Magnetic Resonance Features Research Articles

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) masquerading as CNS demyelination

BackgroundCADASIL is the most common single-gene disorder causing ischemic stroke. CADASIL has been linked to mutations in NOTCH3 gene, due to heterozygous missense mutations. The disease is of insidious onset, presenting with initial clinical features in third and fourth decade of life. However, it is now being increasingly acknowledged that individual clinical presentation, age, time of onset as well as disease severity are quite varied among patients with CADASIL most likely leading to under- or mis-diagnosis. The authors thereby report a genetically confirmed case of CADASIL with atypical clinical course and findings.Case presentationA 48-year-old woman presented with complaints of episodic headache, relapsing–remitting neurological illness, progressive cognitive impairment, and acute-onset loss of speech and ambulation. She was earlier being treated as a case of CNS demyelination for 10 years. On examination, vital parameters were within normal limits. Neurological examination revealed that the patient was drowsy, not verbalizing, not obeying commands, with movement of all four limbs on painful stimuli, hypertonia of all limbs, grade 3 + deep tendon reflexes, bilateral striatal toe and extensor plantar response. Magnetic resonance imaging of brain showed involvement of anterior temporal lobe and external capsule along with multiple acute infarcts. Cerebrospinal fluid analysis was found to be normal. Exome sequencing revealed heterozygous missense mutation in exon 2 of NOTCH3 gene. A definite diagnosis of CADASIL was made and patient was started on fluoxetine and aspirin, following which there was significant improvement over 4–6 weeks. Patient is able to carry out daily activities independently although continues to have mild persistent cognitive impairment with excessive talking and over familiarity.ConclusionsAs CADASIL has a relapsing and partially remitting course with frequently observed varied clinical presentation, patients may receive treatment for demyelination which may not be necessary. Hence, detailed family history along with knowledge of characteristic magnetic resonance imaging findings seen in CADASIL can help discern the diagnosis.

Cardiac Magnetic Resonance Features of Fabry Disease: From Early Diagnosis to Prognostic Stratification.

In the past few years, the wide application of cardiac magnetic resonance (CMR) significantly changed the approach to the study of cardiac involvement in Fabry Disease (FD). The possibility to perform non-invasive tissue characterization, including new sequences such as T1/T2 mapping, offered a powerful tool for differential diagnosis with other forms of left ventricular hypertrophy. In patients with confirmed diagnosis of FD, CMR is the most sensitive non-invasive technique for early detection of cardiac involvement and it provides new insight into the evolution of cardiac damage, including gender-specific features. Finally, CMR multiparametric detection of subtle changes in cardiac morphology, function and tissue composition is potentially useful for monitoring the efficacy of specific treatment over time. This paper aims to provide a comprehensive review of current knowledge regarding the application of CMR in FD cardiac involvement and its clinical implication.

MR features of high-pressure injection injuries caused by grease and paints

ObjectiveThis study investigates the magnetic resonance (MR) features of high-pressure injection injuries (HPII) caused by grease and paints to detect the presence of foreign material and associated complications. MethodsSixteen rat models with HPII were established by injecting industrial grease and marine paints (n = 8 each) into their thighs. All the rats underwent a 3.0 T MR scanning, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), Fat-suppressed T2-weighted imaging (FST2WI), Susceptibility-weighted imaging (SWI), and Diffusion-weighted imaging (DWI). Follow-up MR scanning was performed from 1st to 4th weeks. ResultsAcute subcutaneous grease and paints appeared as different signal intensity characteristics (grease: T1WI ↑, T2WI =, FST2WI ↓, SWI ↓, DWI ↓; paints: T1WI ↑, T2WI ↑, FST2WI ↑↓, SWI ↓, DWI ↓). As time progressed, the signal intensity of HPII lesions caused by both grease and paints became inhomogeneous. Impurity components of the foreign material appeared as marked low signal intensity on SWI. The signal intensity on DWI significantly increased subsequently due to purulent fluids (confirmed surgically). ConclusionsHPII caused by grease and paints have a characteristic appearance on MR imaging. SWI can detect impurity components of the foreign material, while DWI is highly sensitive to abscesses and helpful in monitoring infections.

Machine learning cardiac-MRI features predict mortality in newly diagnosed pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) is a rare but serious disease associated with high mortality if left untreated. This study aims to assess the prognostic cardiac magnetic resonance (CMR) features in PAH using machine learning. Seven hundred and twenty-three consecutive treatment-naive PAH patients were identified from the ASPIRE registry; 516 were included in the training, and 207 in the validation cohort. A multilinear principal component analysis (MPCA)-based machine learning approach was used to extract mortality and survival features throughout the cardiac cycle. The features were overlaid on the original imaging using thresholding and clustering of high- and low-risk of mortality prediction values. The 1-year mortality rate in the validation cohort was 10%. Univariable Cox regression analysis of the combined short-axis and four-chamber MPCA-based predictions was statistically significant (hazard ratios: 2.1, 95% CI: 1.3, 3.4, c-index = 0.70, P = 0.002). The MPCA features improved the 1-year mortality prediction of REVEAL from c-index = 0.71 to 0.76 (P ≤ 0.001). Abnormalities in the end-systolic interventricular septum and end-diastolic left ventricle indicated the highest risk of mortality. The MPCA-based machine learning is an explainable time-resolved approach that allows visualization of prognostic cardiac features throughout the cardiac cycle at the population level, making this approach transparent and clinically interpretable. In addition, the added prognostic value over the REVEAL risk score and CMR volumetric measurements allows for a more accurate prediction of 1-year mortality risk in PAH.

Characteristic Magnetic Resonance Imaging Findings of Osmotic Demyelination Syndrome in a Patient with Minimal Hyponatremia

Characteristic Magnetic Resonance Imaging Findings of Osmotic Demyelination Syndrome in a Patient with Minimal Hyponatremia

Magnetic Resonance Features of Liver Mucinous Colorectal Metastases: What the Radiologist Should Know.

Purpose: The aim of this study is to assess MRI features of mucinous liver metastases compared to non-mucinous metastases and hepatic hemangioma. Methods: A radiological archive was assessed from January 2017 to June 2021 to select patients subjected to liver resection for CRCLM and MRI in the staging phase. We selected 20 patients with hepatic hemangioma (study group B). We evaluated (a) the maximum diameter of the lesions, in millimeters, on T1-W flash 2D in phase and out phase, on axial HASTE T2-W and on portal phase axial VIBE T1 W; and (b) the signal intensity (SI) in T1-W sequences, in T2-W sequences, Diffusion-Weighted Imaging (DWI) sequences and apparent diffusion coefficient (ADC) maps so as to observe (c) the presence and the type of contrast enhancement during the contrast study. The chi-square test was employed to analyze differences in percentage values of the categorical variable, while the non-parametric Kruskal–Wallis test was used to test for statistically significant differences between the median values of the continuous variables. A p-value < 0.05 was considered statistically significant. Results: The final study population included 52 patients (33 men and 19 women) with 63 years of median age (range 37–82 years) and 157 metastases. In 35 patients, we found 118 non-mucinous type metastases (control group), and in 17 patients, we found 39 mucinous type metastases (study group A). During follow-up, recurrence occurred in 12 patients, and three exhibited mucinous types among them. In the study group, all lesions (100%) showed hypointense SI on T1-W, very high SI (similar to hepatic hemangioma) in T2-W with restricted diffusion and iso-hypointense signals in the ADC map. During the contrast study, the main significant feature is the peripheral progressive enhancement.

Structural Basis for Reduced Dynamics of Three Engineered HNH Endonuclease Lys-to-Ala Mutants for the Clustered Regularly Interspaced Short Palindromic Repeat (CRISPR)-Associated 9 (CRISPR/Cas9) Enzyme.

Many bacteria possess type-II immunity against invading phages or plasmids known as the clustered regularly interspaced short palindromic repeat (CRISPR)/CRISPR-associated 9 (Cas9) system to detect and degrade the foreign DNA sequences. The Cas9 protein has two endonucleases responsible for double-strand breaks (the HNH domain for cleaving the target strand of DNA duplexes and RuvC domain for the nontarget strand, respectively) and a single-guide RNA-binding domain where the RNA and target DNA strands are base-paired. Three engineered single Lys-to-Ala HNH mutants (K810A, K848A, and K855A) exhibit an enhanced substrate specificity for cleavage of the target DNA strand. We report in this study that in the wild-type (wt) enzyme, D835, Y836, and D837 within the Y836-containing loop (comprising E827-D837) adjacent to the catalytic site have uncharacterizable broadened 1H15N nuclear magnetic resonance (NMR) features, whereas remaining residues in the loop have different extents of broadened NMR spectra. We find that this loop in the wt enzyme exhibits three distinct conformations over the duration of the molecular dynamics simulations, whereas the three Lys-to-Ala mutants retain only one conformation. The versatility of multiple alternate conformations of this loop in the wt enzyme could help to recruit noncognate DNA substrates into the HNH active site for cleavage, thereby reducing its substrate specificity relative to the three mutants. Our study provides further experimental and computational evidence that Lys-to-Ala substitutions reduce dynamics of proteins and thus increase their stability.

Comparison of cardiovascular magnetic resonance features and clinical consequences in patients with left ventricular non-compaction with and without mitral regurgitation-a multi-institutional study of the retrospective cohort study.

Mitral regurgitation (MR) is common in patients with ischemic or idiopathic cardiomyopathies and may be associated with a poor prognosis; however, the impact of different degrees of MR on cardiovascular magnetic resonance images, left ventricular features, and clinical outcomes of left ventricular noncompaction are unknown. We aimed to investigate and compare cardiovascular magnetic resonance characteristics and clinical consequences in patients with left ventricular non-compaction (LVNC) with and without MR. A cohort of 75 patients with left ventricular noncompaction were retrospectively studied from three institutions; all had undergone cardiovascular magnetic resonance examination with subsequent clinical follow-up. MR was evaluated by echocardiography. Left ventricular myocardial strains including global radial, circumferential, and longitudinal peak strains and left ventricular geometric and functional parameters, including left ventricular ejection fraction, end-diastolic volume, end-systolic volume, left ventricular mass, left ventricular sphericity index, longitudinal shorten, and late gadolinium enhancement (LGE) were measured and compared among groups. The primary endpoint was a composite of heart transplantation, implantable cardioverter-defibrillator insertion, and cardiac death. Compared with the no MR group, the MR groups showed significant deterioration in left ventricular myocardial strains (all P<0.05), and impaired left ventricular geometry and function, including lower left ventricular ejection fraction and greater left ventricular end-systolic volume and left ventricular mass (P<0.05). In the subgroup of moderate-severe MR, patients showed more impaired cardiovascular magnetic resonance features, including left ventricular sphericity index, left ventricular end-diastolic volume, and longitudinal shorten (P<0.05). In this subgroup, Kaplan-Meier analysis showed a significant difference in clinical outcomes (log-rank χ2=4.516, P=0.034; log-rank χ2=4.419, P=0.036, respectively). Additionally, multivariate analyses showed a 6.5-fold higher [hazard ratio, 6.5 (95% CI, 1.015-41.881)] risk of cardiac death with LGE in the moderate-severe MR cohort. In patients with left ventricular noncompaction, MR induced more maladaptive left ventricular remodeling. The incidence of adverse outcomes may be related to the degree of MR. In moderate-severe MR patients, coexisting of LGE may have an additive deleterious effect on clinical outcomes.

Hyperthermic Brain Injury: Characteristic Magnetic Resonance Imaging Findings and Implications for Pathophysiology.

Hyperthermic Brain Injury: Characteristic Magnetic Resonance Imaging Findings and Implications for Pathophysiology.

Rectal Signet Ring Cell Carcinoma: Post-Chemoradiotherapy Evaluation by MRI and Corresponding to Pathology.

BackgroundSignet ring cell carcinoma (SRCC) is recognized as an uncommon subtype of colorectal carcinoma (CRC). It showed characteristic magnetic resonance imaging (MRI) manifestations. However, the MRI features post-chemoradiotherapy (CRT) were not reported, and it is unknown whether the current tumor regression grade (TRG) system by MRI (mrTRG) is applicable to SRCC.PurposeTo summarize the image features of rectal SRCC on post-CRT images corresponding to the pathology, and to determine the predicting value of mrTRG compared with TRG by pathology (pTRG).MethodsWe retrospectively enrolled seven patients (male: female = 3:4; mean age, 45.1 years) with biopsy-pathology proved SRCC, who underwent pre- and post-CRT MR imaging followed by surgery. An experienced gastrointestinal radiologist accessed mrTRG using a 5-point grading system by mandard standard on T2 weighted image (T2WI) and then added diffusion weighted image (DWI) in a 1-month interval. Additionally, MRI features were recorded on pre- and post-CRT images as follows: pattern (target sign) and main signal intensity of T2WI, characterized manifestation of DWI, and mean Apparent Diffusion Coefficient (ADC)values. The mrTRG and all MR image features were compared to the post-operative pathology.ResultsAt post-CRT histology, five patients got a good response (TRG 1, n = 4; TRG 2, n = 1), one patient got a partial response, and one patient got a poor response. The accuracy of MRI predicted the pathology response by mandard standard was 14% and increased to 71.4% when added DWI. After CRT, different degrees of homogeneous high SI without enhancement representing acellular mucin were observed in all patients, and the thick-ring high SI turned into a thin-target sign in most good responders. Moreover, the tumor volume decreased or slightly increased in good responders, while it markedly increased in the partial and poor responder by 57% and 73.8%, respectively.ConclusionHomogeneous high SI on T2WI and thin target sigh on DWI were the main MRI changes of RSRCC, which was corresponding to the mucinous regression and represents for good response post-CRT. The mrTRG and tumor volume was not a reliable indicator to the pathology response. We considered that DWI should be added to T2WI to evaluate RSRCC response to CRT.

Anatomical-MRI Correlations in Adults and Children with Hypertrophic Cardiomyopathy.

Hypertrophic Cardiomyopathy (HCM) is the most frequent hereditary cardiovascular disease and the leading cause of sudden cardiac death in young individuals. Advancements in CMR imaging have allowed for earlier identification and more accurate prognosis of HCM. Interventions aimed at slowing or stopping the disease’s natural course may be developed in the future. CMR has been validated as a technique with high sensitivity and specificity, very few contraindications, a low risk of side effects, and is overall a good tool to be employed in the management of HCM patients. The goal of this review is to evaluate the magnetic resonance features of HCM, starting with distinct phenotypic variants of the disease and progressing to differential diagnoses of athlete’s heart, hypertension, and infiltrative cardiomyopathies. HCM in children has its own section in this review, with possible risk factors that are distinct from those in adults; delayed enhancement in children may play a role in risk stratification in HCM. Finally, a number of teaching points for general cardiologists who recommend CMR for patients with HCM will be presented.

Reduction of abnormal blood flow in frozen shoulder after shoulder manipulation under ultrasound-guided cervical nerve root block: semiquantitative analysis using dynamic magnetic resonance imaging.

BackgroundWe previously reported a characteristic dynamic magnetic resonance imaging (MRI) change in patients with frozen shoulder (FS) and named this abnormal blood flow pattern the “burning sign”. In this study, a semiquantitative method was used to evaluate changes in this abnormal blood flow pattern on dynamic MRI after shoulder manipulation under ultrasound-guided cervical nerve root block (MUC) in patients with FS.MethodsNineteen patients with FS underwent MUC, with dynamic MRI performed before and after. We used dynamic MRI to semiquantitatively assess changes in the burning sign at the axillary pouch (AP) and rotator interval (RI) by examining the enhancement rate in the signal intensity and the enhancement velocity. Functional assessments included a numeric rating scale score, the range of shoulder motion, the American Shoulder and Elbow Surgeons score, and the Constant score.ResultsThe burning sign in the AP and RI was observed with dynamic MRI in all patients before MUC. The average interval from MUC until dynamic MRI was 8.2 months (range, 6-12). Clinical results for all patients improved after MUC. The before and after MUC enhancement rates (%) were 217 ± 51 and 85 ± 36 in the AP and 233 ± 61 and 73 ± 40 in the RI, respectively (both P < .001). The before and after MUC enhancement velocities (ms/s) were 902 ± 335 and 203 ± 125 in the AP and 1249 ± 634 and 213 ± 146 in the RI, respectively (both P < .001).ConclusionDynamic MRI semiquantitatively demonstrated a reduction in abnormal blood flow and improvement in clinical results after MUC in patients with FS.

Cardiac magnetic resonance features of left dominant arrhythmogenic cardiomyopathy: differential diagnosis with myocarditis

Cardiac magnetic resonance features of left dominant arrhythmogenic cardiomyopathy: differential diagnosis with myocarditis

Lower motor neuron involvement in patients with neuromyelitis optica spectrum disorders

BackgroundInvolvement of the central gray matter of spinal cord is a characteristic magnetic resonance imaging (MRI) feature of aquaporin-4-immunoglobulin G antibodies (AQP4-IgG) positive neuromyelitis optica spectrum disorders (NMOSD). However, there has been no systemic electrophysiological study investigating the frequency of lower motor neuron involvement in NMOSD patients. MethodsWe retrospectively reviewed a cohort of 59 NMOSD patients with results of concentric needle electromyography (EMG) and nerve conduction studies (NCS) that were admitted to the Department of Neurology of Chinese PLA General Hospital between January 2016 and December 2019. ResultsAcute and/or chronic denervation was found in 22.0% (13/59) of the NMOSD patients by EMG. Peripheral or cranial neuropathy indicated by abnormal NCS changes was found in 11.9% (7/59) of the NMOSD patients. Denervation indicated by EMG that can be accounted for by abnormal NCS was found in 6.8% (4/59) of the NMOSD patients, while 3.4% (2/59) of the NMOSD patients had NCS abnormality without denervation indicated by EMG. Accordingly, 9 of the 59 NMOSD patients (15.3%) had lower motor neuron involvement, and moreover, 6.8% (4/59) of the NMOSD patients had corresponding spinal cord or brainstem lesions on MRI. ConclusionNot uncommon lower motor neuron involvement exists in NMOSD patients, so needle EMG and NCS studies should be performed in NMOSD patients with suspected lower motor neuron involvement.

A Rare Case of COVID-19-Associated Acute Hemorrhagic Necrotizing Encephalopathy in a Young Patient

Coronavirus disease-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2, a strain of coronavirus. It can also present with neurological sequelae. It has been related to intracranial cytokine storm. Here, we present a case of acute hemorrhagic necrotizing encephalopathy in a young patient who presented with the characteristic magnetic resonance imaging findings. As the pandemic continues, we can expect that the spectrum of neurological presentations will widen. Knowledge of these neuroimaging features may assist in the detection and early management of neurological complications.

COMPARATIVE ANALYSIS OF FRACTAL DIMENSIONS OF HUMAN CEREBELLUM: IMPACT OF IMAGE PREPROCESSING AND FRACTAL ANALYSIS METHODS

The aim: To compare the values of the fractal dimensions of human cerebellum obtained using different algorithms of image preprocessing and different methods of fractal analysis. Materials and methods: The study involved 120 people without structural changes in the brain (age 18-86 years, 55 men and 65 women). T1- and T2-weighted MR brain images were studied. Fractal analysis was performed using box counting and pixel dilatation methods. Fractal dimensions of cerebellar tissue as a whole, cerebellar cortex and its individual layers, cerebellar white matter were measured and compared to each other and to fractal dimension of cerebellar white matter determined in cadaveric cerebella. Results: It was no significant difference between fractal dimension values of cerebellar tissue as a whole measured on T1 and T2 weighted magnetic resonance images of cerebellum, and fractal dimension values measured on the same images using different methods of fractal analysis – pixel dilatation and box counting. T2 weighted images are preferable for fractal analysis of different components of cerebellar tissue. Segmentation according to pixel luminance is the preferable image preprocessing method for fractal analysis of cerebellar cortex as a whole, individual cortical layers and cerebellar tissue as a whole; skeletonizing of cerebellar magnetic resonance images is the preferable method of the image preprocessing for fractal analysis of cerebellar white matter. Conclusions: The algorithm of image preprocessing, magnetic resonance imaging sequence and method of fractal analysis should be chosen according to aim of quantitative study of cerebellar magnetic resonance images and features of the studied structure of cerebellum.

Spectrum of magnetic resonance imaging findings in post-COVID-19 patients presenting with rhino-orbito-cerebral mucormycosis in a teaching hospital in Malwa region of Punjab.

Rhino-orbito-cerebral-mucormycosis (ROCM) associated with COVID-19 infection was at its peak during and immediately after the second wave of the pandemic in India during 2021. Many of the risk factors were implicated in the development of this deadly fungal infection, when there was a sudden surge of cases, especially who had a history of COVID-19 infection. The objective of the study was to describe the characteristic magnetic resonance imaging (MRI) findings in invasive mucormycosis and to evaluate the extent and severity of invasive mucormycosis. A retrospective study was carried out for 4 months which included 60 patients who underwent MRI using a Siemens Avanto 1.5 Tesla scanner. During our study, 68 cases were selected based on clinicoradiological features suspected of ROCM. However, 8 patients were excluded on the basis of exclusion criteria as either there was no definitive evidence of COVID infection or were proven to be negative for mucormycosis on microbiological examination. On the basis of the spectrum of MRI findings, post-COVID-19 related ROCM was broadly categorized into three stages. Out of total of 60 patients, the disease was localized to the nasal and paranasal sinus region (Stage I) in 7 patients (11.66%), extending to adjacent extrasinus orofacial soft tissue structures (Stage II) in 36 patients (60%), and intracranial extension of disease (Stage III) was seen in 17 patients (28.33%). In post-COVID-19 patients presenting with clinical features suspected of ROCM, MRI imaging helps in early diagnosis and staging/severity of ROCM, so that timely intervention can be planned to reduce mortality as well as morbidity.

Hypertension Secondary to COVID-19 Leading to Posterior Reversible Encephalopathy Syndrome in a 13-year-old Male

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological condition defined by white matter vasogenic oedema predominantly affecting the posterior occipital and parietal lobes. A 13-year-old male presented with complaints of fever for 4 days.Upon evaluation, he turned out positive for COVID-19 with a Computed Tomography (CT) severity score of 5/25. Three days post admission (day 7 of illness), patient developed sudden onset of painless, diminution of vision in both eyes followed by two episodes of generalised tonic clonic seizures. Examination revealed a blood pressure of 180/110 mmHg. Characteristic Magnetic Resonance Imaging (MRI) findings led to a diagnosis of PRES. Patient was treated with antiepileptics, antihypertensives and intravenous mannitol and made a complete recovery. Early identification, treatment of symptomatology and correction of the underlying cause are all key aspects of management.

MRI Findings in Osmotic Demyelination Syndrome- A Report of Two Cases

Osmotic demyelination syndrome is a condition seen due to the loss of normal myelin in the central nervous system. Multiple etiologies have been identified as causing this condition, however, the most reported cause is the rapid correction of hyponatremia. Different levels of the central nervous system are involved in the condition. Despite variable etiologies and clinical outcomes of the disease, the Magnetic Resonance Imaging (MRI) findings are well-established and characteristic. Hereby, two cases (45 years and 25 years old males) of Osmotic demyelination syndrome are described, to demonstrate the characteristic magnetic resonance imaging findings of the brain. Both cases were chronic alcoholics with a history of few episodes of vomiting, who later developed neurological symptoms. Their biochemical investigations showed severe hyponatremia. The hyponatremia was corrected rapidly, following which they developed neurological symptoms. Non-contrast MRI brain was done for both patients, which showed abnormal hyperintense T2/Fluid-attenuated Inversion Recovery (FLAIR) signals in central Pons. Both cases showed variable, however characteristics findings of osmotic demyelination syndrome on MRI. Despite, multiple causative factors and clinical outcomes of Osmotic demyelination syndrome, MRI with its characteristic findings plays a key role in diagnosis.

Imaging features of inflammatory pseudotumor-like follicular dendritic cell sarcoma of the spleen.

Inflammatory pseudotumor (IPT)-like follicular dendritic cell sarcoma (FDCS) is an extremely rare malignant neoplasm. Retrospective analysis of imaging features of splenic IPT-like FDCS, including ultrasonography, computed tomography (CT), and magnetic resonance (MR) and contrast-enhanced imaging were performed. When the masses were small, the ultrasound images showed homogeneous hypoechoic signals, clear boundaries, and complete capsules. Abdominal plain CT scans showed equal density (easy to miss diagnosis), unclear boundaries, and no capsules. Magnetic resonance images (MRI) showed slightly shorter T1, slightly shorter T2, and clear boundaries. When the masses were large, the ultrasound images still showed clear boundaries and complete capsules, but the echoes of the masses were not uniform, and some of the masses showed dendritic hyperechoic centers. Abdominal plain CT scans showed irregular low densities in the center (unclear boundaries) and equal densities in the periphery. MRI showed short T1 and T2, but the central signals were mixed. When the mass was accompanied by extensive necrosis, abdominal plain CT scan showed mostly cystic lesions and slight calcifications in low density lesions. Contrast-enhanced CT showed only moderate enhancement in peripheral and septal areas. MRI showed that T1 and T2 were mainly mixed signals. Contrast-enhanced MR showed moderate enhancement of peripheral areas and septum. This is the first report to describe the IPT manifestations of the spleen (ultrasonography, CT, and MR). The diagnosis of IPT can be made by combining three imaging features.