Intravenous Gadolinium Research Articles

Aiming for a simpler early arthritis MRI protocol: can Gd contrast administration be eliminated?

To evaluate whether intravenous gadolinium (Gd) contrast administration can be eliminated when evaluating synovitis and tenosynovitis in early arthritis patients, thereby decreasing imaging time, cost, and invasiveness. Wrist MRIs of 93 early arthritis patients were evaluated by two readers for synovitis of the radioulnar, radiocarpal, and intercarpal joints, according to the Rheumatoid Arthritis MRI Scoring method (RAMRIS), and for tenosynovitis in ten compartments. Scores of MRI images without Gd contrast enhancement were compared to scores obtained when evaluating all, including contrast-enhanced, MRI images as reference. Subsequently, a literature review and pooled analysis of data from the present and two previous studies were performed. At the individual joint/tendon level, sensitivity to detect synovitis without Gd contrast was 91 % and 72 % for the two readers, respectively, with a specificity of 51 % and 81 %. For tenosynovitis, the sensitivity was 67 % and 54 %, respectively, with a specificity of 87 % and 91 %. Pooled data analysis revealed an overall sensitivity of 81 % and specificity of 50 % for evaluation of synovitis. Variations in tenosynovitis scoring systems hindered pooled analyses. Eliminating Gd contrast administration resulted in low specificity for synovitis and low sensitivity for tenosynovitis, indicating that Gd contrast administration remains essential for an optimal assessment. • Eliminating gadolinium contrast administration results in low specificity for synovitis • For tenosynovitis, sensitivity is low without gadolinium contrast administration • Gadolinium contrast administration remains essential for evaluating synovitis and tenosynovitis in early arthritis.

Multicentric Adrenal Myelolipomas: Case Report

Adrenal myelolipomas are rare and non-functioning benign tumors. They are composed of adipose tissue and hemopoietic elements in varying proportions. In this report we present the case with two myelolipomas at the right adrenal gland that was undefined in the literature. A 40-year-old female patient referred our hospital for overweight. During searching the etiology of obesity, lesions were found incidentally on the abdominal computed tomography (CT) imaging. On the right adrenal gland two well-circumscribed mass lesions were found, and magnetic resonance imaging (MRI) was performed. After intravenous (IV) gadolinium administration no contrast enhancement was seen. Surgical operation was recommended to the patient, but the patient has not accepted yet. In the literature, bilateral adrenal myelolipomas were reported, but multicentric adrenal myelolipomas in the same adrenal gland have not been reported yet. In our case we have shown multicentric adrenal myelolipomas which can be seen in the same adrenal gland. Radiologic imaging keeps the most important place in the diagnosis of lesion and planning of the treatment. J Med Cases. 2015;6(2):91-94 doi: http://dx.doi.org/10.14740/jmc1917w

Hypothalamic Hamartomas: Two Cases

This is a MRI study of two patients presented with history of gelastic seizures since many years ago. Plain and post intravenous gadolinium multiplanar MRI imaging of the brain is performed. It showed well-defined non-enhancing mass lesions in the region of hypothalamus and tuber cinereum. It showed signal intensity similar to the gray matter and imaging diagnosis of hypothalamic hamartoma is made.

Additional Diagnostic Value of Inversion Recovery Single-Shot Fast-Spin Echo Sequence in Differentiation Between Hepatic Hemangiomas and Cysts.

The aim of this study was to evaluate the additional diagnostic value of "inversion recovery" single-shot fast-spin echo (IR-SSFSE) sequence using the inversion time at the null point for hepatic hemangiomas as a supplement to standard T2-weighted (T2W) magnetic resonance imaging for the distinction of hemangiomas and cysts. A total of 228 lesions in 56 patients were evaluated in this retrospective study. In addition to routine hepatic magnetic resonance imaging, IR-SSFSE imaging using inversion time value of 600 milliseconds (null point for hepatic hemangiomas) was obtained. Two radiologists independently reviewed T2W images at first and T2W images plus IR-SSFSE sequence 4 weeks afterward and used a 5-point scale to indicate the possibility of detected hyperintense lesion is a cyst or a hemangioma. A receiver operating characteristic analysis and κ statistics were used to evaluate the diagnostic additive value of IR-SSFSE sequence for differentiation of hepatic hemangiomas and cysts, and to determine interobserver agreement, respectively. Among 228 lesions, diameters of which ranges from 2 to 125 mm (mean, 13.84 ± 16.24 mm), 56.14% of them (n = 128) were hemangiomas, and 43.86% of them were cysts (n = 100). In the receiver operating characteristic analysis for the differentiation of hepatic hemangiomas from cysts, the calculated area under the curve (AUC) for standard T2W images alone was 0.889 (95% confidence interval [CI], 0.825-0.953) for the first observer and 0.913 (95% CI, 0.861-0.965) for the second observer. When IR-SSFSE sequence was combined to T2W images, AUC was calculated as 0.958 (95% CI, 0.920-0.996) for the first observer and 0.980 (95% CI, 0.956-1.0) for the second observer. The AUC values obtained from standard T2W images and standard T2W plus IR-SSFSE images were significantly different for both observers (P < 0.01). Both observers demonstrate better performance in differentiating hemangiomas and cysts with a combination of IR-SSFSE sequence and T2W imaging than with T2W imaging alone. Adding IR-SSFSE sequence as a supplement to standard T2W images improved the sensitivity and the κ values. Inversion recovery single-shot fast-spin echo sequence using the inversion time to null signal from the hepatic hemangiomas as a supplement to standard T2W images is useful for distinguishing hemangiomas from hepatic cysts without the need for intravenous gadolinium chelate administration.

Magnetic resonance elastography of liver: influence of intravenous gadolinium administration on measured liver stiffness.

To evaluate the effect of intravenous gadolinium-diethylenetriamine penta-acetic acid (Gd-DTPA) on estimation of liver stiffness using magnetic resonance elastography (MRE) for detection of liver fibrosis. Liver MRI with MRE was performed in 210 subjects on a single 1.5 Tesla clinical MRI scanner. Liver MRE was performed before intravenous Gd-DTPA injection (NC-MRE) and 5 minutes post injection (PC-MRE) using a modified phase-contrast gradient-echo sequence (TR/TE=100/27 ms, FOV = 30-46 cm, 4 x 10 mm slices, gap 5 mm) which automatically generated stiffness maps. Two readers' blinded to clinical details independently performed liver stiffness measurements (LSM) by drawing 2 or more regions of interest (ROI) on the stiffness maps on each of the four slices of NC-MRE and PC-MRE obtained for each patient. The mean LSM in kilopascals (kPa) for NC-MRE and PC-MRE was calculated. The correlation between NC-MRE and PC-MRE LSM was evaluated with a paired t test and Pearson's correlation analysis, and the inter-observer correlation was evaluated using intra class coefficient (ICC) analysis. A receiver operating curve analysis (ROC) was performed to compare accuracies for detection and staging of liver fibrosis in a subgroup of 72 subjects with histological confirmation of liver fibrosis. There was an excellent correlation between NC-MRE and PC-MRE LSM (R(2)=0.98, p<0.001) with no significant differences. The interobserver agreement was also excellent (ICC, 0.94-0.99). There were no significant differences in the cut-off LSM value/accuracy/sensitivity/specificity for detection of significant liver fibrosis with NC-MRE and PC-MRE (2.98 kPa/98.5%/100%/88%, p<0.001 and 3.1 kPa/98.2%/98%/88%, p<0.001 respectively). Intravenous Gd-DTPA had no significant influence on LSM with MRE and does not significantly affect the diagnostic performance of MRE for fibrosis detection.

Histoplasmosis Masquerading as a Rheumatoid Nodule in an Immunocompromised Host: A Case Report.

Articular infection has infrequently been described as being caused by Histoplasma capsulatum . We report a case of a periarticular shoulder mass due to an H. capsulatum infection that mimicked the clinical presentation of a rheumatoid nodule. This case highlights the importance of microbiologic examination when an inflammatory soft-tissue mass is identified, particularly in an immunocompromised host who may not present with classic signs or symptoms of infection. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A sixty-three-year-old man with rheumatoid arthritis presented with a six-month history of pain and swelling of the left shoulder. Medications included methotrexate (12.5 mg weekly), leflunomide (30 mg daily), and prednisone (5 mg daily). He had no history of tumor necrosis factor antagonist therapy. A review of systems was noteworthy for fatigue, joint pain, stiffness, and swelling; he denied chest pain, cough, shortness of breath, fevers, chills, or night sweats. Physical examination revealed a temperature of 36.6°C and a nontender mass over the anterior aspect of the left shoulder; there was no overlying warmth or erythema. The peripheral blood leukocyte count was normal at 8800 cells/mm3 with a polymorphonuclear (PMN) predominance (83%); the remainder of the complete blood-cell count and comprehensive metabolic panel was within normal limits. Erythrocyte sedimentation rate (ESR) was elevated at 65 mm/h, and the C-reactive protein (CRP) level was elevated at 36.5 mg/L. Magnetic resonance imaging (MRI) of the left shoulder following intravenous gadolinium contrast administration revealed an enhancing mass involving the rotator cuff musculature, soft tissue, and adipose tissue. The mass was predominantly extra-articular, but intra-articular enhancement was also noted. The long head of the biceps tendon was completely torn, and there was circumferential labral tearing and degeneration (Figs. 1-A through 1-D). Positron emission tomography revealed markedly increased …

Musical Hallucination in a Patient With Frontal Lobe Meningioma

Introduction: Many conditions can mimic psychiatric symptoms. Amongst them, intracranial mass and space occupying lesions have a significant importance. Aggression and hallucination are seen in association with a basal frontal lesion, and may mimic psychotic syndromes. Case Presentation: A 37-year-old man with no previous mental illness presented with a month history of headache, blurred vision, diplopia, aggression, loss of interest, fatigue, insomnia, and depressed mood. He was suffering from daily auditory hallucination which described as musical hallucination lasting about an hour per day. The headache was tension-type which appeared swinging, two times per week lasting 30 minutes. After auditory hallucination, the patient disclosed nausea, vomiting, and transient loss of consciousness. He referred from a neurologist, because, conventional therapy for the patient had not response. There were no other neurological symptoms or deficits. The results of neurologic examination including evaluation of the cranial nerves as well as head and neck examination were normal; But, psychiatric symptoms developed. Therefore, he was admitted to the psychiatric ward. The patient was diagnosed with major depressive disorder (MDD) with psychotic feature by Diagnostic and Statistical Manual of Mental Disorders (DSM) IV criteria and received psychiatric treatment. He started on antipsychotic agent (olanzapine 5 mg tablet/bid), antidepressant (sertraline 50 mg tablet/qhs) and valproate sodium 200 mg tablet/bid for treatment of aggression and headaches. After five days of admission, primary symptoms of headache and auditory hallucination were better but diplopia and blurred vision were still present. Ophthalmology examination revealed. The pupils were round, isochoric, and normoreactive to light and accommodation, and there was no sign of a relative afferent pupillary defect. Ophthalmoscopy showed a papilledema in both eyes. In order to rule out the intracranial pressure and their causes, neuroimaging was requested. An emergent noncontrast-enhanced computed tomography (CT) image of the head revealed a hyperdense mass in midfrontal convexity. Magnetic resonance imaging of the brain and orbits with and without intravenous gadolinium enhancement further delineated the CT findings and highlighted a large avidly enhancing midline mass within the frontal region measuring approximately 48×50×42 mm in axial dimension, consistent with a meningioma. The patient discharged from psychiatric ward with necessary advices and was admitted to the neurosurgery ward for further evaluation. A first psychosis episode is a clinical condition with principal indication for cerebral CT-scan. Discussion: Meningioma is a common intracranial tumor with a variety of histomorphologic growth patterns, which are usually easily recognized. The three most common symptoms are headaches, mental status changes, and paresis. Aggression and hallucination are seen in association with a basal frontal lesion and may mimic psychotic syndromes like hypomania and schizophrenia. A first psychosis episode is a clinical condition with principal indication for cerebral CT-scan.

Magnetic resonance enterography in pregnant women with Crohn's disease: case series and literature review.

BackgroundEvaluation of pregnant women with known or suspected Crohn’s disease (CD) remains a challenge. Magnetic Resonance Enterography (MRE) is a promising diagnostic tool in these patients; however, the clinical data on MRE utilization in pregnancy is scarce. The aim of the study was to describe the experience with MRE in pregnant CD patients in a tertiary referral center.MethodsWe retrospectively reviewed MRE studies performed in pregnant women with known or suspected CD that were performed between January 2007 and November 2012. Imaging findings, clinical management and outcome were extracted from patient’s file and electronic records. Image quality was evaluated.ResultsTen studies of 9 patients were included. MRE protocol was modified to maximize maternal and fetal safety, and intravenous gadolinium was not used. In 7 patients, CD diagnosis was previously established; six were admitted with clinical symptoms consistent with CD exacerbation, and an additional patient with a recurrent groin abscess without apparent luminal symptoms. In all seven patients, imaging features consistent with active CD were detected; new penetrating complications were detected in 4 patients. Two patients underwent MRE for suspected CD which was not comforted by study results. The clinical management was significantly impacted by MRE results in all positive cases. The image quality of the fast MRE sequences obtained without gadolinium was satisfactory and allowed meaningful interpretation.ConclusionMRE with an adapted protocol for pregnancy is a reliable imaging modality to manage in pregnant women with known or suspected CD.

The use of intravenous gadolinium in children with an incidental MRI finding of a syrinx – is it justified?

The use of intravenous gadolinium in children with an incidental MRI finding of a syrinx – is it justified?

Common Carotid Intima Media Thickness and Ankle-Brachial Pressure Index Correlate with Local but Not Global Atheroma Burden: A Cross Sectional Study Using Whole Body Magnetic Resonance Angiography

BackgroundCommon carotid intima media thickness (CIMT) and ankle brachial pressure index (ABPI) are used as surrogate marker of atherosclerosis, and have been shown to correlate with arterial stiffness, however their correlation with global atherosclerotic burden has not been previously assessed. We compare CIMT and ABPI with atheroma burden as measured by whole body magnetic resonance angiography (WB-MRA).Methods50 patients with symptomatic peripheral arterial disease were recruited. CIMT was measured using ultrasound while rest and exercise ABPI were performed. WB-MRA was performed in a 1.5T MRI scanner using 4 volume acquisitions with a divided dose of intravenous gadolinium gadoterate meglumine (Dotarem, Guerbet, FR). The WB-MRA data was divided into 31 anatomical arterial segments with each scored according to degree of luminal narrowing: 0 = normal, 1 = <50%, 2 = 50–70%, 3 = 70–99%, 4 = vessel occlusion. The segment scores were summed and from this a standardized atheroma score was calculated.ResultsThe atherosclerotic burden was high with a standardised atheroma score of 39.5±11. Common CIMT showed a positive correlation with the whole body atheroma score (β 0.32, p = 0.045), however this was due to its strong correlation with the neck and thoracic segments (β 0.42 p = 0.01) with no correlation with the rest of the body. ABPI correlated with the whole body atheroma score (β −0.39, p = 0.012), which was due to a strong correlation with the ilio-femoral vessels with no correlation with the thoracic or neck vessels. On multiple linear regression, no correlation between CIMT and global atheroma burden was present (β 0.13 p = 0.45), while the correlation between ABPI and atheroma burden persisted (β −0.45 p = 0.005).ConclusionABPI but not CIMT correlates with global atheroma burden as measured by whole body contrast enhanced magnetic resonance angiography in a population with symptomatic peripheral arterial disease. However this is primarily due to a strong correlation with ilio-femoral atheroma burden.

Visualization of White Matter Tracts Using a Non-Diffusion Weighted Magnetic Resonance Imaging Method: Does Intravenous Gadolinium Injection Four Hours Prior to the Examination Affect the Visualization of White Matter Tracts?

ObjectivesVisualization of white matter (WM)-tracts such as the corticospinal tract (CST), medial lemniscus (ML), and superior cerebellar peduncle (SCP) using delayed enhanced (DE)-heavily T2-weighted three-dimensional fluid-attenuated inversion-recovery (hT2w-3D-FLAIR) imaging has recently been reported. In that report, all patients were clinically suspected of having Ménière’s disease, because DE-hT2w-3D-FLAIR imaging of the inner ear has been reported to separately visualize perilymph and endolymph fluid and can identify the presence of endolymphatic hydrops. Therefore, the previous report could not rule out the possible effect of delayed enhancement. From this perspective, the purpose of this study was to elucidate if the use of gadolinium affects the visualization of WM-tracts on hT2w-3D-FLAIR.Materials and MethodsThe records of nine patients with suspected Ménière’s disease who underwent plain (P) and DE-hT2w-3D-FLAIR by 3-Tesla were retrospectively analyzed. The regions of interest were set on the CST, ML, and SCP, and on contiguous brain parenchyma: The thalamus (Th), pontine parenchyma (PP), and cerebellar parenchyma (CP), respectively. The signal intensity ratio between each WM-tract and the relevant contiguous brain parenchyma was calculated for both P- and DE-hT2w-3D-FLAIR images, and statistically compared using paired t-tests.ResultsThe CST/Th signal intensity ratio was 3.75±0.67 on P-hT2w-3D-FLAIR and 3.62±0.50 on DE-hT2w-3D-FLAIR (p = 0.24). The ML/PP signal intensity ratio was 2.19±0.59 on P-hT2w-3D-FLAIR and 2.08±0.53 on DE-hT2w-3D-FLAIR (p = 0.25). The SCP/CP signal intensity ratio was 4.08±0.91 on P-hT2w-3D-FLAIR and 4.04±0.96 on DE-hT2w-3D-FLAIR (p = 0.43). There were no significant differences in the signal intensity ratios between P- and DE-hT2w-3D-FLAIR images.ConclusionsThe use of gadolinium is not necessary for visualization of WM-tracts using hT2w-3D-FLAIR, and P-hT2w-3D-FLAIR without gadolinium may have future clinical applications as an imaging procedure.

Stevens - Johnson syndrome occurring As an Adverse Reaction to Intravenous Gadolinium Contrast

Stevens - Johnson syndrome occurring As an Adverse Reaction to Intravenous Gadolinium Contrast

Endoscopic endonasal trans-sphenoidal management of cystic sellar lesions

Introduction The trans-sphenoidal route is now considered the standard approach for pituitary adenomas. This approach is increasingly safe with the use of endoscope. Aim of the study The aim of this study was to assess 11 patients with cystic sellar lesion operated by an endoscopic endonasal trans-sphenoidal approach. Patients and methods Between January 2007 and January 2011, 11 patients underwent standard endoscopic endonasal trans-sphenoidal surgery in the neurosurgical department, Tanta University, Egypt. All patients underwent complete clinical, endocrinological, and visual field evaluation before operation. The imaging study was performed by MRI of the sellar region with and without intravenous gadolinium contrast. Results The study included 11 patients: six female patients and five male patients, with a mean age of 34 years. The aim of the procedure for cystic lesion was to open the cyst cavity and remove a part of its wall through the sphenoid sinus and to remove the solid component if present. Conclusion The use of endoscopy in the treatment of cystic lesion is considered a very useful tool with its panoramic view that permits better exploration of the cystic cavity to assess the completeness of tumor removal.

Reperfusion Injury on Magnetic Resonance Imaging After Carotid Revascularization

Reperfusion injury can be revealed as delayed gadolinium enhancement in the subarachnoid space on a fluid-attenuated inversion recovery image, which is designated as a hyperintense acute reperfusion marker (HARM). We sought to investigate the occurrence and predictors of HARM and its association with new ischemic infarcts after carotid revascularization. Forty-five patients who underwent carotid endarterectomy or stenting were prospectively enrolled. Diffusion-weighted imaging and fluid-attenuated inversion recovery were performed before and 24 hours after the procedures. Postprocedural fluid-attenuated inversion recovery was done after intravenous gadolinium injection. HARM was observed in 8 (17.8%) patients. Of these, 4 patients showed neurological deterioration associated with HARM. These symptomatic HARMs disappeared on follow-up magnetic resonance imaging. Patients with symptomatic HARM were older (P=0.010) and had more frequent leukoaraiosis (P=0.012) and higher postprocedural systolic blood pressure (P=0.025) than those without. New brain infarcts on postprocedural diffusion-weighted imaging were identified in 13 (28.9%) patients. HARM was not associated with new infarcts. HARM after carotid revascularization is not uncommon. Symptomatic HARM was associated with old age, underlying leukoaraiosis, and postprocedural high blood pressure.

Atypical imaging observations of branchial cleft cysts

The aim of the present study was to assess the atypical imaging manifestations of branchial cleft cysts (BCCs) confirmed by pathology. Computerized tomography (CT) or magnetic resonance imaging (MRI) of 17 BCC cases were reviewed. The imaging features, including laterality, location, border, attenuation and internal architecture, were evaluated. All 17 cases were second BCCs, including 5 cases of Bailey type I classification cysts and 12 cases of type II classification cysts. The atypical imaging features included signal and morphological abnormalities. The abnormal signal intensities were caused by intracapsular bleeding (n=2) or solidification of cystic fluid (n=2). Intracystic hemorrhaging revealed homogeneous hyperintensity on T1-weighted image (T1WI) and T2-weighted image (T2WI). Solidification of cystic fluid revealed slightly homogeneous hyperintensity compared with muscle on T1WI and homogeneous hypointensity on T2WI without enhancement. The aberrant morphology mainly presented as thickening of the cystic wall (n=13). Thickened walls of BCCs with ill- (n=5) or well- (n=8) defined borders were observed in 13 patients. In 3 patients, significant enhancement was identified following intravenous gadolinium administration (n=4). When with atypical CT or MRI features are presented, the typical location of BCCs can help in the diagnosis, as it is located at the lateral portion of the neck adjacent to the anterior border of the mandibular angle or sternocleidomastoid muscle. The atypical observations, including variable signals, imply that the cystic content has changed. Thickened walls indicate inflammation or cancerous tendency and patients with ill-defined margins, vascular involvement or lymphadenopathy atelectasis indicate malignant conversion.

Retraction Note to: CT and MR findings in a neuroforaminal extraskeletal Ewing sarcoma mimicking benign nerve sheath tumor

We report the CT and MR findings in a 30-year-old man with extraskeletal Ewing sarcoma (EES) involving the left neural foramen at L5–S1 level. The patient was evaluated with preoperative lumbosacral CT and MR imaging and postoperative lumbosacral MR imaging. The lesion was hyperdense on CT, isointense on T1- and T2-weighted MR images, and enhanced homogeneously after intravenous gadolinium injection. With these CT and MR findings, surgery was performed with a presumptive diagnosis of nerve sheath tumor, but the histopathological examination revealed EES. Chemotherapy and radiotherapy were planned postoperatively. This case illustrates that even in benign looking lesions in a neuroforamen one can never exclude malignancy, and this is even more true in a population of young adults.

Mycetoma Involving the Heart

A 59-year-old female farm worker developed a dark-centered cutaneous lesion in her right leg, associated with progressive swelling for the past 35 years. During the past 4 years, she also had dry cough and dyspnea, which became more intense for the past 6 months. She complained of asthenia and weight loss of 10 kg in the previous year. The patient had diabetes mellitus and hypertension. On physical examination, she had crackling rale at the base of the lungs, edema of the distal right lower limb, with several sinuses and ulcerated lesions of ≈1 cm with purulent discharge (Figure 1). Figure 1. Right lower foot with several ulcerated lesions with purulent discharge. Radiographic studies showed lytic foci of destruction in the medullary cavity with bone expansion, reactive sclerosis, and thickening of the cortex in right tibia and in bones of the right foot. Metatarsal bones also had cortical scalloping (Figure 2A and 2B). T1-weighted magnetic resonance image of the right foot with fat suppression after intravenous gadolinium demonstrate numerous round lesions containing small low-signal foci, also known as dot-in-circle sign, representing granulation tissue surrounded …

Imaging Evaluation of Endolymphatic Hydrops in Cases with Otosclerosis

Objectives: Human temporal studies have shown that endolymphatic hydrops (EH) is accompanied by otosclerosis, which is a risk factor for complications after stapes surgery. Recently, visualization of EH has become possible using magnetic resonance imaging (MRI) with contrast agents. The presence of EH in cases with otosclerosis was investigated by MRI to prevent complications following stapes surgery. Methods: Sixteen ears from nine cases diagnosed as having otosclerosis were evaluated by 3-Tesla MRI examinations taken 4 h after intravenous gadolinium injection. More than half of the ears showed mixed hearing loss and were suspected to have cochlear otosclerosis. Imaging data were compared with clinical findings in all ears and postoperative symptoms in ears undergoing surgery. Results: Varying degrees of EH were observed in 14 of the 16 ears. Episodes of acute sensorineural hearing loss or vertigo occurred in 4 ears with severe EH in the cochlea and 3 ears with severe EH in the vestibules. Overall, 12 of 14 ears with EH did not undergo stapes surgery. Ears without EH showed no postoperative complications, but one ear with mild EH in the vestibule showed severe vertigo following the surgery. Conclusions: The presence of EH in cases with otosclerosis was clearly visualized, and the degree of EH was correlated with the clinical findings in most patients. Such preoperative MRI evaluation could provide useful information to prevent complications following stapes surgery.

Cardiac MRI for Myocardial Ischemia

Proper assessment of the physiologic impact of coronary artery stenosis on the LV myocardium can affect patient prognosis and treatment decisions. Cardiac magnetic resonance imaging (CMR) assesses myocardial perfusion by imaging the myocardium during a first-pass transit of an intravenous gadolinium bolus, with spatial and temporal resolution substantially higher than nuclear myocardial perfusion imaging. Coupled with late gadolinium enhancement (LGE) imaging for infarction during the same imaging session, CMR with vasodilating stress perfusion imaging can qualitatively and quantitatively assess the myocardial extent of hypoperfusion from coronary stenosis independent of infarcted myocardium. This approach has been validated experimentally, and multiple clinical trials have established its diagnostic robustness when compared to stress single-photon emission computed tomography. In specialized centers, dobutamine stress CMR has been shown to have incremental diagnostic value above stress echocardiography due to its high imaging quality and ability to image the heart with no restriction of imaging window. This paper reviews the technical aspects, diagnostic utility, prognostic values, challenges to clinical adaptation, and future developments of stress CMR imaging.

FRI0398 Tenosynovitis and intratendineous tophi in GOUT: An extremity-dedicated MRI study of the hand and wrist

BackgroundTenosynovitis is a frequent condition in rheumatoid (RA) and psoriatic arthritis, but its frequence in gouty patients is not well known. In gout, it has been recently demonstrated in association...