High T2-weighted Signal Intensity Research Articles

Characteristics of Hirayama Disease in Young South Korean Soldiers.

The purpose of this study was to describe the clinical presentation and features in electrodiagnostic and imaging investigations of young South Korean males diagnosed with Hirayama disease (HD). We reviewed the electronic medical records of South Korean enlisted soldiers who were diagnosed with HD and discharged from military service during 2011-2021. We investigated the clinical characteristics and results of electrodiagnostic and magnetic resonance imaging (MRI) investigations. We analyzed laterality and identified the involved muscles using needle electromyography (EMG). Loss of lordosis, localized cervical cord atrophy, loss of attachment between the posterior dura and subjacent lamina, asymmetric flattening of the cord, crescent-shaped mass in the posterior epidural space, and noncompressive intramedullary T2-weighted high signal intensity were investigated using neutral- or flexion-position MRI. Forty-two male patients aged 20.2±0.8 years (mean±standard deviation) were identified. All patients complained of hand weakness, and 10 complained of hand tremor (23.8%). Four patients (9.5%) had symptoms in both upper limbs, and five (11.9%) had sensory disturbances. Needle EMG revealed that muscles in the C7-T1 myotome were commonly involved, and C5-C6 involvement of the deltoid (10.5%) and biceps brachii (12.5%) was also observed. In cervical MRI, localized cord atrophy (90.0%) was the most characteristic finding, and cord atrophy was most severe at the C5-C6 level (58.3%). This is the first description of a large number of patients with HD in South Korea. The clinical presentation and features found in electrodiagnostic and imaging investigations will improve the understanding of HD in the young South Korean male population.

How to improve O-RADS MRI score for rating adnexal masses with cystic component?

To test the performance of the Ovarian-Adnexal Reporting Data System (O-RADS) MRI in characterizing adnexal masses with cystic components and to test new specific MRI features related to cystic components to improve the ability of the O-RADS MRI score to stratify lesions according to their risk of malignancy. The EURopean ADnexal study (EURAD) database was retrospectively queried to identify adnexal masses with a cystic component. One junior and 13 radiologists independently reviewed cases blinded to the pathological diagnosis. For each lesion, the size of the whole lesion, morphological appearance, number of loculi, presence of a thickened wall, thickened septae, signal intensity of the cystic components on T1-weighted/T2-weighted/diffusion weighted, mean value of the apparent diffusion coefficient, and O-RADS MRI score were reported. Univariate and multivariate logistic regression analysis was performed to determine significant features to predict malignancy. The final cohort consisted of 585 patients with 779 pelvic masses who underwent pelvic MRI to characterize an adnexal mass(es). Histology served as the standard of reference. The diagnostic performance of the O-RADS MRI score was 0.944, 95%CI [0.922-0.961]. Significant criteria associated with malignancy included an O-RADS MRI score ≥ 4, ADCmean of cystic component > 1.69, number of loculi > 3, lesion size > 75 mm, the presence of a thick wall, and a low T1-weighted, a high T2-weighted, and a low diffusion-weighted signal intensity of the cystic component. Multivariate analysis demonstrated that an O-RADS MRI score ≥ combined with an ADC mean of the cystic component > 1.69, size > 75 mm, and low diffusion-weighted signal of the cystic component significantly improved the diagnostic performance up to 0.958, 95%CI [0.938-0.973]. Cystic component analysis may improve the diagnosis performance of the O-RADS MRI score in adnexal cystic masses. • O-RADS MRI score combined with specific cystic features (area under the receiving operating curve, AUROC = 0.958) improves the diagnostic performance of the O-RADS MRI score (AUROC = 0.944) for predicting malignancy in this cohort. • Cystic features that improve the prediction of malignancy are ADC mean > 1.69 (OR = 7); number of loculi ≥ 3 (OR = 5.16); lesion size > 75 mm (OR = 4.40); the presence of a thick wall (OR = 3.59); a high T2-weighted signal intensity score 4 or 5 (OR = 3.30); a low T1-weighted signal intensity score 1, 2, or 3 (OR = 3.45); and a low diffusion-weighted signal intensity (OR = 2.12). • An adnexal lesion with a cystic component rated O-RADS MRI score 4 and an ADC value of the cystic component < 1.69 associated with a low diffusion-weighted signal, has virtually a 0% risk of malignancy.

C2–C3 Anterior Cervical Diskectomy and Fusion for Hangman's Fractures with C2 Posterior Dislocation: Technical Notes

The overwhelming majority of hangman's fractures cause anterior dislocation of C2. Hangman's fracture with C2 posterior dislocation is extremely rare; only 1 pediatric case was reported in 2018 to date. This kind of injury cannot be cataloged using current classification schemes, and no established treatment recommendations exist. The purpose of this article is to report a rare case of a hangman's fracture with C2 posterior dislocation, which does not fit into existing classification systems and discuss management technical notes to avoid pitfalls. We describe this case, review relevant literature, and share our experience. A 31-year-old male sustained a hangman's fracture with C2 posterior dislocation after he fell into a 50-cm deep roadside ditch when riding a motorcycle. Radiograph and computed tomography on admission showed fractures through both pars of C2 and C2 posterior dislocation. Magnetic resonance imaging on admission showed high T2-weighted signal intensity of cervical spinal cord and compression of the cervical spinal cord by posterior dislocation of the C2 vertebral body. A C2-3 anterior cervical diskectomy and fusion was performed. At 6 months after operation, bony fusion was achieved and magnetic resonance imaging showed the T2-weighted signal hyperintensity of cervical spinal cord before surgery disappeared. C2-C3 anterior cervical diskectomy and fusion is recommended for hangman's fractures with C2 posterior dislocation. Traction before surgery is not recommended.

Dynamic contrast enhanced-MRI and diffusion-weighted image as predictors of lymphovascular invasion in node-negative invasive breast cancer

BackgroundLymphovascular invasion (LVI) is an important risk factor for prognosis of breast cancer and an unfavorable prognostic factor in node-negative invasive breast cancer patients. The purpose of this study was to evaluate the association between LVI and pre-operative features of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) in node-negative invasive breast cancer.MethodsData were collected retrospectively from 132 cases who had undergone pre-operative MRI and had invasive breast carcinoma confirmed on the last surgical pathology report. MRI and DWI data were analyzed for the size of tumor, mass shape, margin, internal enhancement pattern, kinetic enhancement curve, high intratumoral T2-weighted signal intensity, peritumoral edema, DWI rim sign, and apparent diffusion coefficient (ADC) values. We calculated the relationship between presence of LVI and various prognostic factors and MRI features.ResultsPathologic tumor size, mass margin, internal enhancement pattern, kinetic enhancement curve, DWI rim sign, and the difference between maximum and minimum ADC were significantly correlated with LVI (p < 0.05).ConclusionsWe suggest that DCE-MRI with DWI would assist in predicting LVI status in node-negative invasive breast cancer patients.

The value of dynamic contrast-enhanced MRI in the diagnosis and management of triple-negative breast cancer

BackgroundBreast cancer is undoubtedly the world’s most frequent cancer among women. Triple-negative breast cancer (TNBC) is a subtype of breast cancer that does not express estrogen, progesterone, or human epidermal growth factor receptors, yet its imaging is considered a challenge to radiologists having imprecise features.In this study, we aimed at defining the MRI characteristics of triple-negative breast cancer to validate its impact on management.ResultsMost of the TNBCs in this study showed malignant pattern kinetic curves (types II and III), 87/104 (83.7%), and P value 0.673 (not significant), and regarding the type of lesion enhancement, 104/172 cases (60.5%) showed mass enhancement compared to 52/172 (30.2%) non-mass enhancement and 16/172 (9.3%) focus enhancement, P value 0.185 (not significant). As for the internal enhancement pattern of mass lesions, rim internal enhancement was predominant in TNBC mass lesions, 48/104 (46.2%), as well as intratumoral bright signal intensity on T2-weighted images, 108/172 (62.8%), P value 0.001 (highly significant).ConclusionTriple-negative breast cancers (TNBC) are larger, better defined, and more necrotic than conventional cancers. On MRI, necrosis yields high T2-weighted signal intensity.

High T2-weighted signal intensity is associated with myocardial deformation in hypertrophic cardiomyopathy

The association between global and segmental myocardial strain impairment and fibrosis extent in hypertrophic cardiomyopathy (HCM) is widely verified. The aim of this study was to investigate the contribution of high T2-weighted signal intensity (HighT2) to myocardial deformation in HCM. We prospectively recruited 57 patients with HCM examined by a 3.0 Tesla magnetic resonance scanner with cine, T2-weighted imaging with fat saturation and phase-sensitive inversion recovery. Global and segmental radial, circumferential and longitudinal strains were included for analysis. The extent of HighT2 was negatively correlated with global radial strain (ρ = −0.275, p = 0.038) and positively correlated with global circumferential strain (ρ = 0.308, p = 0.02) and global longitudinal strain (ρ = 0.422, p = 0.001). Radial, circumferential and longitudinal strains were all significantly associated with segment thickness. Regarding circumferential strain, segments at the mid-ventricular level with LGE and HighT2 showed more impairment than segments with only LGE. For longitudinal strain, the influence of HighT2 appeared only at the mid-ventricular level. The HighT2 extent in HCM was observed to contribute to global and segmental strain parameters. At the segmental level, HighT2 indeed affects left ventricular deformation, and follow-up studies are still warranted.

T91. Factors predicting the successful generation of baseline motor evoked potentials in patients undergoing spine surgery

Introduction The purpose of this study was to search for clinical factors predicting the successful generation of baseline muscle motor evoked potentials (mMEPs) in patients undergoing spine surgery and to determine the relationship with postoperative functional outcome. Methods From July 2014 to June 2015, a total of 345 patients underwent spine surgery with intraoperative mMEPs monitoring and were consecutively included in this study. Their demographic features, clinical parameters, and mMEPs recording results were reviewed retrospectively. Results Two hundred and fifty-three (73%) patients showed the successful generation of baseline mMEPs at all recording muscles, and 92 (27%) patients failed to record baseline mMEPs at one or more limb muscles. When we compared the preoperative clinical parameters of the two groups, the latter group (“Failure group”) significantly had a higher male ratio, lower MRC grades, higher Nurick grades, more often cervical/cervicothoracic segment involvement, higher proportion of the presence of spine surgery history, motor deficits, sensory symptoms, bladder/bowel dysfunction, T2-weighted high signal intensity (HSI) of cord at spine MRI compared to the former group (“Success group”) and were older. Among these factors, male sex, cervical/cervicothoracic lesion location the presence of T2-weighted HSI of cord, preoperative Nurick grade, and MRC grade showed a significant contribution for predicting the successful generation of mMEPs. When analyzing predictors for postoperative poor functional outcomes, the success rate of mMEPs recording and lesion etiology were significantly related factors for the aggravation of the Nurick grades before and after surgery. Conclusion Various clinical parameters including lesion location, abnormal cord signal on MRI, preoperative motor power, and functional status were revealed to have a significant relationship with the successful generation of baseline mMEPs. Additionally, the successful generation of mMEPs was one of the indicators for predicting the long-term functional outcome.

Preoperative magnetic resonance imaging characteristics of oval circumscribed fast enhancing lesions in patients with newly diagnosed breast cancer.

The aim of this study was to investigate the follow-up results and characteristics of oval circumscribed lesions with fast initial enhancement on preoperative magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer.Preoperative data from consecutive patients newly diagnosed with breast cancer between 2010 and 2013 were retrospectively reviewed. Only MRI reports containing, “oval shape, circumscribed margin, and fast initial enhancement,” were extracted and analyzed. Follow-up results and clinical and pathological findings were evaluated.A total of 430 oval circumscribed lesions with fast initial enhancement were included. Forty-eight lesions were pathologically confirmed at initial workup and 382 were followed up. Among the 48 lesions, 14 were found to have additional malignancy and 34 were benign. Among the 382 followed-up lesions, only 1 was subsequently confirmed to be malignant. There were no evident changes in any of the remaining lesions during follow-up. The overall rate of malignancy was 3.5% (15/430). When lesions exhibited delayed washout enhancing kinetics (P < .001), were located ipsilaterally (P = .007), and closer to the primary tumor (P = .012), the possibility of malignancy was high. High T2-weighted imaging signal intensity suggested benignity (P = .043).Although the probability of being diagnosed with malignancy during follow-up in this study was low (0.3%), this investigation revealed several preoperative MRI characteristics that should alert clinicians to the possibility of malignancy.

High T2-weighted signal intensity for risk prediction of sudden cardiac death in hypertrophic cardiomyopathy

In search of improved risk stratification in hypertrophic cardiomyopathy (HCM), CMR imaging has been implicated as a potential tool for prediction of sudden cardiac death (SCD). In follow-up of the promising results with extensive late gadolinium enhancement (LGE), high signal-intensity on T2-weighted imaging (HighT2) has become subject of interest given its association with markers of adverse disease progression, such as LGE, elevated troponin and non-sustained ventricular tachycardia. In lack of follow-up cohorts, we initiated an exploratory study on the association between HighT2 and the internationally defined risk categories of SCD. In a cohort of 109 HCM patients from a multicenter study on CMR imaging and biomarkers, we estimated the 5-year SCD risk (HCM Risk-SCD model). Patients were categorized as low (< 4%), intermediate (≥ 4–<6%) or high (≥ 6%) risk. In addition, risk categorization according to the ACC/AHA guidelines was performed. HighT2 was present in 27% (29/109). Patients with HighT2 were more often at an intermediate-high risk of SCD according to the European (28 vs. 10%, p = .032) and American guidelines (41 vs. 18%, p = .010) compared to those without HighT2. The estimated 5-year SCD risk of our cohort was 1.9% (IQR 1.3–2.9%), and projected SCD rates were higher in patients with than without HighT2 (2.8 vs. 1.8%, p = .002). In conclusion, HCM patients with HighT2 were more likely to be intermediate-high risk, with projected SCD rates that were 1.5 fold higher than in patients without HighT2. These pilot findings call for corroborative studies with more intermediate-high risk HCM patients and clinical follow-up to assess whether HighT2 may have additional value to current risk stratification.

Threshold of the extent of resection for WHO Grade III gliomas: retrospective volumetric analysis of 122 cases using intraoperative MRI.

OBJECTIVE WHO Grade III gliomas are relatively rare and treated with multiple modalities such as surgery, chemotherapy, and radiotherapy. The impact of the extent of resection (EOR) on improving survival in patients with this tumor type is unclear. Moreover, because of the heterogeneous radiological appearance of Grade III gliomas, the MRI sequence that best correlates with tumor volume is unknown. In the present retrospective study, the authors evaluated the prognostic significance of EOR. METHODS Clinical and radiological data from 122 patients with newly diagnosed WHO Grade III gliomas who had undergone intraoperative MRI-guided resection at a single institution between March 2000 and December 2011 were analyzed retrospectively. Patients were divided into 2 groups by histological subtype: 81 patients had anaplastic astrocytoma (AA) or anaplastic oligoastrocytoma (AOA), and 41 patients had anaplastic oligodendroglioma (AO). EOR was calculated using pre- and postoperative T2-weighted and contrast-enhanced T1-weighted MR images. Univariate and multivariate analyses were performed to evaluate the prognostic significance of EOR on overall survival (OS). RESULTS The 5-, 8-, and 10-year OS rates for all patients were 74.28%, 70.59%, and 65.88%, respectively. The 5- and 8-year OS rates for patients with AA and AOA were 72.2% and 67.2%, respectively, and the 10-year OS rate was 62.0%. On the other hand, the 5- and 8-year OS rates for patients with AO were 79.0% and 79.0%; the 10-year OS rate is not yet available. The median pre- and postoperative T2-weighted high-signal intensity volumes were 56.1 cm3 (range 1.3-268 cm3) and 5.9 cm3 (range 0-180 cm3), respectively. The median EOR of T2-weighted high-signal intensity lesions (T2-EOR) and contrast-enhanced T1-weighted lesions were 88.8% (range 0.3%-100%) and 100% (range 34.0%-100%), respectively. A significant survival advantage was associated with resection of 53% or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA, but not in patients with AO. Univariate analysis showed that preoperative Karnofsky Performance Scale score (p = 0.0019), isocitrate dehydrogenase 1 ( IDH1) mutation (p = 0.0008), and T2-EOR (p = 0.0208) were significant prognostic factors for survival in patients with AA and AOA. Multivariate analysis demonstrated that T2-EOR (HR 3.28; 95% CI 1.22-8.81; p = 0.0192) and IDH1 mutation (HR 3.90; 95% CI 1.53-10.75; p = 0.0044) were predictive of survival in patients with AA and AOA. CONCLUSIONS T2-EOR was one of the most important prognostic factors for patients with AA and AOA. A significant survival advantage was associated with resection of 53% or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA.

High T2-weighted signal intensity is associated with elevated troponin T in hypertrophic cardiomyopathy

ObjectiveAreas of high signal intensity (HighT2) on T2-weighted cardiovascular magnetic resonance (CMR) imaging have been demonstrated in hypertrophic cardiomyopathy (HCM). It has been hypothesised that HighT2 may indicate active tissue...

Enchondroma of the Foot

The present study is a review of 20 patients with enchondroma of the foot treated from January 2005 to March 2012. All patients were examined clinically, followed by an evaluation of their enchondroma of the foot radiographically and an assessment of the outcome of their surgical intervention. The patients' sex and age, enchondroma location, findings from imaging studies such as plain radiography, computed tomography, and magnetic resonance imaging, clinical findings, operative findings, and treatment outcomes were recorded. The average postoperative follow-up period was 24 months. Eighty percent of the tumors were located in the proximal phalanx and 14 (70%) patients presented with pathologic fracture. The plain radiographs and computed tomography findings revealed 13 (65%) cases of internal calcification and 11 (55%) with endosteal scalloping. A periosteal reaction was seen only in 4 (20%) cases. Magnetic resonance imaging of 11 (55%) patients showed low T1-weighted and high T2-weighted signal intensity in all cases. Internal septa and nodules with low T2-weighted signal intensity were observed in 9 (82%) out of 11 cases, and adjacent soft tissue edema was noted in 9 (82%). All patients underwent curettage of the tumor and bone grafting as their surgical treatment. No recurrence or postoperative complications were observed during the 24-month follow-up period. Enchondroma of the foot most frequently involves the proximal phalangeal bone and is often associated with pathologic fracture. The unique clinical signs and characteristic radiographic images are easily recognized, making this a relatively easy diagnosis. With appropriate treatment, a good surgical outcome can be expected.

Intramedullary lipoma of the cervico-thoracic spinal cord

Most of the spinal cord lipomas reported in the literature are intradural extramedullary, and true intramedullary lipomas are very rare. We present a case of intramedullary spinal cord lipoma of the cervico-thoracic region with extensions over many spinal segments. Magnetic resonance (MR) examination showed an intramedullary lipoma of the cervico-thoracic spinal cord of both high T1 and T2-weighted signal intensity and suppression on fat saturation sequence. MR imaging assessment is critical in the detection of intramedullary lipomas which may present without any neurological deficit at an early stage. Early diagnosis may lead to prevention of the irreversible deterioration of neurological functions.

Facile and Green Synthesis of Biocompatible and Bioconjugatable Magnetite Nanofluids for High-Resolution T2 MRI Contrast Agents

By using water as an exclusive solvent, a facile one-pot strategy was developed for the preparation of hydrophilic magnetite nanofluids coated with oxidized dextran. These as-synthesized magnetic nanofluids are highly water-soluble, biocompatible, and bioconjugatible for targeted detection because of the enriched carboxylate groups in the oxidized dextran shell. These nanoparticles are less than 10 nm and demonstrate strong magnetization, low cytotoxicity, and high T2-weighted MR image signal intensity (r2 = 250.5 mM–1 s–1, 3.7 times larger than the commercial product). Also, these magnetic nanofluids are highly stable in many kinds of aqueous media; even though a strong magnet is adjoined to the nanofluids, the whole colloid solution rather than the solid particle only is drawn to the side wall of the vial. These novel properties render this magnetic nanofluid desirable for wide bioapplications including MRI, highly efficient magnetic bioseparation, targeted drug delivery, and magnetic hyperthermia.

Triple-negative invasive breast cancer on dynamic contrast-enhanced and diffusion-weighted MR imaging: comparison with other breast cancer subtypes

To determine the MRI features of triple-negative invasive breast cancer (TNBC) on dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted MR imaging (DWI) in comparison with ER-positive/HER2-negative (ER+) and HER2-positive cancer (HER2+). A total of 271 invasive cancers in 269 patients undergoing preoperative MRI and surgery were included. Two radiologists retrospectively assessed morphological and kinetic characteristics on DCE-MRI and tumour detectability on DWI. Apparent diffusion coefficient (ADC) values of lesions were measured. Clinical and MRI features of the three subtypes were compared. Compared with ER+ (n = 119) and HER2+ (n = 94), larger size, round/oval mass shape, smooth mass margin, and rim enhancement on DCE-MRI were significantly associated with TNBC (n = 58; P < 0.0001). On DWI, mean ADC value (× 10(-3) mm(2)/s) of TNBC (1.03) was higher than the mean ADC values for ER+ and HER2+ (0.89 and 0.84; P < 0.0001). There was no difference in tumour detectability (P = 0.099). Tumour size (P = 0.009), mass margin (smooth, P < 0.0001; irregular, P = 0.020), and ADC values (P = 0.002) on DCE-MRI and DWI were independent features of TNBC. In addition to the morphological features, higher ADC values on DWI were independently associated with TNBC and could be useful in differentiating TNBC from ER+ and HER2+. • Triple-negative breast cancers (TNBC) lack oestrogen/progesterone receptors and HER2 expression/amplification. • TNBCs are larger, better defined and more necrotic than conventional cancers. • On MRI, necrosis yields high T2-weighted signal intensity and ADCs. • High ADC values can be useful in diagnosing TNBC.

Cavernous Hemangioma of the Accessory Parotid Gland

We report a rare case of a hemangioma arising from the accessory parotid gland. The patient, a 45-year-old woman, complained of a right midcheek mass. Magnetic resonance imaging showed a well-defined mass located in the right buccal space, anterior to the masseter muscle, and adjacent to the Stensen duct. The mass had high T2-weighted signal intensity and showed strong patchy enhancement with gadolinium. This mass was surrounded by a common capsule with the accessory parotid gland. These findings indicated a hemangioma originating from the accessory parotid gland. The mass was completely removed by an intraoral approach without postoperative facial palsy, skin deformity, and difficulty in secreting saliva. Histologic examination of the tumor revealed multiple, thin-walled, and dilated blood vessels, confirming the diagnosis of a cavernous hemangioma. Magnetic resonance imaging was extremely useful in diagnosing the mass as a hemangioma before surgery, clarifying relationships between the mass and adjacent structures and determining the surgical approach to the mass.

Traumatic Bone Bruises in the Athlete’s Knee

Context:Mobile water within the bone marrow is a physiological phenomenon that is identifiable on magnetic resonance (MR) imaging, and signal changes can result from blood pooling, reactive hyperemia, edema, and microfracture. When these MR lesions are associated with an acute traumatic event, the findings are referred to as bone bruises and so represent a unique manifestation of injury. This review discusses bone bruises in anterior cruciate ligament (ACL) tears, patella dislocations, occult fractures, and contusions.Methods:A PubMed search of the literature from 1982 to December 2009 was conducted with the terms knee and bone bruise.Results:Bone bruises are associated with ACL tears, patella dislocations, occult fractures, and contusions. For each injury, a unique pattern of bone bruising is found on MR imaging, which results from the acute trauma. When acute trauma produces a subchondral lesion with low T1-weighted and high T2-weighted signal intensity, the resulting bony contusion is best described as a bone bruise.Conclusions:Bone marrow edema is identified using MR imaging and may result from traumatic or atraumatic causes. Bone bruises can be characterized by their pattern at presentation, by the mechanism of injury, and by their associated injuries. This type of bone edema can accompany contact and noncontact ACL ruptures as well as patella dislocations. Although increased marrow edema can be associated with an occult fracture, the long-term significance of these lesions is unclear.

Painful Lateral Knee Condyle Bone Marrow Edema after Treatment with Lateral Wedged Insole

A 50-yr-old man arrived at our department for a rehabilitation prescription after a right knee medial collateral ligament sprain. Magnetic resonance imaging showed medial collateral ligament partial rupture and medial femoral condyle increased signal intensity indicating bone edema. After treatment, the patient still complained of weight-bearing knee medial compartment pain. A lateral wedged insole was prescribed to decrease medial compartment compression forces. Initial response to insole use was good, but soon after, the patient complained of severe worsening knee pain. On examination, the lateral joint line and condyle palpation were tender. Insole use discontinuation was recommended, and another magnetic resonance imaging scan was performed. It showed an high T2-weighted signal intensity, representing bone marrow edema comprising a volume of 5 x 5 x 4.5 cm of lateral femoral condyle. Discontinuation of orthosis use relieved the pain, and the edema disappeared. To our knowledge, lateral femoral condyle painful bone marrow edema after lateral wedged insole use has not been previously described. The findings of this case report indicate that lateral wedged insole prescription should be carefully evaluated.

Magnetic resonance imaging appearances following hindquarter amputation for pelvic musculoskeletal malignancy

To describe our experience of the magnetic resonance imaging (MRI) appearances after hindquarter amputation, focusing on the normal pattern of time-related changes in signal intensity within the amputation flap and appearances of local disease recurrence. This was a retrospective review of the records of patients identified on our orthopaedic oncology database who had undergone hindquarter amputation at our centre. Examinations were divided into one group consisting of 'normal' postoperative findings and another group demonstrating local recurrence. 'Normal' postoperative findings were assessed for signal intensity, morphology and presence of the 'muscle texture sign' within the amputation flap. Examinations were grouped according to time from surgery. Examinations demonstrating local recurrence were assessed for site, signal intensity, morphology and axial dimensions of recurrent tumour. Comparison was made to pre-operative imaging. Thirty-five patients with postoperative MR images were identified. Seventy-seven examinations were reviewed (range 1-18 per patient). The 'normal group' comprised 18 patients (seven female, 11 male, mean age 44 years, range 16-75 years), with 47 examinations reviewed. The 'muscle texture sign' was preserved in all examinations in this group. Up to 6 months after surgery, 100% (10) of examinations showed hyperintense T2- and short-tau inversion recovery (STIR-weighted) signals within the muscle flap, indicating oedema. Only after 4 years was the muscle flap signal isointense in all cases (13). Up to 6 months after surgery, 50% (5 of 10) of examinations demonstrated flap swelling, but after 1 year, 100% (28) showed atrophy. Twenty percent (2 of 10) of examinations 0-6 months from surgery showed hyperintense T1-weighted signal within the muscle flap, consistent with fatty infiltration, but after 2 years, 100% (20) showed a hyperintense T1-weighted signal. The 'local recurrence' group comprised 20 patients (six female, 14 male, mean age 45.7 years, range 14-69 years), with 30 examinations demonstrating recurrent disease or metastasis. There were 23 recurrent tumours, of which 43% (10) were in the muscle component of the amputation flap, 13% (3 of 23) were in subcutaneous tissues of the flap, 13% (3 of 23) were at the posterior margin of the bone resection and 13% (3 of 23) were paraspinal. All recurrent tumours demonstrated hyperintense T2 and STIR signals. The signal intensity pattern of recurrence closely followed that of the original tumour. The 'muscle texture sign' was absent in all examinations demonstrating recurrence in muscle flap. A pattern of time-related signal intensity and morphological changes is observed within normal hindquarter amputation flaps on MRI. Recurrent disease is most likely to occur within the muscle flap, typically of high T2-weighted signal intensity and characteristically follows the signal pattern of the original tumour.

Brainstem Involvement in Sjögren's Syndrome‐Related Sensory Neuronopathy

Sensory neuronopathies (SN) are peripheral nervous system disorders associated with degeneration of dorsal root ganglion neurons. Magnetic resonance imaging (MRI) studies have shown abnormalities limited to T2-weighted high signal intensity in the posterior columns. A 65-year-old woman with Sjögren syndrome had slowly progressive unsteadiness of gait and limb paresthesias. A blink reflex examination suggested a paramedian brainstem lesion, confirmed by MRI. Sjögren's syndrome-related SN may be associated with a more diffuse immune-mediated aggression, involving also the brainstem, and leading to some of the blink reflex abnormalities observed in nonparaneoplastic SN.