced CT Scanning and/or Radionuclide Brain Scanning

Edward A. Neuwelt, H. David Specht, John Howieson, James E. Haines, Michael J. Bennett, Suelien A. Hill and Eugene P. Frenkel
American Journal of Neuroradiology July 1983, 4 (4) 907-913;
Edward A. Neuwelt
1Department of Surgery, Division of Neurosurgery, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97201. Address reprint requests to E. A. Neuwelt
2Department of Biochemistry, Oregon Health Sciences University, and Department of Surgery, Veterans Administration Medical Center, Portland, OR 97201
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H. David Specht
3Department of Clinical Pathology, Division of Nuclear Medicine, Oregon Health Sciences University, Portland, OR 97201
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John Howieson
4Department of Radiology, Division of Neuroradiology, Oregon Health Sciences University, Portland, OR 97201
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James E. Haines
3Department of Clinical Pathology, Division of Nuclear Medicine, Oregon Health Sciences University, Portland, OR 97201
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Michael J. Bennett
5Department of Anesthesiology, Oregon Health Sciences University, Portland, OR 97201
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Suelien A. Hill
1Department of Surgery, Division of Neurosurgery, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97201. Address reprint requests to E. A. Neuwelt
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Eugene P. Frenkel
6Department of Internal Medicine, Division of Hematology, University of Texas Health Science Center, Dallas, TX 75235
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Abstract

Results of initial clinical trials of brain tumor chemotherapy after osmotic blood-brain barrier disruption are promising. In general, the procedure is well tolerated. The major complication has been seizures. In this report, data are presented which indicate that the etiology of these seizures is related to the use of contrast agent (meglumine iothalamate) to monitor barrier modification. A series of 19 patients underwent a total of 85 barrier modification procedures. Documentation of barrier disruption was monitored by contrast-enhanced computed tomographic (CT) scanning, radionuclide brain scanning, or a combination of both techniques. In 56 procedures (19 patients) monitored by enhanced CT, seizures occurred a total of 10 times in eight patients. Twenty-three barrier modification procedures (in nine of these 19 patients) documented by nuclear brain scans alone, however, resulted in only one focal motor seizure in each of two patients. In eight of the 19 patients who had seizures after barrier disruption and enhanced CT scan, four subsequently had repeat procedures monitored by radionuclide scan alone. In only one of these patients was further seizure activity noted; a single focal motor seizure was observed. Clearly, the radionuclide brain scan does not have the sensitivity and spatial resolution of enhanced CT, but at present it appears safer to monitor barrier modification by this method and to follOW tumor growth between barrier modifications by enhanced CT. Four illustrative cases showing methods, problems, and promising results are presented.

  • © American Roentgen Ray Society
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American Journal of Neuroradiology
Vol. 4, Issue 4
1 Jul 1983
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Osmotic Blood-Brain Barrier Modification: Clinical Documentation by Enhanced CT Scanning and/or Radionuclide Brain Scanning
Edward A. Neuwelt, H. David Specht, John Howieson, James E. Haines, Michael J. Bennett, Suelien A. Hill, Eugene P. Frenkel
American Journal of Neuroradiology Jul 1983, 4 (4) 907-913;

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Osmotic Blood-Brain Barrier Modification: Clinical Documentation by Enhanced CT Scanning and/or Radionuclide Brain Scanning
Edward A. Neuwelt, H. David Specht, John Howieson, James E. Haines, Michael J. Bennett, Suelien A. Hill, Eugene P. Frenkel
American Journal of Neuroradiology Jul 1983, 4 (4) 907-913;
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