Magnetic Resonance Imaging Manifestations Research Articles

High-resolution magnetization transfer MRI in patients with cervical spondylotic myelopathy

Magnetization transfer (MT) contrast has been established as a marker of myelin integrity, and cervical spondylotic myelopathy is known to cause demyelination. Ten patients with clinical and magnetic resonance imaging (MRI) manifestations of cervical spondylotic myelopathy (CSM) were compared to the MRIs of seven historic healthy controls, using the magnetization transfer ratio (MTR) and Nurick scores as the primary metrics. Transverse slices through the intervertebral discs of the cervical spine were acquired using a gradient echo sequence (MEDIC) with and without an MT saturation pulse on a 3 Tesla Siemens Prisma scanner (TR = 300 ms, TEeff = 17 ms, flip angle = 30°, in-plane resolution = 0.47 × 0.47 mm2). The CSM patients tended to have a lower mean MTR (30.4 ± 6.5) than the controls (34.8 ± 3.8), but the difference was not significant (independent samples t-test, p = 0.110, Cohen’s d = 0.80). The mean MTR across all intervertebral disc levels was not significantly correlated to the Nurick score (Spearman’s ρ = −0.489, p = 0.151). The intervertebral level with the lowest MTR in each cohort was not significantly different between groups (equal variances not assumed, t = 1.965, dof = 14.8, p = 0.068, Cohen’s d = 0.88), but the CSM patients tended to have a lower MTR. The mean MTR at this level was negatively correlated to the Nurick score among CSM patients (Spearman’s ρ = −0.725, p = 0.018). CSM patients tended to have decreased MTR indicating myelin degradation compared to our healthy subjects, and MTR was negatively correlated with the severity of CSM.

A Study on Clinical Characteristics and Magnetic Resonance Imaging Manifestations on Systemic Rosai-Dorfman Disease.

Background:Rosai-Dorfman disease (RDD) is typically characterized by painless bilateral and symmetrical cervical lymphadenopathy, with associated fever and leukocytosis. The aim of the current study was to summarize the clinical features and imaging characteristics of RDD, in an effort to improve its diagnostic accuracy.Methods:The study was analyzed from 32 patients between January 2011 and December 2017; of these, 16 patients had pathologically diagnosed RDD, eight had pathologically diagnosed meningioma, and eight pathologically diagnosed lymphoma. All patients underwent computed tomography and magnetic resonance imaging (MRI). Clinical features and imaging characteristics of RDD were analyzed retrospectively. The mean apparent diffusion coefficient (ADC) values of lesions at different sites were measured, and one-way analysis of variance and the least significant difference t-test were used to compare the differences between groups and draw receiver operating characteristic curves. The tumors were excised for biopsy and analyzed using immunohistochemistry.Results:The mean ADCs were (0.81 ± 0.10) × 10−3 mm2/s for intercranial RDD, (0.73 ± 0.05) × 10−3 mm2/s for nasopharyngeal RDD, (0.74 ± 0.11) × 10−3 mm2/s for bone RDD, and (0.71 ± 0.04) × 10−3 mm2/s for soft-tissue RDD. The optimum ADC to distinguish intracranial RDD from lymphoma was 0.79 × 10−3 mm2/s (62.5% sensitivity and 100% specificity) and to distinguish meningioma from intracranial RDD was 0.92 × 10−3 mm2/s (62.5% sensitivity and 100% specificity). Levels of C-reactive protein, erythrocyte sediment rate and D-dimer were significantly elevated (81%, 87%, and 75%, respectively). On immunohistochemistry, RDD was positive for both S-100 and CD68 proteins but negative for CD1a.Conclusions:Conventional MRI, combined with diffusion-weighted imaging and ADC mapping, is an important diagnostic tool in evaluating RDD patients. An accurate diagnosis of RDD should consider the clinical features, imaging characteristics, and the pathological findings.

Different Magnetic Resonance Imaging Manifestations of Diabetic Chorea in a Case with Hyperglycemia and Another One with Hypoglycemia

Diabetic chorea (DC) is a rare complication of diabetes. Here we describe two cases of DC; patient 1 was an 87-year-old woman with chronic kidney disease and was administered with sulphonylurea and dipeptidylpeptodase-4 inhibitor. She showed right side hemiballismus and head magnetic resonance imaging T1-weighted images revealed a high intensity area in the putamen and caudate nucleus. Patient 2 was a 51-year-old woman who was diagnosed with diabetic ketoacidosis. She showed right side hemiballism and multiple, small hyperintense regions in both the periventricular sides in diffusion weighted images. Based on the hemiballism, we concluded a diagnosis of DC in the diabetic patient, although the case presentation is rare or has atypical MRI findings.

Magnetic Resonance Imaging Manifestations of Bilateral Cerebral Amyloid Angiopathy-Related Inflammation with Seizures

Cerebral Amyloid Angiopathy-related inflammation (CAA-ri) is a distinct subtype of CAA characterized by rapidly progressive cognitive decline, focal deficits, seizures, and headache. It is characterized by vasculitis associated with cerebral amyloid deposition. Differential diagnosis may be challenging due to overlapping symptoms and lack of clear imaging criteria, although CCA-ri is usually responsive to immunosuppressive therapy. We describe an 81-year-old female diagnosed with CAA-ri by Magnetic Resonance Imaging (MRI). Fluid-Attenuated Inversion Recovery (FLAIR) imaging revealed hyperintense lesions in the bilateral temporal and occipital areas, and T2*-weighted gradient echo (T2*-GRE) imaging demonstrated multiple cortical and subcortical hypointensities in the same areas. Furthermore, the findings of T2*-GRE were confirmed by Susceptibility-Weighted Imaging (SWI). In cases of encephalopathy, CAA-ri should be considered in the differential diagnosis, and the presence of microbleeds should be examined using T2*-GRE and (or) SWI MRI.

Magnetic resonance imaging manifestations of deep vascular diseases in children with superficial vascular diseases

Objective To assess the clinical value of magnetic resonance imaging (MRI) in the diagnosis of deep vascular diseases in children with superficial vascular diseases. Methods From January 2012 to December 2016, 105 children with superficial vascular diseases in the Department of Dermatology of Shanghai Children′s Hospital underwent MRI examination, and the clinical and imaging data were analyzed. Results Of the 105 children, 42 were male and 63 were female. Their ages ranged from 0.5 to 168 months with an average age of 21.6 months. As MRI showed, 25 (23.8%) children had deep vascular diseases, which could not be seen with naked eyes. These deep vascular diseases included multisite deep capillary hemangiomas in 15 cases, cranial-facial hemangioma syndrome in 4, arteriovenous malformation in 3, persistent intracranial artery sinus in 2, and varicosity and bone hypertrophy syndrome in 1. Conclusion MRI is of great value to the diagnosis of deep vascular diseases in children with superficial vascular diseases. Key words: Hemangioma; Magnetic resonance imaging; Vascular malformations

Quantitative and qualitative MRI evaluation of cerebral small vessel disease in an elderly population: a longitudinal study.

Background Cerebral white matter hyperintensities (WMHs), lacunes, and microbleeds are seen on magnetic resonance imaging (MRI) in small vessel disease (SVD). Purpose To assess SVD on MRI and its evolution over five years in an elderly population and to investigate whether relative cerebral blood flow (rCBF) at baseline was related to the progression of white matter (WM) lesions. Material and Methods In a population-based study, 406 participants aged 75 years underwent morphological MRI of the brain and 252 of them again at age 80 years. At age 75 years, a perfusion scan was also done. WMHs were evaluated qualitatively (visual scoring) and quantitatively (CASCADE software). Lacunes and microbleeds were counted. Results A significant progression of the WMH score and WMH volume occurred over five years ( P < 0.0001). New lacunes were seen in 10%. Participants with new lacunes at age 80 years showed a more pronounced increase in WMHs (P < 0.0001). Microbleeds were present in 14% at age 75 years. The visual WMH score was significantly associated with the presence of microbleeds ( P < 0.0001). There was no relationship between total WM rCBF and WMH volume at age 75 years, and no significant associations between regional or total rCBF at age 75 years and changes in WMH volume over five years. The total WM and GM volume decreased significantly between the ages of 75 and 80 years ( P < 0.0001). Conclusion MRI manifestations of SVD progressed over five years in an elderly population (age range = 75-80 years). rCBF was not associated with WMH volume or progression of WMH volume.

Dural arteriovenous fistula disguised as cerebral venous sinus thrombosis.

Dural arteriovenous fistulas (DAVFs) are direct communications between the intracranial arterial and venous systems without an intervening nidus. Clinicians sometimes fail to give a correct diagnosis of DAVF. Given the similarity of their clinical and magnetic resonance imaging (MRI) manifestations, diagnostic confusion may arise between DAVF and cerebral venous sinus thrombosis (CVST) (Simon et al., 2009). The clinical management of DAVFs differs from that of CVST (Ma et al., 2015; Yang et al., 2015). Anticoagulation therapy is restricted in some cases of DAVFs, especially when they are associated with retrograde venous flow, due to the increased risk of hemorrhage. Here we present a case of a DAVF patient who had been initially misdiagnosed as CVST. We summarize the reasons for misdiagnosis and give some recommendations to address this problem.

MRI findings of cerebral schistosomiasis in acute stage：establishment of experimental model of acute cerebral schistosomiasis with rabbits

To establish an experimental model of acute cerebral schistosomiasis japonica and explore the MRI manifestations of acute cerebral schistosomiasis. Rabbits were divided into 3 groups with 10 rabbits in each group. The rabbits in the experimental group were directly injected with suspension fluid of Schistosoma japonicum eggs (0.9 mg, 1 ml) by the cranial drilling method, those in the negative control group were given saline (1 ml) by the same method above-mentioned, and those in the blank control group were not given any treatment. Antibiotic was given to the first two groups after the operation. The clinical manifestations of the 3 groups were observed, and the magnetic resonance imaging (MRI) was performed in 30 days post-operation, and then the brain tissues were taken for pathological examinations. All the rabbits in the experimental group exhibited inappetence, various neurological symptoms including hemiplegia, and weight loss after the operation; while those in the negative control group showed inappetence in 3 days after the operation, and 1 week later, the symptom disappeared; there were no adverse reactions in the blank control group. MRI of the experimental group showed nodular or patchy enhancement on T1WI enhancement, brain edema, abnormal ventricular dilatation, and needle augmentation. SWI displayed hypointense in the abnormal enhanced nodules and flaky hypointense on the operation brain. In the negative control group, 2 rabbits showed abnormal enhancement of the needle canal, and 1 showed mild dilatation of the ventricle. The blank control group showed normal manifestations. The pathological examinations showed abnormal appearances in 10 rabbits of the experimental group, including 6 with S. japonicum egg granuloma nodules, nonspecific granuloma nodules coexisted with perivascular inflammation; no granuloma nodules were found in the negative control group, but 2 rabbits showed vascular inflammation; the blank control group showed the normal brain tissue. An experimental model of acute cerebral schistosomiasis is successfully established in rabbits by intracranial injection of schistosome eggs. The MRI examination combined with the clinical manifestations can improve the accuracy of early diagnosis of cerebral schistosomiasis.

Association Between Subclinical Cardiac Biomarkers and Clinically Manifest Cardiac Diseases With Cortical Cerebral Microinfarcts

Subclinical and clinical cardiac diseases have been previously linked to magnetic resonance imaging (MRI) manifestations of cerebrovascular disease, such as lacunes and white matter hyperintensities, as well as dementia. Cortical cerebral microinfarcts (CMIs), a novel MRI marker of cerebral vascular disease, have not been studied, to date, in relation to subclinical and clinical cardiac diseases. To examine the association of blood biomarkers of subclinical cardiac disease and clinically manifest cardiac diseases with CMIs graded on 3-T MRI in a memory clinic population. This baseline cross-sectional analysis of a cohort study performed from August 12, 2010, to July 28, 2015, included 464 memory clinic participants. All participants underwent collection of blood samples, neuropsychological assessment, and 3-T MRI. N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) concentrations were measured by electrochemiluminescence immunoassays. Cardiac disease was defined as a history of atrial fibrillation, ischemic heart diseases, or congestive heart failure. The CMIs were graded according to a previously validated protocol. Of 464 participants, 124 had insufficient blood plasma samples and 97 had no CMI grading (none, incomplete, or ungradable MRI), leaving a sample size of 243 for final analysis (mean [SD] age, 72.8 [9.1] years; 116 men [42.9%]). Seventy participants (28.8%) had cortical CMIs (median, 1; range, 0-43). Compared with participants with no CMIs, those with CMIs had a significantly higher prevalence of atrial fibrillation (rate ratio [RR], 1.62; 95% CI, 1.20-21.8), ischemic heart disease (RR, 4.31; 95% CI, 3.38-5.49), and congestive heart failure (RR, 2.05; 95% CI, 1.29-3.25). Significantly higher levels of NT-proBNP (RR, 3.16; 95% CI, 2.33-4.27) and hs-cTnT (RR, 2.17; 95% CI, 1.00-4.74) were found in participants with CMIs. In multivariate models adjusted for demographics and vascular risk factors, higher levels of NT-proBNP (RR, 3.19; 95% CI, 2.62-3.90) and hs-cTnT (RR, 4.86; 95% CI, 3.03-7.08) were associated with CMIs. These associations persisted even after excluding patients with clinically manifest cardiac disease. This study found that biomarkers of subclinical cardiac disease and clinically manifest cardiac diseases were associated with CMIs on 3-T MRI in patients attending a memory clinic, suggesting that cardiac disease may contribute to the development of CMIs. Hence, cardiac dysfunction should be targeted as a potentially modifiable factor to prevent CMI-related brain injury.

Association between the extent of white matter damage and early cognitive impairment following acute ischemic stroke.

White matter (WM) injury following acute ischemic stroke (AIS) is associated with cognitive decline. Establishing relationships between the specific cognitive tests used to assess post-AIS cognition and various clinical indices of WM injury severity and distribution may aid in prognosis and early treatment decisions. We enrolled 62 patients with AIS to Weifang People's Hospital between September 2014 and August 2015. WM lesion severity and distribution were examined by computed tomography (CT) and magnetic resonance imaging (MRI). The Blennow scale was used for scoring the distribution and degree of WM lesions (WMLs) on CT images, the Fazekas scale for scoring periventricular and deep WMLs on MRI, and the Cholinergic Pathways Hyperintensities Scale (CHIPS) for scoring MRI manifestation of cholinergic fiber damage. The 8-domain Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive function. Mean ± standard deviation scores on the Blennow scale was 1.6±0.5; Fazekas scale, 3.4±0.8; and CHIPS, 65.7±12.5. The proportion of patients with a MoCA score <26 (indicating cognitive dysfunction) was significantly higher in subgroups with Blennow scale score >2, Fazekas scale score >4, and CHIPS score >51 (all P<0.001). The MoCA score was negatively correlated with Blennow scale score (r=−0.326, P=0.002), Fazekas scale score (r=−0.404, P=0.031), and CHIPS score (r=−0.234, P=0.042). Thus, the degree and distribution of whole-brain, deep, and cholinergic WMLs were associated with cognitive impairment. The Blennow scale, Fazekas scale, and CHIPS all provide good predictive efficacy of post-AIS cognitive dysfunction.

Cytomegalovirus Encephalitis in an Infant; MRI Manifestation: A Clinical Image

Clinical Image: A 7- month old male infant and a known case of cerebral palsy (CP) because of perinatal infection was referred to our academic Taleghani children hospital(Gorgan, Northern Iran), due to inability to intake food percutaneous insertion of gastrostomy tube was planned for him. In a retrograde investigation, we noticed his post natal brain Magnetic Resonance Imaging (MRI) (Figure 1). It illustrates severe hypoxic ischemic change of hemispheres, hydrocephalus, white matter signal abnormality predominantly in posterior regions esp. in parieto-temporal lobes and encephalomalacic cysts esp. in temporal poles; His MRI also depicted atrophy of caudate nuclei and T2 hypersignal intensity of thalami. In addition to above radiologic findings, urine quantitative real-time PCR was positive for CMV with a DNA viral load of 143700 IU/ml. All these findings were highly suggestive for cystic encephalopathy due to CMV (TORCH classification) infection of the brain for this infant. He was born symptom-free from repeated cesarean-section (RCS) of a term non-complicated pregnancy with a birth weight of 3900 g, appropriate for gestational age in a Turkmen family from a consanguineous marriage. His drug history consisted of phenytoin (5 mg/kg/day). CMV is the most common cause of intra-uterine infection and most common cause of congenital infective brain damage, occurring in 0.2-2.4% of live births. The vast majority (90%) of infected babies are asymptomatic at birth, but some may develop symptoms after 6-9 months [1]. Some of MRI findings include [2]: • White matter lesions: Predominantly parietal or posterior white matter involvement • Ventriculomegaly and subarachnoid space enlargement • Delayed myelination • Periventricular and temporal pole cysts The Differential diagnosis include HIV encephalitis, progressive multifocal leukoencephalitis (PML) and primary CNS lymphoma (periventricular but has mass effect and enhances). Primary stabilizing measures were undertaken for our patient. No more abnormality was found in laboratory tests. His PEG tube was inserted successfully and the infant was discharged after acceptable clinical condition.

Magnetic resonance imaging features of massive ovarian edema in pregnancy: utility for decisions in expectant management.

IntroductionMassive ovarian edema (MOE) is a rare disease and few reports have described the magnetic resonance (MR) imaging manifestations in pregnancy.Case descriptionWe report here a case of MOE in a patient at 12 weeks’ gestation. Abdominal T2-weighted MR images showed asymmetric ovarian enlargement in a teardrop configuration, hyperintense peripherally displaced follicles, and twisting of the vascular pedicle between the enlarged ovary and uterus. The diagnosis of MOE due to ovarian torsion was confirmed by exploratory laparotomy. Preoperative imaging, especially the MR imaging could distinguish MOE from other conditions and demonstrate the relations of adjunct organ, and allowed for untwisting during laparotomy with successful preservation of the ovary.Discussion and evaluationUltrasonography is important in detecting, evaluating, and determining the malignant potential of adnexal masses in pregnancy, but its findings may be nonspecific and then MR may assist characterization. This case was tentatively diagnosed as typical MOE by preoperative imaging, but the shape and location of the hugely enlarged ovarian mass suggested torsion of the ovarian pedicle. In our case, the diagnosis was confirmed by exploratory laparotomy and the pedicle was successfully untwisted.ConclusionMR imaging proved useful for decisions on expectant management of MOE in pregnancy, and the patient’s affected ovary could be preserved.

Analysis of Clinicopathological Feature and Prognosis for Leptomeningeal Metastasis in Non-small Cell Lung Cancer

背景与目的脑膜转移(leptomeningeal metastasis, LM)是晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)严重并发症之一, 生活质量降低, 预后差。本研究旨在探讨NSCLC-LM患者的临床病理特征及预后。方法回顾性分析2015年1月-2016年6月首都医科大学附属北京朝阳医院收治的3例NSCLC-LM患者的临床资料, 并结合文献进行分析。结果3例患者均为肺腺癌, 且表皮生长因子受体(epidermal growth factor receptor, EGFR)21外显子L858R突变(mutations, m), 其中男性1例, 女性2例; 年龄59岁-64岁, 平均年龄61.3岁, 主要临床表现及查体:头痛(3/3)、头晕(3/3)、恶心呕吐(3/3)、癫痫(2/3)、复视(1/3)、听力下降(1/3)、脑膜刺激征(3/3)。出现症状到LM确诊时间为1个月-4个月(平均2.3个月)。除了1例肺癌和LM同时诊断, 2例分别在EGFR酪氨酸激酶抑制剂(tyrosine kinase inhibitors, TKIs)和化疗进展后出现LM, 肺癌到LM平均确诊时间为8.5个月。3例患者脑增强磁共振成像(magnetic resonance imaging, MRI)均显示软脑膜线性强化; 3例脑脊液中找到癌细胞, 其中2例行EGFR检测, 均为EGFR 21外显子L858R突变。2例患者接受TKIs治疗, 症状好转, 其中1例联合替莫唑胺, 无进展生存期(progression-free survival, PFS)达4.9个月, 总生存时间(overall survival, OS)为13.9个月。结论EGFRm肺腺癌可能易出现LM; NSCLC-LM症状不典型, 易漏诊、误诊; TKIs联合替莫唑胺可能是EGFRm-NSCLC-LM的治疗选择。

The mammography and MRI manifestations of adenomyoepithelioma of the breast

To investigate mammography and magnetic resonance imaging (MRI) manifestations of benign and malignant adenomyoepithelioma (AME), in order to improve our understanding of this disease. Thirteen patients (11 cases of benign AME and two cases of malignant AME) were included. All patients underwent preoperative mammography, and four underwent preoperative MRI examinations. Mammography revealed that 11 cases showed round, lobulate, or oval masses. One case was accompanied by calcification with blurred edges; the remaining 10 cases showed masses with clear or shaded borders. One case exhibited structurally distorted lesions, and another showed focal opacities. Among the four patients who also underwent preoperative MRI examinations, signals in the three benign cases were clearly enhanced homogeneously, and the dynamic enhancement curves were progressive. The one case of malignant AME showed an irregularly shaped mass with spiculate margins on the MRI images. The signals were homogeneously enhanced, and the dynamic enhancement curve was of the washout type. AME usually exhibited oval or round masses with smooth edges and no calcification, and, in a portion of the cases, structurally distorted lesions or focal opacities. On different MRI sequences, AME usually showed homogeneous signal. The apparent diffusion coefficient value of malignant AME is relatively low.

Study on the relationship between imaging features of rheumatoid arthritis and TCM syndrome types

Objective To study the relationship between magnetic resonance imaging (MRI) of rheumatoid arthritis (RA) and traditional Chinese medicine (TCM) syndrome types. Methods 90 patients with RA were selected as the research subjects.Through 2 attended doctors more strict according to the specific diagnostic criteria of the syndrome, the implementation of the diagnosis of TCM syndromes.The conventional treatment of the patients were recorded, and the X line of the two hands joint was obtained by double blind reading.At the same time, the relevant symptoms and symptoms of the laboratory and other related information were analyzed. Results Of 90 RA patients, 22.22% patients were cold dampness stasis type, 27.78% patients were damp heat blocking collaterals, 26.67% patients were cold and heat syndromes, 23.33% patients were deficiency of liver and kidney and phlegm stasis stasis type.Patients after the initial diagnosis, hands joint implementation hands joint side position was detected by MRI, the MRI results showed thickened synovium, bone erosion, bone marrow edema and joint effusion, and the constituent ratio of MRI images had significant difference (χ2=13.372, P<0.05). Four TCM syndrome types of RA patients, after treatment, again implement hands joint anteroposterior and lateral radiographs of the MRI detection, after detection of radiology hands joint MRI detection results showed that implementation stage and detailed records, and at the time of initial diagnosis.The patients' hands joint MRI examination test showed that the control, any bone damage intensifies, the MRI signs of more serious progress.However, impaired bone level unchanged, MRI without aggravate was not changed. Conclusion For RA patients, MRI manifestations and TCM syndrome type has relationship.At early stage of the disease, active and reasonable use of anti-rheumatic drug treatment to improve the condition of RA can reduce the morbidity. Key words: Arthritis, rheumatoid; Magnetic resonance imaging; Medicine, Chinese tradition

Low gradient echo parenchymal signal in late infantile GM1 gangliosidosis

GM1 gangliosidosis is a rare storage disorder caused by a deficiency of lysosomal beta-galactosidase. Symptoms are nonspecific and include profound central nervous system involvement, and visceral and musculoskeletal manifestations. We report a case of late infantile GM1 gangliosidosis with magnetic resonance imaging manifestations that have not been previously described. These include regions of patchy parenchymal gradient echo signal loss, progressive atrophic changes, and magnetic resonance spectroscopy demonstrating decreased N-acetyl aspartate, and increased choline and myoinositol peaks.

Assessment of bilateral cerebral peduncular infarction: Magnetic resonance imaging, clinical features, and prognosis

BackgroundBilateral cerebral peduncular infarction (BCPI) is an extremely rare neurological disorder, and related literature is scarce. This study investigated the clinical manifestations, magnetic resonance imaging (MRI) features and prognosis of BCPI. MethodWe retrospectively reviewed the clinical features, MRI and magnetic resonance angiography manifestations, and prognosis of 14 patients with BCPI, confirmed by diffusion-weighted MRI from 5050 cerebral infarction patients at our medical center from January 2007 to June 2013. ResultEleven of the 14 (78.6%) patients had quadriplegia and 9 (64.3%) had decreased consciousness. At the most severe stage, the National Institutes of Health Stroke Scale scores ranged from grades 4 to 26 (mean grade, 18.9). Eleven (78.6%) cases were caused by large artery atherosclerosis. Besides the bilateral cerebral peduncle, the pons (85.7%) and cerebellum (42.9%) were the other infarct locations. Twelve (85.7%) patients had vertebrobasilar artery occlusion or severe stenosis, and 12 (85.7%) did not have collateral patency of the posterior cerebral artery. Thirteen (92.9%) patients had poor prognosis and 9 of them died. OcclusionBCPI is a very rare disorder and associated with severe vertebrobasilar artery stenosis or occlusion without collateral patency of the posterior communicating artery. It has a very poor prognosis.

Comparison of cardiac MRI and 18F-FDG positron emission tomography manifestations and regional response to corticosteroid therapy in newly diagnosed cardiac sarcoidosis with complete heart block

Complete heart block (CHB) caused by myocardial inflammation is a serious consequence of cardiac sarcoidosis (CS) that requires early diagnosis for effective anti-inflammatory treatment. This study aimed to clarify the cardiac magnetic resonance imaging (MRI) and (18)F-fluoro-2-deoxyglucose positron emission tomography ((18)F-FDG PET) manifestations of newly diagnosed CS with CHB and to assess whether certain imaging features could predict responders to corticosteroid therapy. Fifteen newly diagnosed CS patients with CHB and 17 without CHB were examined. We defined abnormal (18)F-FDG uptake on (18)F-FDG PET and increased T2-weighted signal on cardiac MRI as signs of myocardial inflammation and delayed enhancement (DE) on cardiac MRI as a sign of myocardial fibrosis. Ten CHB+ patients were then treated with corticosteroids. The CHB+ group showed higher (18)F-FDG uptake and increased T2-weighted signal in the interventricular septum, which involves the electrical pathway of atrioventricular conduction, than the CHB- group (P = .001 and P < .0001, respectively), whereas there was no group difference in DE (P = .232). Six corticosteroid-treated patients recovered from CHB; all had exhibited increased T2-weighted signal, (18)F-FDG uptake, and DE in the interventricular septum before therapy. In contrast, among the 4 patients without recovery, 2 showed no abnormal (18)F-FDG uptake and 3 had no increased T2-weighted signal in the interventricular septum, but all showed DE. The 2 patients without recovery with abnormal (18)F-FDG uptake showed wall thinning in the interventricular septum. Focal inflammation in the interventricular septum was associated with CHB and might predict recovery from CHB after corticosteroids if it coexists with preserved wall thickness.

Indian Hedgehog signaling pathway members are associated with magnetic resonance imaging manifestations and pathological scores in lumbar facet joint osteoarthritis.

Indian Hedgehog (HH) has been shown to be involved in osteoarthritis (OA) in articular joints, where there is evidence that Indian HH blockade could ameliorate OA. It seems to play a prominent role in development of the intervertebral disc (IVD) and in postnatal maintenance. There is little work on IHH in the IVD. Hence the aim of the current study was to investigate the role of Indian Hedgehog in the pathology of facet joint (FJ) OA. 24 patients diagnosed with lumbar intervertebral disk herniation or degenerative spinal stenosis were included. Preoperative magnetic resonance imaging (MRI) and Osteoarthritis Research Society International (OARSI) histopathology grading system was correlated to the mRNA levels of GLI1, PTCH1, and HHIP in the FJs. The Weishaupt grading and OARSI scores showed high positive correlation (r = 0.894) (P < 0.01). MRI Weishaupt grades showed positive correlation with GLI1 (r = 0.491), PTCH1 (r = 0.444), and HHIP (r = 0.654) mRNA levels (P < 0.05 in each case). OARSI scores were also positively correlated with GLI1 (r = 0. 646), PTCH1 (r = 0. 518), and HHIP (r = 0.762) mRNA levels (P < 0.01 in each case). Cumulatively our findings indicate that Indian HH signaling is increased in OA and is perhaps a key component in OA pathogenesis and progression.

CT and MRI manifestations of luxatio erecta humeri and a review of the literature

AimWe aimed to study luxatio erecta humeri using advanced imaging modalities. MethodPatients with luxatio erecta humeri and a subsequent magnetic resonance imaging (MRI) and/or computed tomography (CT) scan were included in this study. ResultsAmong 10 identified cases, we detected 2 rotator cuff, 4 labral, and 2 inferior glenohumeral ligament tears as well as 2 glenohumeral cartilage defects. We observed six comminuted displaced greater tuberosity fractures, four anterior inferior glenoid fractures, and four impaction fractures of humeral head. ConclusionThis study provides detailed radiologic findings associated with luxatio erecta humeri using MRI and CT.