Common Magnetic Resonance Imaging Findings Research Articles

Orbital magnetic resonance imaging profile and clinicoradiological correlation in COVID-19-associated rhino-orbital-cerebral mucormycosis: A single-center study of 270 patients from North India

Purpose:To study the clinical profile and magnetic resonance imaging (MRI) features in patients of COVID-19-associated rhino-orbital-cerebral mucormycosis (CA-ROCM) with orbital involvement and perform a clinicoradiological correlation.Methods:A cross-sectional study was performed at a tertiary care center in north India from May 2021 to June 2021. Consecutive patients with clinical, nasal endoscopic, and/or microbiological evidence of CA-ROCM underwent MRI of paranasal sinuses, orbit, and brain as per the study protocol. Orbital MRI findings were studied in detail and were correlated with clinical signs.Results:Two hundred and seventy patients were studied. The mean age was 48.4 (± 16.82) years. A male predilection was noted (male:female = 1.77). Orbital involvement was seen in 146 (54%) patients on clinical evaluation and in 184 (68%) patients on MRI. Unilateral orbital involvement was more common (134; 92%). The most common presenting symptom was periorbital and/or facial pain (141; 52.2%) and the most common clinical sign was periorbital edema (116; 43%). The most common MRI finding was suggestive of orbital cellulitis (160; 59%). Orbital compartment syndrome was found in 17 (6.3%) patients. The inter-rater agreement between clinical and radiological assessments to detect the involvement of infraorbital nerve and frontal nerve was found to be 85.56%, (κ 0.621) and 93.70% (κ 0.776), respectively. The diagnostic accuracy, sensitivity, and specificity of MRI to detect medial orbital wall defect were found to be 87.9%, 65%, and 97%, respectively.Conclusion:Orbital imaging features of a cohort of ROCM patients have been presented with clinicoradiological correlation.

Pattern of structural magnetic resonance imaging lesions in the patients with progressive cognitive decline

Objectives: The aim of the index study was to describe the pattern and frequency of structural brain lesions in magnetic resonance imaging (MRI) of patients with dementia. Methods: This was a retrospective, descriptive study carried out in Memfys Hospital in Enugu, South East Nigeria, to review all MRIs of patients who presented with progressive cognitive decline. Results: Out of a total of 147 (86.5%) scan reviewed, 6 (6.8%) had normal brain scan, while 95 (64.6%) had brain atrophy, followed by white matter lesions 78 (49.7%). Strokes, including lacunar stroke, were seen in 44 (29.9%). Hydrocephalus (14.3%) and brain tumors (11.6%) were the most common surgical lesion found. Patients with atrophy (P < 0.01) and white matter lesions (P < 0.01) were significantly older compared to the average age of the cohort, while patients with normal brain scans and brain tumors were younger P < 0.01 and P = 0.02, respectively. Conclusion: Brain atrophy and white matter lesions were the most common MRI findings in patients presenting with cognitive decline in Enugu, South East Nigeria. Such patients also tended to be older than those with normal brain scans or brain tumors.

Cortical Atrophy, White Matter Lesions, and Bulb Configuration in Patients with Idiopathic Olfactory Loss and Other Causes of Olfactory Loss

Introduction: While magnetic resonance imaging (MRI) is not included in the current guidelines for diagnosing olfactory disorders in the most recent position paper on olfactory dysfunction, both 1.5T and 3T MRI are commonly used in the diagnostic workup of many patients with olfactory loss. Often, MRI is used to rule out intracranial tumours, but other useful information may be obtained from MRI scans in these patients. The potential of MRI in olfactory loss depends on sufficient knowledge of structural changes in different aetiologies of olfactory loss. We present common clinical MRI findings in olfactory loss and evaluate the usefulness of structural integrity scores in differentiating between aetiologies. Methods: In this study, we investigated if white matter hyperintensities (WMHs, measured by Fazekas score), global cortical atrophy (GCA), and medial temporal lobe atrophy (MTA) are more common in patients with idiopathic olfactory loss than in patients with acquired olfactory loss due to other aetiologies. Furthermore, we compared olfactory bulb (OB) configurations in different olfactory loss aetiologies. Results: In 88 patients with olfactory loss, WMHs, GCA, and MTA were not more significant findings on MRI in idiopathic olfactory loss (n = 51) compared with other causes of acquired olfactory loss (Fazekas score p = 0.2977; GCA score p = 0.6748; MTA score p = 0.7851). Bulb configurations differed in patients suffering from post-traumatic olfactory loss and may aid in identifying the underlying aetiology in patients where trauma is among the suspected causes of olfactory loss. Conclusion: We recommend that structural MRI with an OB sequence is included in the diagnostic evaluation of olfactory loss with suspected congenital and post-traumatic aetiology and should be considered in idiopathic olfactory loss with suspected central aetiology (e.g., tumour).

A characteristic MRI finding to diagnose a partial tear of the medial meniscus posterior root: an ocarina sign

BackgroundDiagnosing partial tears of the medial meniscus (MM) posterior root is difficult. The aim of this study was to evaluate diagnostic values involved in conventional magnetic resonance imaging (MRI) features of MM posterior root tears (MMPRTs) and find other MRI-based findings in patients with partial MMPRTs.MethodsEighteen patients who had arthroscopically confirmed partial MMPRTs were included. As a control, 18 patients who underwent partial meniscectomy for other types of MM tears were evaluated. Isolated partial MMPRTs were classified into the following three types: type A, accurate partial stable tear (cleavage < 1/2 of root width); type B, bridged unstable root tear (cleavage ≥ 1/2 of root width); type C, complex horn tear expanded to the root. Conventional MRI-based findings of MMPRTs were evaluated between two groups (n = 23). Posterior root irregularity, bone marrow spot, and ocarina-like appearance showing several condensed circles in triangular meniscal horn (ocarina sign) were also evaluated.ResultsPosterior root irregularity and bone marrow spot were frequently observed in the partial MMPRTs (47.8%), compared with the other MM tears (P = 0.007 and 0.023, respectively). The ocarina sign was detected in 69.6% of patients with partial MMPRTs. A significant difference between two groups was observed in a positive ratio of ocarina sign (P < 0.001). Types A, B, and C of the partial tear/damage were observed in three, eight, and seven patients, respectively. The ocarina sign was the most common MRI finding in each type of partial MMPRT.ConclusionsThis study demonstrated that a characteristic MRI finding, “ocarina sign,” was frequently observed in patients with partial tear/damage of the MM posterior root. The ocarina sign was the most common MRI finding in several types of partial MMPRTs. Our results suggest that the ocarina sign may be useful to diagnose unnoticed partial MMPRTs.Level of evidence: IV, retrospective comparative study.

Role of Cardiac Magnetic Resonance Imaging in Assessment of Cardiovascular Abnormalities in Patients with Coronavirus Disease 2019

Background: Long-term effects of coronavirus disease-2019 (COVID-19) causing pulmonary fibrosis are a well-established fact. Whether similar changes persist in myocardium remains a cause of concern. Cardiac magnetic resonance imaging (MRI), although logistically limited during the acute phase of illness, is an excellent modality for evaluating persisting myocardial involvement in patients recovering from COVID-19. No previous study has described cardiac MRI in Indian patients with COVID-19. Materials and Methods: We summarize cardiac MRI findings in 43 patients (29 males) who underwent cardiac MRI at our center for various clinical indications after recovering from their COVID-19 episodes. All cardiac MRI examinations were performed on Siemens Verio 3 Tesla Scanner System with 70 cm bore. Necessary precautions and safety measures were taken as per the Society for Cardiovascular Magnetic Resonance recommendations and standard imaging protocols were followed. Results: Half of all patients (22, 51.2%) had presented after 6 weeks of their initial COVID-19, whereas most of the remaining patients (19, 44.2%) underwent MRI during 3–6 weeks after recovering from COVID-19. Exercise intolerance was the most common clinical presentation observed in 22 (51.2%) patients, followed by fatigue or generalized weakness (15 patients), fast heart rate (12 patients), and breathlessness (12 patients). The most common cardiac MRI finding was elevated T1 and T2 mapping values (14 patients, 32.6%). The other common findings were late gadolinium enhancement in 12 (27.9%) patients, pericardial effusion ± enhancement in 12 (27.9%) patients, and impaired left ventricular systolic function in 9 (20.9%) patients. Eleven (25.6%) patients had normal cardiac MRI. Conclusions: Our findings summarize common cardiac abnormalities detected by cardiac MRI in patients with recent COVID-19. Although these results cannot be postulated to estimate the overall burden of cardiac involvement in COVID-19, they provide valuable insight into clinical spectrum of these patients in Indian scenario.

Interpretation of the Common MRI Findings in Patients with Painful Knee Joint

Nowadays knee joint pain is a major public health issue and for an appropriate treatment option, it is important to have a clear understanding of the cause of pain as well as to identify the exact location of the pain. In the initial evaluation of acute knee pain, radiological findings help physicians in taking decisions regarding appropriate treatment. Besides conventional radiography and computed tomography (CT), Magnetic resonance imaging (MRI) is often used to diagnose the reason for knee problems. This study it is tried to evaluate the common MRI findings in patients with painful knee joints. The sample population comprised 77 outpatients had an age range between 14 to 66 years, representing male 70.13% and Female 29.87%. The study shows that the maximum numbers of patients were in the 26-30 years age group, which exposed that young people are more affected with knee pain. In this study, it is found that joint effusion is the most common pathology frequently found in 59.74% of patients followed by meniscus injury 53.24%, anterior cruciate ligament (ACL) tear 36.06%, Lateral meniscus injury 16.88%, Posterior cruciate ligament (PCL) tear 7.8%, Bone marrow contusion 22.07%, Osteoarthritis12.98%, Medial collateral ligament (MCL) injury 3.89%, Lateral collateral Ligament (LCL) 0%, Fracture 6.49%, Chondromalacia1.3%, Baker cyst 1.3%. Though knee pain can be diagnosed by other imaging modalities, MRI can often provide strong evidence to support one.

Late-Onset Aicardi-Goutières Syndrome: A Characterization of Presenting Clinical Features

BackgroundAicardi-Goutières syndrome (AGS) is a genetic interferonopathy characterized by early onset of severe neurological injury with intracranial calcifications, leukoencephalopathy, and systemic inflammation. Increasingly, a spectrum of neurological dysfunction and presentation beyond the infantile period is being recognized in AGS. The aim of this study was to characterize late-infantile and juvenile-onset AGS. MethodsWe conducted a multi-institution review of individuals with AGS who were older than one year at the time of presentation, including medical history, imaging characteristics, and suspected diagnoses at presentation. ResultsThirty-four individuals were identified, all with pathogenic variants in RNASEH2B, SAMHD1, ADAR1, or IFIH1. Most individuals had a history of developmental delay and/or systemic symptoms, such as sterile pyrexias and chilblains, followed by a prodromal period associated with increasing symptoms. This was followed by an abrupt onset of neurological decline (fulminant phase), with a median onset at 1.33 years (range 1.00 to 17.68 years). Most individuals presented with a change in gross motor skills (97.0%), typically with increased tone (78.8%). Leukodystrophy was the most common magnetic resonance imaging finding (40.0%). Calcifications were less common (12.9%). ConclusionsThis is the first study to characterize the presentation of late-infantile and juvenile onset AGS and its phenotypic spectrum. Late-onset AGS can present insidiously and lacks classical clinical and neuroimaging findings. Signs of early systemic dysfunction before fulminant disease onset and loss of motor symptoms were common. We strongly recommend genetic testing when there is concern for sustained inflammation of unknown origins or changes in motor skills in children older than one year.

Ankle Joint Injuries Accompanying Fifth Metatarsal Base Fractures.

Fifth metatarsal base fractures are the most commonly seen fractures of the foot. Ankle sprains occur with inversion and plantarflexion mechanisms, similar to most fifth metatarsal base fractures. We sought to investigate the possible ankle injuries that accompany fifth metatarsal base fractures. A hospital's digital database was searched for the International Classification of Diseases, Tenth Revision codes for metatarsal bone fractures (codes S92.30 and S92.35) between January 2015 and January 2018. Thirty-nine patients with fifth metatarsal base fracture who underwent ankle magnetic resonance imaging (MRI) within 14 days of injury were included in the study. The MRI findings were evaluated, and comparisons were performed according to fracture zone, sex, and age. The most common MRI finding was talocrural joint effusion, which was observed in 28 patients (71.8%). Bone marrow edema was observed in 16 patients (41.0%). Chondral injury at the medial dome of talus was observed in three patients (7.7%). Grade 1 ligament sprain was observed in six patients (15.4%): two in the lateral ligament and four in the deltoid ligament. Although most fifth metatarsal base fractures and ankle sprains occur as a result of a common mechanism, physical examination findings and patients' complaints are very important. Routine MRI should be unnecessary for most patients. If a patient with a fifth metatarsal base fracture has complaints about the ankle joint, one should be aware of bone marrow edema, which was observed in 41.0% of the study population.

Structural changes in the brain on cranial magnetic resonance imaging in severely malnourished children before and after treatment.

The aim of this study was to examine the structural changes in brain on magnetic resonance imaging (MRI) in severely malnourished children before and after treatment. This was a prospective study conducted at a Severe Malnutrition Treatment Unit (SMTU) at a tertiary care center. The study was carried out with 52 severely malnourished children 0 to 5 y of age admitted to the SMTU. The cases with neurologic diseases such as epilepsy, cerebral palsy, meningitis, tumor, or hydrocephalus; or history of perinatal asphyxia were excluded to enable us to detect central nervous system changes attributable to malnutrition only. MRI brain without contrast was performed on all 52 cases at admission and after 6 mo of treatment and were reported by an experienced radiologist. The common MRI findings in the study included cerebral atrophy, dilated ventricles, periventricular white matter changes, widened cortical sulci, enlarged basal cisterns, and widened interhemispheric fissure. Development assessment using the Denver Developmental Screening Test II was also performed to infer correlation with MRI findings. Of the 52 children who were severely malnourished, 10 (i.e., 19.2%) had abnormal MRI findings. Development assessment revealed that of the 10 abnormal MRI cases, 80% had delayed developmental milestones as well. These changes are reversible in most cases after nutritional rehabilitation. The present study revealed that malnutrition per se has a significant effect on the structure of the developing brain and also affects neurologic development. These changes are reversible after treatment so early stimulation and nutritional rehabilitation can help to prevent permanent neurologic derangements.

A Study of the Clinical Profile, Radiologic Features, and Therapeutic Outcomes in Neurosarcoidosis from Two Tertiary Care Centers in Southern India.

Sarcoidosis is an inflammatory granulomatous disease affecting multiple organ systems. Neurological manifestations are rare and seen in approximately 5% cases of sarcoidosis. They may commonly precede the diagnosis of sarcoidosis. Since there is paucity of Indian literature on this subject, we decided to review the clinical and radiological profile, laboratory abnormalities, treatment and long-term outcomes in our patients with neurosarcoidosis (NS). The study was done by retrospective review of medical records for all cases diagnosed as NS during the period Jan 2014-Jan 2018. These cases were classified as definite, probable, and possible NS, on the basis of established diagnostic parameters (Zajicek criteria). The follow-up record in these cases ranged from 6 months to 3 years, with special emphasis on monitoring the response to treatment and long-term disability. The cases showed varied clinical abnormalities and imaging findings. Cranial neuropathies and myelopathy were the most common clinical presentations. Optic neuritis was most common cranial neuropathy, followed by facial nerve palsy and lower cranial nerve palsies. Most common magnetic resonance imaging findings were T2 hyperintense parenchymal lesions and meningeal enhancement. There was strong correlation between baseline clinico radiological parameters and long-term outcomes, as evidenced by relatively poor prognosis seen in cases with bilateral optic neuritis, myelopathy and imaging evidence of hydrocephalus, or leptomeningitis. The diagnosis of NS requires a high degree of suspicion, coupled with exclusion of alternate diagnosis. It commonly precedes the onset of systemic sarcoidosis. Central nervous system involvement in sarcoidosis is associated with poor clinical outcomes.

Magnetic resonance imaging of the elbow.

Elbow pain can cause disability, especially in athletes, and is a common clinical complaint for both the general practitioner and the orthopaedic surgeon. Magnetic resonance imaging (MRI) is an excellent tool for the evaluation of joint pathology due to its high sensitivity as a result of high contrast resolution for soft tissues. This article aims to describe the normal imaging anatomy and biomechanics of the elbow, the most commonly used MRI protocols and techniques, and common MRI findings related to tendinopathy, ligamentous and osteochondral injuries, and instability of the elbow.

Brain MRI in Epstein-Barr Virus Meningoencephalitis in Children.

Background and Purpose:Epstein–Barr virus (EBV) meningoencephalitis can have variable and nonspecific brain magnetic resonance imaging (MRI) findings in children. This study was done with the purpose of describing brain MRI findings in children with EBV meningoencephalitis.Materials and Methods:The study included 45 pediatric patients that presented with variable neurological symptoms and were found to have EBV meningoencephalitis based on positive EBV deoxyribonucleic acid (DNA) in the cerebrospinal fluid. All these patients had undergone brain MRI. Clinical and radiological features were evaluated.Results:Fever was a presenting feature in all cases. Signs of meningitis and raised intracranial pressure (ICP) were seen in 24 (53.3%) cases, encephalopathy in 15 (33.3%), and seizures were present in 33 (73.3%). MRI was abnormal in 29 (64.4%) patients. The cortical/subcortical pattern was diagnosed in 9 (20%) cases, white matter involvement in 7 (15.5%), basal ganglia in 5 (11.1%), thalamic involvement in 4 (8.8%), brain stem involvement in 2 (6.2%), substantia nigra involvement in 2 (4.4%), and cerebellar involvement in 2 (4.4%). Diffusion restriction was present in 11 (24.4%) cases and susceptibility changes in 7 (15.5%). Meningeal enhancement was present in 10 (22.2%) cases. In addition, brain abscess and subdural effusion/empyema were present in 1 (2.2%) case each.Conclusion:Pediatric EBV meningoencephalitis has varied clinicoradiological spectrum and there is no specific MRI pattern to characterize the meningoencephalitis on imaging. Common MRI findings include cortical-subcortical involvement, white matter changes, basal ganglia, and thalamic involvement.

MRI of Acute Gynecologic Conditions.

Although usually not a first-line imaging modality in the setting of acute pelvic pain, magnetic resonance imaging (MRI) is able to depict and characterize a wide range gynecologic diagnoses with high accuracy. Lack of ionizing radiation renders MRI particularly useful for assessment of pregnant women and children. Furthermore, inherent high soft-tissue resolution of MRI allows accurate diagnosis without intravenous contrast use, which is advantageous for patients with renal insufficiency and pregnant patients. Familiarity with the typical MRI appearance of various acute gynecologic conditions helps establish the correct diagnosis. This article reviews the common MRI findings of acute gynecologic processes, in both pregnant and nonpregnant patients. Level of Evidence: 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1291-1309.

Imaging findings of penetrating spinal cord injuries secondary to stab wounds on magnetic resonance imaging in a tertiary trauma unit, South Africa.

BackgroundIn South Africa, the leading cause of spinal cord injuries is motor vehicle accidents, followed by violence-related injuries, including gunshot injuries and stab wounds. Controversy regarding management persists. Magnetic resonance imaging (MRI) is the gold standard to rule out surgical causes of neurological deficit.ObjectivesTo determine the spectrum of imaging findings in penetrating spinal cord injuries, specifically related to stab wounds, in a Tertiary Academic Hospital in the Free State province and whether these imaging findings influenced immediate surgical decision-making and outcomes of patients.MethodConsecutive sampling was used to retrospectively select patients who presented with spinal penetrating injuries secondary to stab wounds during the period 01 August 2013–30 September 2016 and received MRI investigation. Fifty-six patients were included. Magnetic resonance imaging investigations were reviewed by the authors, with documentation of MRI findings, relevant patient demographics and clinical information into Excel spread sheets. Statistical analysis was performed by the Biostatistics Department of the University of the Free State.ResultsThe most common MRI finding was a high signal intensity wound tract (96.6%), followed by cord signal changes (91.1%) and cord oedema (82.1%). Thirty-nine extra-axial collections were diagnosed in 30 penetrating injuries, of which only one had spinal compressive effects. Four patients (7.1%) demonstrated pseudo-meningoceles. None of the included patients had an indication for emergency spinal surgery on review of imaging.ConclusionMagnetic resonance imaging findings did not alter the surgical course of action in our study patients. Despite this, MRI is a valuable modality in evaluation of penetrating spinal cord injuries in the post-traumatic phase (<24 h) for the presence of pseudo-meningoceles that pose an infection and delayed complication risk.

Diagnostic contribution of focal cortical dysplasia MRI imaging findings and ADC values

BackgroundFocal cortical dysplasia (FCD) is a condition that often interferes with the cranial mass. Knowledge of focal cortical dysplasia magnetic resonance imaging (MRI) characteristics is of utmost importance for diagnosis. This study aimed to determine the diagnostic contribution of cranial MRI and the apparent diffusion coefficient (ADC) in FCD.ResultsCranial MRI revealed subcortical hyperintensity (SCH) in 52 patients (82.5%), blurring of the gray-white matter (GWM) interface (blurring) in 52 patients (82.5%), cortical thickening (CT) in 48 patients (76%), cortical signal increase (CSI) in 41 patients (65%), and transmantle sign (TMS) in 29 patients (46%). All of the FCDs had a diffusion increase in diffusion-weighted images (DWIs). The mean ADC value at the lesion level was 1.087 × 10−3 mm2/s (0.82/1.316 × 10−3 mm2/s), which was significantly higher than the mean ADC value measured from the contralateral symmetric region (0.758 × 10−3 mm2/s, 0.678/0.872 × 10−3 mm2/s, p = 0.001).ConclusionResults of this study revealed that the most common MRI findings in FCD patients are SCH, blurring, and CT. These findings aid in an easier diagnosis in patients with suspected FCD. All of the lesions studied here in had a diffusion increase in DWI. The quantitative mean ADC values detected in the differential diagnosis of other lesions with a diffusion increase can be used as a reference. Therefore, in addition to the ADC values and electroencephalography (EEG) findings, the conventional MRI findings of FCD, which is resistant to medical treatment, can help to facilitate the diagnosis of FCD, which can be treated with surgery.

Clinical characteristics and magnetic resonance imaging findings in nine patients with nonalcoholic Wernicke's encephalopathy: a retrospective study.

PurposeWernicke’s encephalopathy (WE) is a severe neurological disorder caused by thiamine deficiency. The most common cause of WE is alcoholism. However, there is a significant paucity of information in the existing literature relating to nonalcoholic WE. In this study, we investigated the clinical characteristics and neuroimaging findings of nine patients with nonalcoholic WE.Patients and methodsWe retrospectively collated clinical data from nine patients who had been diagnosed with WE in accordance with established criteria including age, gender, risk factors and clinical manifestations. We also collated initial hematological and neuroimaging findings.ResultsThe mean age of the nine patients was 54.0±17.1 years; four of these patients (44.4%) were male. All nine patients had a history of fasting (range, 5–47 days) prior to WE. Four of the nine patients (44.4%) exhibited the classical triad, and eight (88.9%) showed alterations in mental status. Magnetic resonance imaging (MRI) scans showed that all nine patients had symmetric lesions of the medial thalamus. MRI also revealed other WE-related lesions in mammillary bodies (22.2%), the periaqueductal region (55.6%), the tectal plate of the midbrain (77.8%), cranial nerve nuclei (77.8%) and in the symmetric subcortical white matter (11.1%).ConclusionOur analysis showed that fasting is a common cause of WE in nonalcoholic patients and that MRI is a useful tool for the diagnosis of WE. The most common MRI findings were symmetrical lesions of the medial thalamus lesions, followed by the tectal plate of the midbrain and cranial nerve nuclei.

P2‐410: A RISK FACTOR PROFILE OF INCREASED WHITE MATTER HYPERINTENSITY BURDEN IN THE ABERDEEN CHILDREN OF THE NINETEEN FIFTIES COHORT

The Aberdeen Children of the Nineteen Fifties (ACONF) is a well-characterised cohort of healthy, community-dwelling individuals, born in Aberdeen, Scotland (UK) between 1950 and 1956. This rich source of data allows us to investigate early- and mid-life risk factors for poor health in later life. Recently, subgroup of this cohort underwent brain magnetic resonance imaging (MRI), as well as health and neuropsychological assessments. Here, we aimed to utilise these life-course data to identify risk-factors for increased brain white matter hyperintensity (WMH) burden: a common MRI finding in older adults, associated with cognitive decline, dementia, stroke and death. We calculated the relative risk (RR) of certain factors on increased global WMH burden in 277 cognitively healthy ACONF participants (mean age = 62.3). Global WMH burden was measured as total WMH volume (ml) using an automated WMH segmentation algorithm. We investigated potential risk factors within the domains of demographics, early-life, medical history, socioeconomic circumstance, late-life objective health, and late-life cognition. We identified elevated risk factors for increased global WMH burden among each domain mentioned above. The most significant risk factors for increased WMH burden in this cohort included medical histories of stroke (RR = 2.642, 95% CI = 1.59 – 4.39), heart disease (RR = 1.864, 95% CI = 1.098 – 3.165), diabetes (RR = 1.903, 95% CI = 1.194 – 3.032), and high cholesterol (RR = 1.566, 95% CI = 1.077 – 2.277). Notable early- and mid-life risk factors approaching significance included birth weight of less than 5.5lbs (RR = 1.697, 95% CI = .913 – 3.153) and working in lower-income occupations (RR = 1.049, 95% CI = .715 – 1.538). We were able to confirm age and cardiometabolic risk factors for increased WMH burden in a relatively young cohort of older adults, and add contributions of emerging early and mid-life risk factors. Many of these cardiometabolic risk factors have their origins in early life and are greatest in those with the least resilience. Future work will involve developing a robust model of risk- and protective determinants of WMH burden.

Pattern of Lumbar MRI Changes in Patients with Chronic Low Back Pain in a Tertiary Care Center

Introduction: Chronic low back pain (LBP) is a common cause of disability worldwide. Magnetic resonance imaging (MRI) is an excellent non-invasive imaging modality for morphologic evaluation of the lumbar spine in patients with chronic low back pain because of its high contrast resolution and lack of ionizing radiation. This study was done to see the patterns of MRI changes in patients with chronic low back pain in a tertiary care center in Western Nepal. Methods: This was a cross-sectional study conducted on patients presenting with chronic low back pain. Eleven MRI parameters were noted and analyzed. Chi square test and Fisher’s Exact test were employed to see the associations between the various MRI findings. Results: A total of 108 patients were evaluated during the study period. MRI changes were noted in over 95% of the cases. Degenerative changes were the most common cause of low back pain, disc bulge being the most common MRI finding. A significant association was found between radiculopathy and decreased lumbar lordosis and vertebral endplate changes. Conclusion: MRI is an invaluable tool in the evaluation of chronic LBP because of its high resolution and lack of ionizing radiation. Significant MRI findings are noted in most of the cases of chronic LBP, degenerative changes being the most common and ranging from congenital to malignant lesions.

Rhabdomyolysis revisited

The objective is to evaluate the magnetic resonance imaging (MRI) findings in rhabdomyolysis in detail and determine their correlation with the development of peripheral neuropathy.Magnetic resonance images for 23 patients with confirmed rhabdomyolysis with (n = 11) or without (n = 12) peripheral neuropathy were retrospectively reviewed for the signal intensity on T1- and T2-weighted images, intramuscular hemorrhage, enhancement pattern, shape and margin in the longitudinal plane, edema in the deep fascia and overlying subcutaneous layer, multiplicity, and bilateral limb involvement. The collected data were statistically analyzed and the relationship between the imaging findings and the development of peripheral neuropathy was determined.Abnormal signal intensities on T1- or T2-weighted images were observed for all patients except one. Fourteen patients (60.9%) showed intramuscular hemorrhage. Stippled enhancement (11/23; 47.8%) was the most common enhancement pattern. Nineteen patients (86.4%) showed a well-defined rectangular shape with a ragged margin in the longitudinal plane. The affected muscle volume usually increased (17/23; 73.9%), with edema in the deep fascia and the overlying subcutaneous layer (13/23; 56.5%). Multiplicity within a muscle, compartment, and limb was observed in 7 (31.8%), 18 (81.8%), and 16 (72.7%) patients, respectively. Bilateral involvement was observed in 7 patients (30.4%). Only multiplicity within a compartment showed a statistically significant correlation with peripheral neuropathy development.Common MRI findings in rhabdomyolysis include intramuscular hemorrhage, stippled enhancement, a well-defined rectangular shape with a ragged margin in the longitudinal plane, and multiplicity. Multiplicity within a compartment may be a predictor of the development of peripheral neuropathy.

MR imaging of endolymphatic hydrops in Ménière's disease: not all that glitters is gold.

SUMMARYMénière’s disease (MD) is a chronic condition characterised by fluctuating hearing loss, intermittent vertigo, tinnitus and aural fullness. Its anatomical and pathological counterpart is represented by endolymphatic hydrops (EH). Recent development and progress in magnetic resonance (MR) imaging techniques has enabled visualisation of EH in living human subjects using a 3 Tesla (T) scanner and gadolinium-based contrast-agent (GBCA) via intravenous (IV) or intra-tympanic (IT) administration. Data emerging from the literature about MR imaging of EH in MD patients are limited, and we therefore reviewed the most common MR imaging findings in the study of the endolymphatic space in both MD and non-MD patients.