Areas Of High Signal Intensity Research Articles

Aquaporin-4 gene silencing protects injured neurons after early cerebral infarction.

Aquaporin-4 regulates water molecule channels and is important in tissue regulation and water transportation in the brain. Upregulation of aquaporin-4 expression is closely related to cellular edema after early cerebral infarction. Cellular edema and aquaporin-4 expression can be determined by measuring cerebral infarct area and apparent diffusion coefficient using diffusion-weighted imaging (DWI). We examined the effects of silencing aquaporin-4 on cerebral infarction. Rat models of cerebral infarction were established by occlusion of the right middle cerebral artery and siRNA-aquaporin-4 was immediately injected via the right basal ganglia. In control animals, the area of high signal intensity and relative apparent diffusion coefficient value on T2-weighted imaging (T2WI) and DWI gradually increased within 0.5–6 hours after cerebral infarction. After aquaporin-4 gene silencing, the area of high signal intensity on T2WI and DWI reduced, relative apparent diffusion coefficient value was increased, and cellular edema was obviously alleviated. At 6 hours after cerebral infarction, the apparent diffusion coefficient value was similar between treatment and model groups, but angioedema was still obvious in the treatment group. These results indicate that aquaporin-4 gene silencing can effectively relieve cellular edema after early cerebral infarction; and when conducted accurately and on time, the diffusion coefficient value and the area of high signal intensity on T2WI and DWI can reflect therapeutic effects of aquaporin-4 gene silencing on cellular edema.

Occlusion of artery of percheron: A rare Aetiology of Bilateral Thalamic infarct

The Artery of Percheron, a rare anatomical variant of brain vascularisation, arises from the posterior cerebral artery. Occlusion of this artery leads to bilateral paramedian thalamic infarct leads to dysfunction of central nervous system. Incidence of bilateral thalamic infarct secondary to occlusion of artery of Percheron is unknown because of its rarity. Here we report a case of 35 year old female presented with altered state of consciousness and the underlying cause was occlusion of Artery of Percheron which leads to bilateral thalamic infarct detected on MRI scanning. It showed hyperintensities on T2W1 and FLAIR, and hypointensity on T1W1, restricted to bilateral ventromedial thalami showing corresponding area of high signal intensity on diffusion weighted images and hypointensity on apparent diffusion coefficient images indicating diffusion restriction, suggestive of infarct. On further investigation magnetic resonance arteriogram (MRA) of the brain demonstrated a single common artery arising from the left P1 segment which divided into two branches distally supplying bilateral thalami. Patient became alright after 2 weeks of medical line of treatment.

Cyclosporine-Induced Posterior Reversible Encephalopathy Syndrome in a Patient with Pemphigus Vulgaris.

Dear Editor: Cyclosporine is an immunosuppressive drug originally isolated from Tolypocladium inflatum in 19701. Here, we report a case of cyclosporine-induced posterior reversible encephalopathy syndrome (PRES) in a patient with pemphigus vulgaris. A 41-year-old Korean woman who had no underlying disease except pemphigus vulgaris was admitted to the emergency room owing to a sudden onset of severe headache, nausea, vomiting, and vision loss. A few minutes after admission, she presented with generalized tonic-clonic convulsive movement and became confused. Transient hypertension (160/100 mmHg) accompanied the episode. Laboratory tests showed leukocytosis (17.9×109/L) with neutrophilia (92.2%); cerebrospinal fluid was normal. Multiple ill-defined high-signal enhanced lesions were visible in the cortex and subcortical white matter of the bilateral parieto-occipital lesion on a T2-weighted brain magnetic resonance imaging (MRI) (Fig. 1A). Six months earlier, the patient presented with highly crusted vegetating lesions on her lower lip (Fig. 2A) as well as several flaccid blisters and scaly crusted erosions on her trunk (Fig. 2B). Histopathological examination showed suprabasal acantholysis (Fig. 2C), and a direct immunofluorescence study on the perilesional dorsal skin showed intercellular epidermal IgG deposition (Fig. 2D). Therefore, she was diagnosed with pemphigus vulgaris. Initially, the patient received prednisolone 100 mg/day for 2 weeks and tapered for 4 months; this was followed by cyclosporine 200 mg/day (4 mg/kg) for 2 months. We considered acute hypertension and cyclosporine administration as possible causes of the convulsive encephalopathy. Cyclosporine was discontinued immediately, and conservative therapy was administered. The patient showed a complete clinical recovery in 6 weeks, and signal enhancement also decreased on follow-up brain MRI (Fig. 1B). Cyclosporine is rarely reported to cause PRES; its association with cyclosporine was first described by Adams et al.2 in 1987. PRES is characterized by clinical symptoms including headache, mental confusion, vomiting, visual disturbance, and multiple generalized tonic-clonic seizures; it is associated with characteristic radiological abnormalities in the posterior area of the cerebral white matter3. In addition to immunosuppressive or cytotoxic drugs, reported causes of PRES also include acute hypertension, infection, autoimmune disease, eclampsia, and pre-eclampsia3. Although the pathophysiology of PRES remains unclear, several mechanisms have been proposed. Cyclosporine has a direct toxic effect on vascular endothelial cells, causing them to release endothelin, prostacyclin, and thromboxane; these may cause microthrombi and also damage the blood-brain barrier3. Many PRES cases have been reported in organ and bone marrow transplant recipients receiving high-dose cyclosporine4. However, in the present case, the patient had been taking low-dose cyclosporine 4 mg·kg-1·day-1 and had no associated risk factors for neurotoxicity. We finally diagnosed the patient with PRES because of her favorable response to cyclosporine discontinuation and the ultimately near-full reversal of encephalopathy. Thus, the possibility of PRES in patients taking even low-dose cyclosporine who present with neurologic symptoms should be emphasized. Physicians should rapidly diagnose this disease and withdraw the causative drug(s), because delayed diagnosis could lead to permanent sequelae. Fig. 1 (A) Axial T2-weighted magnetic resonance imaging (MRI) showing an area of high signal intensity in the bilateral white matter of the posterior parieto-occipital area. (B) Six weeks later, axial T2-weighted MRI showing significant improvement after cyclosporine ... Fig. 2 (A) Highly crusted vegetating lesions on the lower lip. (B) Several flaccid blisters and scaly crusted erosions are distributed on her trunk. (C) Separation of the epidermis above the basal layer and scattered acantholytic cells (H&E, ×200). ...

Clinical Significance of Discrepancy between Arterial Spin Labeling Images and Contrast-enhanced Images in the Diagnosis of Brain Tumors.

In the imaging of intra-axial brain tumors, we sometimes found areas of high signal intensity around the enhanced tumor lesions on arterial spin labeling (ASL) magnetic resonance (MR) imaging. We undertook this study to investigate the relationship between high signal intensity on ASL imaging outside the area of contrast enhancement (CE) and histological diagnosis of intra-axial brain tumors. We examined images from 28 consecutive patients with intra-axial brain tumors who underwent ASL and CE MR imaging-three with low grade glioma (LGG), 13 with high grade glioma (HGG), six with metastasis, and six with primary central nervous system lymphoma (PCNSL)-and divided imaging findings into an "ASL dominant" group when hyperintensity on ASL was found outside the CE area and a "CE dominant" group when hyperintensity on ASL was not found outside the area of enhancement. We then analyzed the relationship between imaging findings and the histological diagnosis of the tumors. Four cases were excluded because of poor quality of ASL images, 7 cases were classified as ASL dominant, and 17 cases were classified as CE dominant. The histological diagnoses of ASL dominant cases were LGG in 3 cases, HGG in 3 cases, and PCNSL in one case. Those of CE dominant cases were HGG in 10 cases, metastasis in 5 cases, and PCNSL in 2 cases. All cases with brain metastasis were classified as CE dominant. The high signal intensity outside the area of contrast enhancement is probably caused by increased perfusion or vascular proliferation, which indicates the presence of glioma or PCNSL and not metastasis. This finding indicates a new utility for ASL images in the diagnosis of brain tumors as a supplement to the conventional measurement of perfusion obtained from ASL images.

Adult-Onset Adrenoleukodystrophy with Frontal Lobe Symptoms: A Case Report

ALD, which is the X-linked adrenoleukodystrophy (X-ALD), is a rare inherited metabolic disease caused by an enzyme deficiency leading to accumulation of saturated very long chain fatty acid (VLCFA), especially in brain and adrenal cortex. Its prevalence is currently estimated at 1:30,000 to 50,000 in males in Japan. We report a 34-year-old man, who acts of theft, peep and obscenity with adult onset cerebral adrenoleukodystrophy (ALD). An elevated VLCFA and a point mutation in the ABCD1 gene confirmed the diagnosis of ALD. Diffusion-weighted MRI revealed a high intensity area in the white matter of the frontal lobes. T2-weighted image revealed diffuse high signal intensity in the deep white matter. MR diffusion-weighted image revealed high signal intensity area in the white matter of the frontal lobes. Proton magnetic resonance spectroscopy (H-MRS) of the white matter of the frontal lobes revealed an extreme decrease of N-acetylaspartate (NAA) and an increase of the choline (Cho)/creatinine (Cr) ratio. The mild hypoperfusion was detected in the both cerebral hemispheres by the single photon emission CT (SPECT). The genetic phenotype was detected and he was diagnosed adult onset ALD. The only neurological sign was deviant behaviors as frontal lobe symptoms; despite a diffuse high signal intensity was detected in the deep white matter in the MRI examination. Psychiatric symptomatology is presented and may be one of the earliest manifestations of ALD. Psychiatrists as well as and physicians may encounter ALD.

Correlation between the outcome of extracorporeal shockwave therapy and pretreatment MRI findings for chronic plantar fasciitis

Background. The purpose of this study was to investigate the relationship between magnetic resonance imaging (MRI) findings before extracorporeal shockwave therapy (ESWT) and the treatment outcome of ESWT.Methods. This study examined 50 feet with chronic plantar fasciitis. The scores before ESWT and after a six-month follow-up were investigated using the Japanese Society for Surgery of the Foot (JSSF) Ankle-Hindfoot Scale and the Visual Analog Scale (VAS). MRI before ESWT was used for image evaluation. MRI revealed thickening of the plantar fascia (PF), and an investigation was conducted regarding the findings of a high-signal-intensity area (HSIA) inside the PF, edema near the PF, and bone marrow edema (BME) of the calcaneus.Results. The average JSSF score and VAS score improved significantly at follow-up. In total, 44 feet were noted in the improved group. MRI revealed that the average amounts of PF thickening did not significantly differ between the improved group and the non-improved group. HSIA, edema near the PF, and BME were observed in 36, 41, and 11 feet in the improved group, respectively; and 2, 4, and 2 feet in the non-improved group, respectively.Conclusions. An HSIA in the PF predicted symptom improvement more easily than other MRI findings.Level of Evidence: IV

Whole-body MRI and diffusion MRI

Metastatic bone disease is a common manifestation of advanced cancers with a very high prevalence in breast, prostate and lung cancers. In order to effectively manage patients with metastatic bony disease it is essential to have consistent, reproducible and validated methods for detecting and assessing the response to therapy. In response assessments, confident categorization of response is needed to enable therapeutic strategies to be tailored to individual patient’s benefit. Commonly used methods such as x-rays, bone and CT scans do not always enable the positive assessment of therapeutic benefit to be made but instead provide an evaluation of progression, which then guides therapy decisions in the clinic. Whole body MRI incorporating DW imaging (WB-DWI) has emerged as a promising bone marrow assessment tool [1] for detection [2,3] and therapy monitoring of bone metastases [4]. On WB-DWI, lytic/infiltrative skeletal metastases appear as focal or diffuse areas of high-signal intensity on high b-values on a background of lower signal intensity of the normal bone marrow [4,5]. Metastasis detection with DWI should be done with anatomical MRI [1,4,5]; a recent meta-analysis demonstrated high sensitivity of WB-DWI to detect metastases at the expense of specificity [2]. Causes for false-positive findings on WB-DWI include bone marrow oedema, vertebral haemangioma, isolated bone marrow islands and bone marrow hyperplasia. False-negative findings occur when there are low levels of bone marrow infiltration or when background bone marrow hyperplasia obscures metastases. Detection of skeletal metastases may be impaired in areas of body movement and the visibility of skull base infiltrations is impaired because of the adjacent high signal of the brain. False-negative findings also include treated malignant disease and sclerotic deposits. WB-DWI when combined with emerging “wet” biomarkers can improve the classification of therapy response in patients with metastatic bone disease. Both high b-value image signal intensity and ADC value changes are needed for therapeutic assessments [4,5]. A range of imaging findings can be seen depending on the type of therapy and duration of treatment [4]. Morphologic and diffusion MRI therapy response criteria need to be tested in prospective studies in order to address current, unmet clinical and pharmaceutical needs for reliable measures of tumor response in metastatic bone disease [5].

PO-0241 Bilateral Basal Ganglia Infarction In Pneumococcal Meningoencephalitis In A Child

Background and aims Basal ganglia infarction is considered a complication of chronic refractory meningitis. In acute infection the basal ganglia are usually spared. Here we report an exceptional case of bilateral infarction of the basal ganglia in a child with acute S. pneumoniae meningoencephalitis. Methods A 4 year old girl with a short history of fever and left sided otalgia presented with drowsiness in a referral hospital. Cerebral spinal fluid (CSF) examination showed pleocytosis (900 leucocytes/mm 3 )and immediately corticosteroids, ceftriaxone and acyclovir were started. Because of a rapid decline inconsciousness she was transferred to our tertiairy PICU centre. Results Ad admission the girl had become unresponsive and was intubated. Her pupils were mid wide and non-reacting to light. Neurologic examination showed a bipyramidal syndrome with hypertonicity of the lower extremities, brisk deep tendon reflexes and bilateral positive Babinski’s. S.pneumoniae was cultured from CSF and blood. An MRI 4 days after admission showed bilateral sharply demarcated areas of high-signal intensity in the thalamus indicating infarction (Figure 1). In addition osteomyelitis of the tip of the petrous pyramid was observed. Her consciousness gradually improved with bilateral reactive pupils and spontaneous limb movements. Brainstem evoked response audiometry (BERA) of the left ear was negative. Gross motor deficits and impaired eye movements persisted. Conclusion Acute pneumococcal meningoencephalitis can cause bilateral basal ganglia infarction in a child.

Intraoral cysticercosis of the masseter muscle- A rare finding; correlation of histopathology with MRI and USG

Cysticercosis refers to infection of tissues after exposure of eggs of pork tapeworm Taenia solium. The authors report a rare case of a solitary intraoral cysticercosis in a thirty-four year female who presented with a mass in the left buccal mucosa of two months duration. The attending dentist could not have an impression of the lesion and sent for ultrasonography. The ultrasonographic report described a well defined hypoechoic lesion with central hypoechoic mural nodular area in left buc­cal region with muscle plane along with posterior enhancement suggestive of cystic nature. The impression was of benign cystic lesion in left buccal region (muscle plane). The MRI report revealed a 12 mm diameter T2 high signal intensity area noted in the anterior aspect of the left masseter muscle that showed iso to low signal in T1 weighted images. An ill margin­ated T2 high signal intensity was seen in left masseter muscle which also showed slight enlargement. The impression was of cystic lesion in left masticator space with edema in surrounding soft tissue plane. The lesion was enucleated and the histological findings revealed a cystic lesion containing parasitic larva. The cystic cavity was surrounded by a collagenous capsule of multinucleated foreign body giant cells with admixture of lymphocytes, plasma cells and histiocytes. The para­sitic larva showed thick integument with projections and a myxomatous inner stroma. Thus a definitive diagnosis of “oral cysticercosis” was given. Oral cysticercosis rarely involves the oral cavity. This case reports a rare involvement of cysticer­cosis involving the masseteric space. DOI: http://dx.doi.org/10.3126/jcmc.v4i2.10864 Journal of Chitwan Medical College 2014; 4(2): 44-47

Magnetic Resonance Imaging Staging to Evaluate the Stability of Capitellar Osteochondritis Dissecans Lesions

Background: Treatment for capitellar osteochondritis dissecans (COCD) lesions is usually based on their stability from the bony floor after arthroscopic or open direct observation. Thus, a noninvasive means of lesion stability assessment by use of imaging is desirable to preoperatively determine treatment strategy. Purpose: To evaluate our modified MRI staging system for COCD, we compared the results of MRI staging with the International Cartilage Repair Society (ICRS) classification for lesion stability. Intra- and interrater reliability for MRI staging was examined as well. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Fifty-two COCD lesions were preoperatively evaluated by T2-weighted MRI and classified into 5 stages: stage 1 = normally shaped capitellum with several spotted areas of high signal intensity that is lower than that of cartilage; stage 2 = as with stage 1 but with several spotted areas of higher intensity than that of cartilage; stage 3 = as with stage 2 but with both discontinuity and noncircularity of the chondral surface signal of the capitellum and no high signal interface apparent between the lesion and the floor; stage 4 = lesion separated by a high intensity line in comparison with cartilage; and stage 5 = capitellar lesion displaced from the floor or defect of the capitellar lesion noted. The MRI staging results were compared with the intraoperative ICRS classification for lesion stability of each patient. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were all determined for fragment instability. Intra- and interrater correlations for our MRI staging were calculated among 3 examiners. Results: Preoperative MRI grading correctly matched ICRS classification in 49 of 52 patients (94%), with a sensitivity of 100% and a specificity of 80%. The PPV and NPV were 93% and 100%, respectively, for diagnosing lesion instability. Intrarater reliability (intraclass correlation coefficient [ICC]) for MRI staging was high at ICC(1, 1) = 0.86 and ICC(1, 2) = 0.90, as was interrater reliability at ICC(2, 1) = 0.82 and ICC(2, 3) = 0.88. Conclusion: The MRI staging system provides accurate and reliable evidence for estimating ICRS classification and instability of COCD and is useful to decide appropriate treatment.

Prognostic factors for cervical spondylotic amyotrophy: are signs of spinal cord involvement associated with the neurological prognosis?

The purpose of this study was to clarify the prognostic factors for cervical spondylotic amyotrophy (CSA). The authors retrospectively reviewed the medical records of 47 consecutive patients with CSA in whom the presence/absence of the pyramidal tract sign was noted. We analyzed whether the age, sex, presence of diabetes mellitus, medication (vitamin B12), type of the most atrophic and impaired muscle, the muscle strength at the presentation, the presence of the pyramidal tract sign, magnetic resonance imaging (MRI) findings, including the presence and number of T2 high signal intensity areas (T2 HIA) in the spinal cord and the conversion to surgery were associated with the recovery of muscle strength in the patients. In addition, we also investigated whether the duration of symptoms before surgery and the type of surgery were associated with the recovery of muscle strength in patients who required conversion to surgical treatment. The presence of T2 HIA on MRI (P=0.002), the number of T2 HIA on MRI (P=0.002) and conversion to surgery (P=0.015) were found to be significantly associated with a poorer recovery at the observational final follow-up. Further, the presence of the pyramidal tract sign (P=0.043) was significantly associated with a poor recovery at the final follow-up after surgery. The presence of a high signal intensity change on T2-weighted MRI and the pyramidal tract sign can be used as prognostic factors for patients with CSA.

Procarbazine, CCNU, and Vincristine Chemotherapy in Gliomatosis Cerebri.

A 49-year-old female patient was admitted due to memory disturbances. Magnetic resonance (MR) imaging suggested gliomatosis cerebri (GC), which had spread to both insular lobes, both frontal and basal ganglia and the brain stem. A stereotactic biopsy was performed at the high signal intensity area of the T2-weighted MR image, and the revealed a diffuse astrocytoma. Radiation therapy was judged not to be an appropriate treatment for the patient because of her cognitive impairment. A combinatorial chemotherapy regiment consisting of Procarbazine, CCNU, and Vincristine (PCV) was agreed upon after discussion. The patient underwent six cycles of PCV chemotherapy (a full dose was applied until the 3rd cycle, and dose then was reduced to 75% for the remaining cycles). Although the patient exhibited side effects such as bone marrow suppression and gastrointestinal symptoms, these were managed by medication. Over the 28 months following initiation of treatment, the high signal area in the right frontal and temporal lobes in the T2-weighted MR image decreased, and the patient's cognitive function [global deterioration scale (GDS) 4 points, mini-mental state examination (MMSE) 25 point] also improved (GDS 1 points, MMSE 29 points). PCV chemotherapy can therefore be an alternative therapeutic option for patients with GC who cannot be treated with radiation therapy or other chemotherapies.

Unilateral lingual paralysis after isolated unilateral infarction in the primary motor cortex

A 37-year-old man presented with sudden onset of dysarthria. He had a history of colorectal cancer. On examination, his tongue deviated to the right on protrusion (figure 1) but his...

The Usefulness of Diffusion-Weighted MRI for Evaluating the Effects of Steroid Therapy for Autoimmune Pancreatitis and Differentiating it from Pancreatic Cancer

Purpose: Autoimmune Pancreatitis (AIP) is a disease which is remarkably responsive to steroid therapy. The methods used to evaluate the effects of steroid therapy vary by hospital. In addition, there are many reports of cases difficult to distinguish from pancreatic cancer. Diffusion-weighted magnetic resonance imaging (DWI) is a non-invasive and quantitative evaluation that uses the apparent diffusion coefficient(ADC) values. This study revealed the usefulness of DWI for evaluating the effects of steroid therapy for AIP, and differentiating it from pancreatic cancer in our hospital. Methods: Four AIP patients underwent DWI before steroid therapy after one week and one month of treatment. We measured each ADC value and compared them. We also compared the ADC values of AIP patients to those of 30 pancreatic cancer patients. Results: AIP and pancreatic cancer were detected as high-signal intensity areas on DWI. In all AIP cases, the enlarged pancreas was reduced and the ADC values were increased after the start of treatment. The ADC values of AIP patients were 0.90×10-3 mm2/s (0.82-0.95×10-3 mm2/s) before steroid therapy, and were 1.19×10-3 mm2/s (1.06-1.21×10-3 mm2/s) after one week. They were 1.41×10-3 mm2/s(1.32-1.44×10-3 mm2/s) after one month from the start of treatment. The ADC values of the pancreatic cancer patients were 1.26×10-3 mm2/s (1.20-1.35×10-3 mm2/s) and were significantly higher than those of the AIP patients before steroid therapy. Conclusion: DWI is non-invasive and useful for evaluating the effects of steroid therapy for AIP. The ADC values may be useful for distinguishing AIP from pancreatic cancer.

Correlation between the area of high-signal intensity on SPIO-enhanced MR imaging and the pathologic size of sentinel node metastases in breast cancer patients with positive sentinel nodes

BackgroundWe previously demonstrated that superparamagnetic iron oxide (SPIO)-enhanced MR imaging is promising for the detection of metastases in sentinel nodes localized by CT-lymphography in patients with breast cancer. The purpose of this study was to determine the predictive criteria of the size of nodal metastases with SPIO-enhanced MR imaging in breast cancer, with histopathologic findings as reference standard.MethodsThis study included 150 patients with breast cancer. The patterns of SPIO uptake for positive sentinel nodes were classified into three; uniform high-signal intensity, partial high-signal intensity involving ≥50% of the node, and partial high-signal intensity involving <50% of the node. Imaging results were correlated with histopathologic findings.ResultsThirty-three pathologically positive sentinel nodes from 30 patients were evaluated. High-signal intensity patterns that were uniform or involved ≥50% of the node were observed in 23 nodes that contained macro-metastases and no node that contained micro-metastases, while high-signal intensity patterns involving <50% of the node were observed in 2 nodes that contained macro-metastases and 8 nodes that contained micro-metastases. When the area of high-signal intensity was compared with the pathological size of the metastases, a pathologic >2 mm sentinel node metastases correlated with the area of high-signal intensity, however, a pathologic ≤2 mm sentinel node metastases did not.ConclusionsHigh-signal intensity patterns that are uniform or involve ≥50% of the node are features of nodes with macro-metastases. The area of high-signal intensity correlated with the pathological size of metastases for nodes with metastases >2 mm in this series.

MR Imaging Features of Triple-Negative Breast Cancers

Triple-negative (TN) breast cancers, which are associated with a more aggressive clinical course and poorer prognosis, often present with benign imaging features on mammography and ultrasound. The purpose of this study was to compare the magnetic resonance imaging features of TN breast cancers with estrogen (ER) and progesterone (PR) positive, human epidermal growth factor receptor (HER2) negative cancers. Retrospective review identified 140 patients with TN breast cancer who underwent a preoperative breast MRI between 2003 and 2008. Comparison was made to 181 patients with ER+/PR+/HER2- cancer. Breast MRIs were independently reviewed by two radiologists blinded to the pathology. Discrepancies were resolved by a third radiologist. TN cancers presented with a larger tumor size (p = 0.002), higher histologic grade (<0.001), and were more likely to be unifocal (p = 0.018) compared with ER+/PR+/HER2- tumors. MRI features associated with TN tumors included mass enhancement (p = 0.026), areas of intratumoral high T2 signal intensity (p < 0.001), lobulated shape (p < 0.001), rim enhancement (p < 0.001), and smooth margins (p = 0.005). Among the TN tumors with marked necrosis, 26% showed a large central acellular zone of necrosis.

SAT0324 A population based study of the association between hip bone marrow lesions and pain

BackgroundBone marrow lesions (BMLs) are detected using magnetic resonance imaging (MRI) and defined as non-cystic ill-defined subchondral areas of high signal intensity. BMLs are now considered as one of the...

16 Syndrome in a Patient With Multiple Sclerosis

We read with interest the report of Connors et al (1) of a case of 16 syndrome with complete horizontal gaze paralysis and facial diplegia caused by a pontine hemorrhage. We describe a patient with multiple sclerosis (MS) who experienced an evolving eye movement disorder, which included internuclear ophthalmoplegia, one-and-a-half syndrome, eight-and-a-half syndrome, fifteen-and-a-half syndrome, and finally 16 syndrome. A 44-year-old man with a history of hypertension, heavy smoking, and a positive family history of cardiovascular disease complained of double vision upon awakening. Neurological examination revealed bilateral internuclear ophthalmoplegia (INO), which was attributed to a brainstem infarction given the sudden onset and patient’s vascular risk factors. Magnetic resonance imaging (MRI) of the brain and the intracranial vessels revealed several periventricular white matter lesions but no brainstem abnormality. Three days later, the patient developed drooping of the right corner of his mouth and complained of drooling. Examination revealed a right lower motor neuron facial nerve paresis in addition to bilateral INO. Repeat MRI revealed a nonenhancing lesion in the midline of the dorsal pons (Fig. 1). Two days later, he developed a complete right conjugate horizontal gaze palsy which, coupled with his left INO, produced a one-and-a-half syndrome. Concurrently, he also experienced bilateral facial paresis.FIG. 1: Axial fluid-attenuated inversion recovery (A) and sagittal T2 (B) MRI show an area of high signal (arrows) in the dorsal pons ventral to the fourth ventricle.Evaluation for stroke including extensive hematological tests, Holter cardiac monitoring, and transesophageal echocardiography was normal. Cerebrospinal fluid analysis for IgG, oligoclonal bands, and aquaporin-4 antibodies as well as visual evoked responses were normal. MRI of the cervical spinal cord revealed no lesions. On the 11th day of hospitalization, the patient developed bilateral horizontal gaze palsies with worsening of his facial diplegia. His clinical course in combination with the periventricular white matter lesions was highly suggestive of demyelinating disease. Treatment with methylprednisolone was begun, and 3 weeks later, he had recovered completely. Several follow-up MRIs were performed. The most recent MRI, 1.5 years after the onset of symptoms, revealed an increase in number and extent of the white matter hyperintensities (Fig. 2). Glatiramer acetate therapy was initiated.FIG. 2: Axial fluid-attenuated inversion recovery (A) and sagittal T2 (B) scans reveal several areas of high signal intensity in the periventricular region and corpus callosum.On occasion, a one-and-a-half syndrome can be accompanied by a facial paresis if the fascicle or nucleus of the seventh cranial nerve in the lower part of the dorsal pontine tegmentum is also affected. Eggenberger (2) designated this as eight-and-a-half (1.5 + 7) syndrome. As mentioned by Connors et al (1), variations of this syndrome caused by pathology of the dorsal pontine tegmentum have since been described including a combination of a one-and-a-half syndrome and a bilateral peripheral facial paresis which Bae and Song (3) designated fifteen-and-a-half (1.5 + 7 + 7) syndrome. Only 3 cases of isolated eight-and-a-half syndrome caused by MS have been described in the literature (4,5). In one of these cases (4), the eight-and-a-half syndrome was, as in our patient, the initial symptom of MS. A 16 syndrome caused by MS has not been reported previously.

AB1288 Method for automated, computer-based quantitative assessment of fluorescence optical imaging (FOI)

BackgroundDiagnostic imaging, including ultrasound and MRI is routinely used in joint diseases. Besides initial diagnosis of the disease, imaging is also of strong interest for monitoring of treatment response. In...

AB0492 Sonographic changes of temporomandibular joint in systemic sclerosis

BackgroundThe inflammatory involvement of temporomandibular joint (TMJ) in rheumatic diseases may induce the damage of the TMJ provoking a severe impairment of mouth opening and affecting patient’s quality of life....