Coronal T1 Research Articles

Symptoms: Sudden Hearing Loss and Aural Fullness

Symptoms: Sudden Hearing Loss and Aural Fullness

ROLE OF MAGNETIC RESONANCE IMAGING IN EVALUATION OF PAINFUL HIP JOINT

This study aims to evaluate the diagnostic value of MRI in the assessment of painful hip joint. Background: Radiographic evaluation is an initial and crucial role in patients with painful hip joint. Hip pain has different aetiologies in adults and children. MRI is the investigation choice for characterizing the various disorders and assessing the full extent of bone, cartilage and soft tissue abnormality of the hip joint. Methods: This prospective study included 50 patients with painful hip joint. The following MR sequences were performed to all patients: Coronal T1, T2 & STIR WIs, axial T1&T2WIs, and sagittal T1WI. Patient's history, local examination of the diseased hip and laboratory investigations were performed. Results: Male patients ages ranged from 1 to 60 years with a mean age of 35 years. Conclusion: MRI of the hip joint is informative, diagnostic, and accurate for the assessment of hip pain and sufficient imaging modality for delineation of different hip joint pathology.

Dysphagia and Tongue Deviation: An Unexpected Cause.

Dysphagia and Tongue Deviation: An Unexpected Cause.

The influence of bone marrow edema for the assessment of the boundaries of necrotic lesions in patients with osteonecrosis of the femoral head

This study aimed to investigate the influence of bone marrow edema (BME) for the assessment of the boundaries of necrotic lesions using unenhanced and contrast-enhanced (CE) magnetic resonance (MR) images in patients with osteonecrosis of the femoral head (ONFH). We retrospectively reviewed 72 consecutive hips in 55 patients of ONFH that were Association Research Circulation Osseous (ARCO) stage III or higher and underwent both unenhanced and contrast-enhanced MR imaging between January 2005 and February 2016. The degree of extension of BMEs, and the boundaries of the necrotic lesions were compared using unenhanced and CE MR images on both mid coronal and mid oblique-axial slices. Forty-two percent of the coronal T1 images, 40% of the coronal fat-saturated T2 images, and 48% of the oblique-axial T1 images showed differences in the boundaries of necrotic lesion, by comparison with those of CET1-weighted MR images. The boundaries of necrotic lesions were clearly detected in all hips on CE coronal slices and 97% of all hips on CE oblique-axial slices. The BME grade in the difference group was significantly higher than in the non-difference group on the coronal plane (P = 0.0058). There were significant differences between the BME grade and duration from the onset of hip pain to MR imaging examination. Multivariate analyses revealed that the duration from the onset to MR imaging examination in both coronal (P = 0.0008) and oblique-axial slices (P = 0.0143) were independently associated with differences in the boundary of necrotic lesion between T1 and CET1-weighted MR images. Our findings suggest that unenhanced MR image may be insufficient for a precise assessment of the boundaries of the necrotic lesions for ONFH cases in the early phase of subchondral collapse due to the diffuse BME.

Reduced Sulcal Depth in Central Sulcus of Major Depressive Disorder.

Major depressive disorder (MDD) is one of the most common psychiatric disorders, and present various symptoms such as the dysregulation of mood, cognition, and behavior. The purpose of the present study was to investigate the morphometric change in MDD patients by voxel-based morphometry (VBM) and sulcal depth analyses. Forty-six MDD patients (mean age, SD; 36.07±14.34), and 23 age- and sex-matched normal controls (NML) (mean age, SD; 36.78±14.42) were included. Coronal 3D T1 magnetic resonance imaging (MRI) was obtained with the resolution of isotropic 1.0 mm. To check morphological changes of brain, T1 MRIs were objectively processed by VBM and sulcal depth methods. In sulcal depth analysis, depressed patients showed reduced sulcal depth in the areas of left posterior ramus of the lateral sulcus, superior frontal sulcus, supramarginal gyrus, central sulcus (Rolando's fissure), and Heschl's gyrus. And right posterior ramus of the lateral sulcus, temporal plane of the superior temporal gyrus, anterior transverse collateral sulcus, and central sulcus (Rolando's fissure) were also reduced compared to NML. But, VBM analyses did not showed significant finding. Reduced sulcal depth in the motor and emotion related areas were found in patients with MDD. Especially reduced sulcal depth in bilateral central sulci which are connecting between primary motor cortex and primary sensory cortex seems to be related with social and physical anhedonia in MDD.

Symptom: Runny Nose Six Years After Acoustic Neuroma Surgery

Symptom: Runny Nose Six Years After Acoustic Neuroma Surgery

S2429 A Rare Case of Esophageal Adenocarcinoma Presenting as an Isolated Brain Lesion 6 Years After Treatment

Introduction: Esophageal adenocarcinomas account for ∼1% of all cancers in the U.S. The prevalence of central nervous system (CNS) metastases associated with these cancers is around 1.8%. Response rates to standard of care are poor and prognosis is dismal. Often CNS involvement is associated with widely metastatic disease, herein, we present a case of a solitary brain lesion from esophageal adenocarcinoma at first recurrence. Case Description/Methods: A 72-year-old-male with a 40 pack-year smoking presented with progressive dysphagia in March 2015. Contrast enhanced CT of the chest, abdomen and pelvis revealed a constricting mass at the esophagogastric junction that led to endoscopy guided biopsy revealing esophageal adenocarcinoma. He underwent neoadjuvant chemotherapy (cisplatin/5-fluorouracil) and radiation therapy followed by esophagogastrectomy in July of 2015 where diagnosis of stage IIIBT3N2cM0 esophageal adenocarcinoma was confirmed. Clinical and imaging surveillance for 6 years had not shown any progression of cancer. However, in June of 2021, he presented with altered mental status that led to contrast enhanced brain MRI showing a T2 hyperintense left parietal lobe mass with an 8 mm midline shift and surrounding vasogenic edema (Figure). FDG PET-CT head to toes did not show extracranial recurrence. He underwent left posterior temporal craniotomy for resection of tumor confirming the diagnosis of metastatic esophageal adenocarcinoma. IHC showed positivity of cytokeratin7, CDX2 and SATB2. Whole exome sequencing revealed mutations in ARID1A, FH, and TP53 with variants of unknown significance of ATM and CDH. Tumor displayed proficient mismatch repair protein, a combined positive score of 15 for PD-L1, and negative Her2/Neu. Further sequencing showed tumor mutational burden of 4, no genomic loss of heterozygosity, and stable microsatellite repeats. He received gamma-knife radiation to the solitary left temporal lobe lesion. Patient continues to maintain his quality of life with no evidence of clinical and radiographic recurrence. Discussion: Isolated brain metastasis from esophageal adenocarcinoma is a very rare phenomenon. Limited data suggests that the survival of patients with isolated CNS lesions is < 1 year, however, achieving pathologic complete response after neoadjuvant chemo-radiation therapy has shown to improve survival. These esophageal cancers with isolated CNS metastases may share a unique genomic profile and more research is required to understand their alterations.Figure 1.: MRI of the brain. 1A- Pre-op axial OLEA of L. temporal lobe tumor (06/2021), 1B- Pre-op axial coronal T1 (06/2021), 1C- Follow-up T2 MRI.

Utility of selected sequence MRI imaging of the axial skeleton in the diagnosis of axial spondyloarthritis

BackgroundWhole body MRI has been used to evaluate inflammatory lesions associated with axial spondyloarthritis (SpA). These sequences are extensive, time consuming and add to the cost of the investigation. We aimed to determine the utility of selected sequence MRI imaging of the axial skeleton including spine, pelvis and sacroiliac (SI) joints to identify features of (SpA). MethodsA retrospective study was conducted on 76 patients diagnosed with SpA that underwent a selective sequence MRI imaging of the axial skeleton. The MRI were reported by two musculoskeletal trained radiologists were reviewed. The MRI sequences included whole spine sequences of sagittal STIR (short tau inversion recovery), T1 weighted and T2 weighted sequences. Coronal STIR and T1 weighted images were studied for SI joints and pelvis. The MRI were assessed based on the guidelines outlined by the Assessment of SpondyloArthritis International Society (ASAS) for features of spondylitis, spondylodiscitis, enthesitis, synovitis, capsulitis, bone marrow edema, fatty marrow replacement, erosions and bony ankylosis. Inflammatory lesions were documented in the spine, sacroiliac, facet, hip and costovertebral joints. ResultsThe mean scan duration was 28 min. SI joint involvement was noted in 74 (97.3%) of patients. The other most prevalent findings were spondylitis in 44 (57.8%) patients, costovertebral joint involvement in 31 (40.7%), facet joint lesions in 32 (42.1%), spondylodiscitis in 21 (27.6%), enthesitis in 13 (17.1%), hip lesions in 16 (21%) and ankylosis in 10 (13.1%). ConclusionsThis selective sequence imaging of the pelvis and spine was able to identify typical lesions of SpA in a shorter time period. Fifty-five percent patients had lesions in the posterior elements including facet joints and costovertbral joints that would be missed on traditional SI joint imaging.

Whole-body MRI in oncology: can a single anatomic T2 Dixon sequence replace the combination of T1 and STIR sequences to detect skeletal metastasis and myeloma?

ObjectivesTo compare the diagnostic accuracy of a single T2 Dixon sequence to the combination T1+STIR as anatomical sequences used for detecting tumoral bone marrow lesions in whole-body MRI (WB-MRI) examinations.MethodsBetween January 2019 and January 2020, seventy-two consecutive patients (55 men, 17 women, median age = 66 years) with solid (prostate, breast, neuroendocrine) cancers at high risk of metastasis or proven multiple myeloma (MM) prospectively underwent a WB-MRI examination including coronal T1, STIR, T2 Dixon and axial diffusion-weighted imaging sequences. Two radiologists independently assessed the combination of T1+STIR sequences and the fat+water reconstructions from the T2 Dixon sequence. The reference standard was established by consensus reading of WB-MRI and concurrent imaging available at baseline and at 6 months. Repeatability and reproducibility of MRI scores (presence and semi-quantitative count of lesions), image quality (SNR: signal-to-noise, CNR: contrast-to-noise, CRR: contrast-to-reference ratios), and diagnostic characteristics (Se: sensitivity, Sp: specificity, Acc: accuracy) were assessed per-skeletal region and per-patient.ResultsRepeatability and reproducibility were at least good regardless of the score, region, and protocol (0.67 ≤ AC1 ≤ 0.98). CRR was higher on T2 Dixon fat compared to T1 (p < 0.0001) and on T2 Dixon water compared to STIR (p = 0.0128). In the per-patient analysis, Acc of the T2 Dixon fat+water was higher than that of T1+STIR for the senior reader (Acc = +0.027 [+0.025; +0.029], p < 0.0001) and lower for the junior reader (Acc = −0.029 [−0.031; −0.027], p < 0.0001).ConclusionsA single T2 Dixon sequence with fat+water reconstructions offers similar reproducibility and diagnostic accuracy as the recommended combination of T1+STIR sequences and can be used for skeletal screening in oncology, allowing significant time-saving.Key Points• Replacement of the standard anatomic T1 + STIR WB-MRI protocol by a single T2 Dixon sequence drastically shortens the examination time without loss of diagnostic accuracy.• A protocol based on fat + water reconstructions from a single T2 Dixon sequence offers similar inter-reader agreement and a higher contrast-to-reference ratio for detecting lesions compared to the standard T1 + STIR protocol.• Differences in the accuracy between the two protocols are marginal (+ 3% in favor of the T2 Dixon with the senior reader; −3% against the T2 Dixon with the junior reader).

Evidence of neural crest cell origin of a DICER1 mutant CNS sarcoma in a child with DICER1 syndrome and NRAS-mutant neurocutaneous melanosis.

Evidence of neural crest cell origin of a DICER1 mutant CNS sarcoma in a child with DICER1 syndrome and NRAS-mutant neurocutaneous melanosis.

Whole-body magnetic resonance imaging findings and patterns of chronic nonbacterial osteomyelitis in a series of Greek pediatric patients.

Background:Chronic nonbacterial osteomyelitis (CNO) is a pediatric autoinflammatory disorder presenting with sterile inflammatory bone lesions. Whole-body MRI (WBMRI) has most recently emerged for disease assessment, but data are limited.Purpose:The purpose is to evaluate the imaging findings and patterns of CNO on WBMRI in a series of Greek pediatric patients.Material and Methods:Whole-body magnetic resonance imaging studies of all children with documented CNO, performed in a single tertiary center, were retrospectively reviewed. WBMRI included coronal T1 and short-tau inversion recovery (STIR), whole spine sagittal STIR, and ankle/foot sagittal STIR images. High signal intensity lesions on STIR images corresponding to bone marrow edema were recorded. The SPSS v.20 statistical package was used for descriptive statistics.Results:Twenty children were included (mean age: 12, range: 6–16 years) with 1–31 lesions (mean: 11.8) on WBMRI. Two children had unifocal disease localized at the clavicle, three paucifocal (1–4 lesions), and 15 multifocal bone involvement. All but two children presented with ankle pain and exhibited lesions at the bones of the ankle joint (90%) followed by the knee (50%) and pelvis (10%). The tibia was the most frequently affected bone (70%) followed by calcaneus (60%), fibula (50%), femur (45%), talus, and metatarsals (45%). No lesions in the cervical, thoracic, lumbar spine, and mandible were documented. Only small sacral lesions were seen in 25% of patients with the extensive peripheral disease. Bilateral metaphyseal and epiphyseal involvement with transphyseal extension were common, but the periosteal reaction and well-defined lesion margins were rare.Conclusion:Frequent involvement of the foot and ankle and paucity of substantial spinal involvement were seen in Greek pediatric patients with CNO.

Visual rating of cortical atrophy in migraine and tension-type headache

Background: Studies of cortical atrophy in migraine and tension-type headache (TTH) have reported inconsistent results. Some studies have reported decreased cortical thickness or volume, while others have reported thickening in the somatosensory and visual cortices in migraine patients. The same controversy is true with respect to episodic and chronic headaches. This study evaluated and compared cortical atrophy in migraine and TTH as well as in episodic and chronic headache. Methods: The study included 43 (37 female) migraine and 15 (12 female) TTH patients. Demographic, clinical, and brain magnetic resonance imaging (MRI) data were evaluated. 1.5 Tesla MRI brain coronal T2 sequences were reviewed by two neurologists, and atrophy was graded according to a visual rating scale (VRS). Two neurologists jointly evaluated and scored cortical thickness on a Likert scale of 0 to 3 or 4 at the following sites bilaterally: olfactory sulcus, anterior cingulate sulcus, circular insular sulcus, anterior temporal and medial temporal lobes, and posterior cingulate and parieto-occipital sulci. The scores at all sites were then summed into a total atrophy score (TAS) for each subject. Results: There was no significant difference between the migraine and TTH groups regarding demographics, clinical findings, and atrophy scores in any particular region or with respect to the TAS. When we divided our study subjects into episodic and chronic headache groups, there was no significant difference between these groups in terms of demographic and clinical findings or individual and total atrophy scores. Conclusions: These results are in line with previous studies that have reported no differences between migraine and TTH in terms of cortical atrophy.

Symptoms: Unilateral Hearing Loss and Facial Paresis

Symptoms: Unilateral Hearing Loss and Facial Paresis

Vascular Lesions and Brain Atrophy in Alzheimer's, Vascular and Mixed Dementia: An Optimized 3T MRI Protocol Reveals Distinctive Radiological Profiles.

Vascular lesions may be a common finding also in Alzheimer's dementia, but their role on cognitive status is uncertain. The study aims to investigate their distribution in patients with Alzheimer's, vascular or mixed dementia and detect any distinctive neuroradiological profiles. Seventy-six subjects received a diagnosis of Alzheimer's (AD=32), vascular (VD=26) and mixed (MD=18) dementia. Three independent raters assessed the brain images acquired with an optimized 3T MRI protocol (including (3D FLAIR, T1, SWI, and 2D coronal T2 sequences) using semiquantitative scales for vascular lesions (periventricular lesions (PVL), deep white matter lesions (DWML), deep grey matter lesions (DGML), enlarged perivascular spaces (PVS), and microbleeds (MB)) and brain atrophy (medial temporal atrophy (MTA), posterior atrophy (PA), global cortical atrophy- frontal (GCA-F) and Evans' index). Raters reached a good-to-excellent agreement for all scales (ICC ranging from 0.78-0.96). A greater number of PVL (p<0.001), DWML (p<0.001), DGML (p=0.010), and PVS (p=0.001) was observed in VD compared to AD, while MD showed a significant greater number of PVL (p=0.001), DWML (p=0.002), DGML (p=0.018), and deep and juxtacortical MB (p=0.006 and p<0.001, respectively). Comparing VD and MD, VD showed a higher number of PVS in basal ganglia and centrum semiovale (p=0.040), while MD showed more deep and juxtacortical MB (p=0.042 and p=0.022, respectively). No significant difference was observed in scores of cortical atrophy scales and Evans' index among the three groups. The proposed MRI protocol represents a useful advancement in the diagnostic assessment of patients with cognitive impairment by more accurately detecting vascular lesions, mainly microbleeds, without a significant increase in time and resource expenditure. Our findings confirm that white and grey matter lesions predominate in vascular and mixed dementia, whereas deep and juxtacortical microbleeds predominate in mixed dementia, suggesting that cerebral amyloid angiopathy could be the main underlying pathology.

Cerebral Gnathostomiasis: An Unusual Course of Recurrent Hemorrhagic Stroke.

Cerebral Gnathostomiasis: An Unusual Course of Recurrent Hemorrhagic Stroke.

Symptoms: Sudden Hearing Loss and Vertigo

Symptoms: Sudden Hearing Loss and Vertigo

Multivariable Diagnostic Prediction Model to Detect Hormone Secretion Profile From T2W MRI Radiomics with Artificial Neural Networks in Pituitary Adenomas.

Objective:This study aims to develop neural networks to detect hormone secretion profiles in the pituitary adenomas based on T2 weighted magnetic resonance imaging (MRI) radiomics.Methods:This retrospective model-development study included a cohort of patients with pituitary adenomas (n=130) from January 2015 to January 2020 in one tertiary center. The mean age was 46.49±13.69 years, and 76/130 (58.46%) were women. Three observers segmented lesions on coronal T2 weighted MRI, and an interrater agreement was evaluated using the Dice coefficient. Predictors were determined as radiomics features (n=851). Feature selection was based on intraclass correlation coefficient, coefficient variance, variance inflation factor, and LASSO regression analysis. Outcomes were identified as 7 hormone secretion profiles [nonfunctioning pituitary adenoma, growth hormone-secreting adenomas, prolactinomas, adrenocorticotropic hormone-secreting adenomas, pluri-hormonal secreting adenomas (PHA), follicle-stimulating hormone and luteinizing hormone-secreting adenomas, and thyroid-stimulating hormone adenomas]. A multivariable diagnostic prediction model was developed with artificial neural networks (ANN) for 7 outcomes. ANN performance was presented as an area under the receiver operating characteristic curve (AUC) and accepted as successful if the AUC was >0.85 and p-value was <0.01.Results:The performance of the ANN distinguishing prolactinomas from other adenomas was validated (AUC=0.95, p<0.001, sensitivity: 91%, and specificity: 98%). The model distinguishing PHA had the lowest AUC (AUC=0.74 and p<0.001). The AUC values for the other five ANN were >0.85 and p values were <0.001.Conclusions:This study was successful in training neural networks that could differentiate the hormone secretion profile of pituitary adenomas.

Assessment of the normal pediatric pineal gland - MR findings of a single centre; A retrospective study.

To analyse the size and morphology of the normal pineal gland in the paediatric age group using magnetic resonance imaging. The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of patients aged <18 years who had magnetic resonance imaging done between 2007 and 2017. Pineal size was estimated measuring its largest anteroposterior and supero-inferior diameters on sagittal T2-weighted sequences on any slice with maximal diameter. The width of pineal gland was measured on axial or coronal T2 sequences. The volume, morphology and enhancement patterns of the gland were also assessed. Data was analysed using SPSS 21. Of the 200 patients, 116(58%) were males and 84(42%) were females. The overall mean age was 7.8±5.5 years. The mean anteroposterior dimension was 4.85±1.46mm, height 3.31±0.95mm, width 4.16±1.19, and volume 39.54±38.12 mm3. Mean size of cyst was 2.77±1.4mm (range: 1.2-7.5mm). No significant differences in the pattern of enhancement were found in different age groups (p>0.05). Comprehensive knowledge of the size of the typical pineal organ is useful for radiologists in the identification of pineal gland anomalies and the exclusion of neoplastic lesions.

Role of adding coronal short T1 inversion recovery (STIR) sequence to MRI for evaluation of low back pain

Role of adding coronal short T1 inversion recovery (STIR) sequence to MRI for evaluation of low back pain

Role of MRCP to determine the etiological spectrum, level and degree of biliary obstruction in obstructive jaundice.

Obstructive jaundice as a result of hepatocellular disease many a times is indistinguishable from jaundice due to extrahepatic biliary obstruction based on just clinical and biochemical examinations. It is one of the most frequent and grave form of hepatobiliary disease which may lead to complications like ascending cholangitis, malabsorption and hepatorenal syndrome, thus demanding urgent surgical intervention. Thus not only early diagnosis but also accurate identification of level and cause of obstruction is crucial in managing these patients. The aim of this study is to evaluate the role of MRCP in the determination of the etiological spectrum, to evaluate level and degree of biliary obstruction in cases of obstructive jaundice, and to correlate MRCP findings with surgical/histopathology/ERCP findings where possible. It is an observational study done after the Institutional Ethics Committee (I.E.C.)- 2 approval. (IEC no: IEC/HMPCMCE/122/Faculty/8/186/20) Outdoor and indoor patients referred to radiodiagnosis department of Shree Krishna Hospital, Karamsad, for MRCP with clinical and laboratory parameters suggesting obstructive jaundice were included in the study. Patients less than 10 years of age, those with contraindications to MRI and patients with clinico-laboratory evidence of perihepatic/hepatic jaundice were excluded. A total of 50 patients were included after taking an informed consent from each patient. Demographic data, clinical details were recorded and collated along with MRI findings. Descriptive statistics was used to explore MRI findings and findings were correlated with surgical/histopathology/ERCP findings whichever applicable. The MRI scan was performed with 5 mm thick axial T1W, T2W and STIR, 5 mm thick coronal T1W, T2W and STIR TRUFIS, Thin coronal T2 FS, Thick coronal T2 FS, T2W coronal respiratory trigger sequences, 3-5 mm thick T2 weighted Haste and 3D sequence. Analysis was performed using STATA (14.2). Descriptive statistics was used of study population. Sensitivity and specificity value was used to compare the modality and individually calculated for various causative factors of jaundice. Of the 50 patients, 9 had CBD stones, it is observed that MRCP has sensitivity and specificity of 100% and 100%, respectively, in detecting Bile duct stones, whereas sensitivity and specificity of ERCP was 87.5% each. About 11 patients had CBD strictures, which were seen as narrowing of CBD with upstream dilatation. It was observed in our study that the sensitivity of MRCP was 93% and specificity was 95% in detecting CBD strictures while ERCP had 100% sensitivity and specificity. About 12 patients had CBD tumor for sensitivity and specificity of MRCP and ERCP was 100%. Out of 50 patients, 36% had gall bladder stones in whom MRCP sensitivity and specificity was 88.89% and 100% and was found to comparable with ERCP. Only three patients in our study had ampullary carcinoma out of which the sensitivity and specificity came 100% for MRCP. One patient, in whom MRCP and HPE detected ampullary carcinoma, ERCP detected no ampullary carcinoma thus favoring MRCP. However, owing to inadequate study population results are inconclusive. There is significant difference between MRCP and ERCP accuracy rate in detection of ampullary carcinoma. Therefore, our study which is more in favor of MRCP. There were 78% patients who were detected with biliary duct dilatation in ERCP, which was equally detected in MRCP. Thus MRCP had 100% sensitivity and specificity in detecting biliary duct dilatation compared to ERCP. Pancreatic dilatation was detected in four patients and there were two patients who were detected with ampullary stones and its sensitivity, specificity came up to 100% compared to ERCP. Conclusion: Thus to conclude, MRCP has high sensitivity for CBD such as stones, strictures and malignancies therefore to avoid unnecessary diagnostic ERCP; in cases with suspicion (clinical/CBD-IHBR dilatation on USG) of choledocholithiasis/ampullary stone, MRCP is recommended.