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Difficulty in Diagnosing Secondary Peripheral Chondrosarcoma: Radiology versus Anatomical Pathology Ruhimat, Undang; Hendarin, Arie
Journal of Medicine and Health Vol 1, No 4 (2016)
Publisher : Maranatha Christian University

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Abstract

Chondrosarcoma is a malignant tumor derived from bone cartilage. This tumor can be either primary or secondary. Secondary chondrosarcoma has some differences compared to the primary type i.e. the incidence is rarer, the younger age group, and many are low grade. The authors report a case of a 26-year-old man came to Hasan Sadikin Hospital with a chief complaint of a lump in the right thigh with mild pain since 5 months before consulation that is increasingly enlarging. After undergoing physical and radiological examinations, the patient was diagnosed with suspect chondrosarcoma in right thigh. Histopathologic examinations were performed 2 times, one of which used ultrasound guidance, giving a diagnosis of chondroma in right thigh. However the lesion was finally treated as chondrosarcoma. We suspected that the patient was more likely to suffer from secondary peripheral chondrosarcoma originating from malignant transformation of multiple osteochondromas. As widely known, it is almost impossible to differentiate between the low grade chondrosarcoma and chondroma with full certainty and this poses a classical problem in diagnostic medicine. Case described here was an example of the difficulty in distinguishing between these two diseases. Key words: secondary chondrosarcoma, peripheral chondrosarcoma, chondrosarcoma arising  in osteochondroma
Perbedaan Intensitas Penyengatan Meningeal Hasil MRI antara Sekuens T2 FLAIR Post Contrast dan T1WI Post Contrast Gadolinium-DTPA dalam Mendeteksi Penyangatan Meningeal pada Kasus Meningitis Tuberkulosis Hendarin, Arie; Soetikno, Rista D.; Nugraha, Harry Galuh
Majalah Kedokteran Bandung Vol 49, No 3 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1379.365 KB) | DOI: 10.15395/mkb.v49n3.1117

Abstract

Diagnosis meningitis TB terutama pada kasus possible dan probable sulit ditegakkan. Pemeriksaan MRI kepala dengan kontras Gadolinium-DTPA adalah modalitas radiologi yang paling sensitif untuk membantu mendiagnosis penyakit ini. Penyangatan meningeal di daerah basal merupakan gambaran MRI yang paling banyak ditemukan pada meningitis TB. Tujuan penelitian ini adalah mengetahui perbedaan peningkatan intensitas sinyal meningen sekuens T2-FLAIR dengan T1WI pada pasien meningitis tuberkulosis menggunakan pemeriksaan MRI kepala dengan kontras Gadolinium-DTPA di RSUP Dr. Hasan Sadikin Bandung pada bulan Januari 2015–Juni 2016. Subjek penelitian sebanyak 21 orang dengan meningitis TB dilakukan pemeriksaan MRI kepala dengan kontras Gadolinium-DTPA. Analisis statistik komparatif dilakukan untuk menguji perbedaan peningkatan intensitas sinyal meningen sekuens T2-FLAIR post contrast dengan T1WI post contrast. Hasil penelitian menujukkan rerata peningkatan intensitas sinyal meningen sekuen T2-FLAIR (∆T2-FLAIR) sebesar 360,59±182,19 aμ sedangkan T1WI (∆T1WI) sebesar 126,47±72,57 aμ. Hasil uji statistik menggunakan uji T pada derajat kepercayaan 95% menunjukkan perbedaan yang bermakna ∆T2-FLAIR dengan ∆T1WI pada nilai p=0,000. Sebagai simpulan didapatkan peningkatan intensitas sinyal meningen sekuens T2-FLAIR post contrast lebih besar daripada T1WI post contrast pada kasus meningitis TB.  [MKB. 2017;49(3):172–78]Kata kunci: Meningitis tuberkulosis, MRI sekuens T1WI dan T2-FLAIR, penyangatan meningealDifference between Gadolinium-DTPA Enhanced T2 FLAIR Sequence and T1WI Sequence MRI in Detecting Meningeal Enhancement in Tuberculous MeningitisThe diagnosis of TB meningitis, especially in possible and probable cases, is difficult. Contrast-enhanced MRI of the head with Gadolinium-DTPA is the most sensitive imaging modality that supports diagnosis of this disease. The most common presentation of TB meningitis in MRI is basal meningeal enhancement. The objective of this study was to determine the difference in the increase of T2-FLAIR and T1WI sequence meningeal signal intensity of in patients with tuberculous meningitis using contrast-enhanced MRI of the head with Gadolinium-DTPA in Dr. Hasan Sadikin General Hospital from January 2015–June 2016. Contrast enhanced MRI examination was conducted in 21 subjects with TB meningitis. Statistical analysis was performed to examine the difference in the increase in meningeal signal intensity of post contrast T2-FLAIR and post contrast T1WI. The result showed that the mean increases in meningeal signal intensity of T2-FLAIR (ΔT2-FLAIR) and T1WI (ΔT1WI) were  360.59±182.19 au and 126.47±72.57 aμ respectively. Statistical test results using T test at 95% confidence level indicated that there was a difference between ΔT2-FLAIR and ΔT1WI at p-value=0.000. In conclusion, the mean increase in meningeal signal intensity of post contrast T2-FLAIR is greater than in the post contrast T1WI in TB meningitis. [MKB. 2017;49(3):172–78]Key words: Meningeal enhancement, T1WI and T2-FLAIR sequence MRI, tuberculous meningitis