Main Magnetic Resonance Imaging Findings Research Articles

Primary and secondary non-traumatic intra-cerebral haemorrhage: MRI findings

Intracranial haemorrhage (ICH) accounts for 10–30% of strokes, being the form with the worst prognosis. The causes of cerebral haemorrhage can be both primary, mainly hypertensive and amyloid angiopathy, and secondary, such as tumours or vascular lesions.Identifying the aetiology of bleeding is essential since it determines the treatment to be performed and the patient's prognosis. The main objective of this review is to review the main magnetic resonance imaging (MRI) findings of the primary and secondary causes of ICH, focusing on those radiological signs that help guide bleeding due to primary angiopathy or secondary to an underlying lesion. The indications for MRI in the event of non-traumatic intracranial haemorrhage will also be reviewed.

The Limits between Schizophrenia and Bipolar Disorder: What Do Magnetic Resonance Findings Tell Us?

Schizophrenia and bipolar disorder, two of the most severe psychiatric illnesses, have historically been regarded as dichotomous entities but share many features of the premorbid course, clinical profile, genetic factors and treatment approaches. Studies focusing on neuroimaging findings have received considerable attention, as they plead for an improved understanding of the brain regions involved in the pathophysiology of schizophrenia and bipolar disorder. In this review, we summarize the main magnetic resonance imaging findings in both disorders, aiming at exploring the neuroanatomical and functional similarities and differences between the two. The findings show that gray and white matter structural changes and functional dysconnectivity predominate in the frontal and limbic areas and the frontotemporal circuitry of the brain areas involved in the integration of executive, cognitive and affective functions, commonly affected in both disorders. Available evidence points to a considerable overlap in the affected regions between the two conditions, therefore possibly placing them at opposite ends of a psychosis continuum.

Shaken Baby Syndrome: Magnetic Resonance Imaging Features in Abusive Head Trauma.

In the context of child abuse spectrum, abusive head trauma (AHT) represents the leading cause of fatal head injuries in children less than 2 years of age. Immature brain is characterized by high water content, partially myelinated neurons, and prominent subarachnoid space, thus being susceptible of devastating damage as consequence of acceleration–deceleration and rotational forces developed by violent shaking mechanism. Diagnosis of AHT is not straightforward and represents a medical, forensic, and social challenge, based on a multidisciplinary approach. Beside a detailed anamnesis, neuroimaging is essential to identify signs suggestive of AHT, often in absence of external detectable lesions. Magnetic resonance imaging (MRI) represents the radiation-free modality of choice to investigate the most typical findings in AHT, such as subdural hematoma, retinal hemorrhage, and hypoxic-ischemic damage and it also allows to detect more subtle signs as parenchymal lacerations, cranio-cervical junction, and spinal injuries. This paper is intended to review the main MRI findings of AHT in the central nervous system of infants, with a specific focus on both hemorrhagic and non-hemorrhagic injuries caused by the pathological mechanisms of shaking. Furthermore, this review provides a brief overview about the most appropriate and feasible MRI protocol to help neuroradiologists identifying AHT in clinical practice.

Evaluation of LI-RADS 3 category by magnetic resonance in US-detected nodules ≤ 2 cm in cirrhotic patients.

Liver Imaging Reporting and Data System (LI-RADS) for hepatocellular carcinoma (HCC) diagnosis in high-risk patients is a dynamic system, which was lastly updated in 2018. We aimed to evaluate the accuracy for HCC diagnosis of LI-RADS v2018 with magnetic resonance imaging (MRI) with extracellular contrast for solitary nodules ≤ 20 mm detected during ultrasound (US) surveillance in cirrhotic patients, with particular interest in those observations categorized as LI-RADS 3. Between November 2003 and February 2017, we included 262 consecutive cirrhotic patients with a newly US-detected solitary ≤ 20-mm nodule. A LI-RADS (LR) v2018 category was retrospectively assigned. The diagnostic accuracy for each LR category was described, and the main MRI findings associated with HCC diagnosis were analyzed. Final diagnoses were as follows: 197 HCC (75.2%), 5 cholangiocarcinoma (1.9%), 2 metastasis (0.8%), and 58 benign lesions (22.1%); 0/15 (0%) LR-1, 6/26 (23.1%) LR-2, 51/74 (68.9%) LR-3, 11/12 (91.7%) LR-4, 126/127 (99.2%) LR-5, and 3/8 (37.5%) LR-M were HCC. LR-5 category displayed a sensitivity and specificity of 64% (95% CI, 56.8-70.7) and 98.5% (95% CI, 91.7-100), respectively. Considering also LR-4 as diagnostic for HCC, the sensitivity slightly increased to 69.5% (95% CI, 62.6-75.9) with minor impact on specificity (96.2%; 95% CI, 89.3-99.6). Regarding LR-3 observations, 51 out of 74 were HCC, 2 were non-HCC malignancies, and 20 out of 21 LR-3 nodules > 15 mm (95.2%) were finally categorized as HCC. The high probability of HCC in US-detected LR-3 observations (68.9%) justifies triggering an active diagnostic work-up if intended to diagnose HCC at a very early stage. • In cirrhotic patients with nodules ≤ 20 mm detected during US surveillance, 51 out of 74 (68.9%) of LR-3 nodules by MRI corresponded to an HCC. • In LR-3 nodules, HCC diagnosis was closely related to baseline tumor size. All 5 nodules smaller than 1 cm were diagnosed as benign. Oppositely, 20 out of 21 LR-3 observations > 15 mm (95.2%) were diagnosed as HCC. • The high probability of HCC in US-detected LR-3 observations justifies triggering an active diagnostic work-up if intended to diagnose HCC at a very early stage.

Multiple Endocrine Deficiencies are Common in Hypoparathyroidism–Retardation–Dysmorphism Syndrome

The rare hypoparathyroidism-retardation-dysmorphism (HRD) syndrome (OMIM #241410) is caused by the mutated tubulin chaperone E (TBCE) gene. This gene encodes a critical protein in the microtubule assembly pathway. To evaluate the endocrine profile of patients with HRD. The study used a retrospective analysis of a large cohort of patients in a single university medical center. Sixty-three patients were diagnosed with HRD during 1990 to 2019; 58 of them had an endocrine evaluation. We investigated somatic growth parameters, the prevalence of hypoglycemia, growth hormone deficiency, hypothyroidism, hypogonadism, and cortisol deficiency. All patients were born small for gestational age, and severe growth retardation was found in all patients with mean height standard deviation score (SDS) of -8.8 (range: -5.1 to -15.1) and weight SDS -18 (range: -5.1 to -61.2). Serum insulin-like growth factor-1 concentrations were very low among the 21 studied patients: -2.32 SDS (range: -0.6 to -2.7). Four out of 14 (28%) investigated patients had growth hormone deficiency, and 55% of patients were hospitalized due to symptomatic hypoglycemia. Adrenal glucocorticoid insufficiency was diagnosed in 22% of those tested. Hypothyroidism was found in 36% of patients. Both hypogonadotrophic and hypergonadotrophic hypogonadism were observed. The main magnetic resonance imaging findings were small anterior pituitary gland, small hippocampus, brain atrophy, thin corpus callosum, Chiari type I malformation, and septo-optic dysplasia. Multiple endocrine abnormalities are common in patients with HRD syndrome. Periodic screening of thyroid and adrenal functions is recommended.

Value of Magnetic Resonance Imaging Findings in Differential Diagnosis between the Adult Reversible Splenial Lesion Syndrome and Ischemic Infarction of the Splenium of the Corpus Callosum

Objective To evaluate the magnetic resonance imaging (MRI) findings in differential diagnosis between the adult reversible splenial lesion syndrome (RESLES) and ischemic infarction of the splenium of the corpus callosum (SCC). Methods The MRI findings and clinical data of 7 RESLES patients and 13 patients with ischemic infarction of SCC who were clinically diagnosed and treated in our center from May 2015 to June 2017 were analyzed retrospectively. The main MRI findings included location,morphology,signal intensity,maximum cross-sectional area,diffusion weighted imaging (DWI),and apparent diffusion coefficient (ADC) value. Results On the MRI findings of 7 RESLES patients (5 males and 2 females),the centers of all lesions of the SCC were located in the midline of SCC,the lesion shapes were round,ellipse,or spindle,and the distribution of the lesions was bilateral and symmetric as the center of the midline of SCC. The lesions were hyperintense on DWI,and the mean maximum cross-sectional area of lesions was (56.9±32.6) mm2 and the mean ADC value was (0.3963±0.0715) ×10-3 mm2/s. On the review MRI,all the lesions disappeared (mean interval:10 days). On the MRI findings of 13 patients with ischemic infarction of SCC (10 males and 3 females),the lesions were irregular or patchy in shape and were almost laterally and asymmetrically distributed. The lesions were hyperintense on DWI,and the mean maximum cross-sectional area was (55.1±43.9) mm2 and the mean ADC value was (0.4978±0.0123) ×10-3 mm2/s. The mean maximum cross-sectional area (t=0.096,P=0.925) and the ADC value (t=-1.988,P=0.062) were not significantly different between RESLES group and ischemic infarction of SCC group. Conclusions The location,morphology,and distribution of the SCC lesions and the co-existence of other lesions in the brain are helpful for the differential diagnosis between RESLES and ischemic infarction of SCC. However,the mean maximum cross-sectional area and the ADC value show no obvious difference between these two diseases.

Evaluation of the fetal abdomen by magnetic resonance imaging. Part 2: abdominal wall defects and tumors.

Although ultrasound is still the gold standard for the assessment of fetal malformations, magnetic resonance imaging (MRI) has gained great prominence in recent years. In situations in which ultrasound has low sensitivity, such as maternal obesity, abdominal scarring, and oligohydramnios, MRI has proven to be a safe and accurate method. Regarding fetal abdominal wall defects, MRI appears to be widely used in the prognostic assessment of gastroschisis with intestinal atresia or of complications of omphalocele, allowing better perinatal management and parental counseling. In addition, MRI allows the assessment of local invasion of fetal abdominal tumors, with significant prognostic value for the postnatal period. In this article, we review the main MRI findings in the evaluation of fetal abdominal wall defects and tumors.

ANALYSIS OF THE PATTERN AND MECHANISM OF ELBOW INJURIES RELATED TO ARMBAR-TYPE ARMLOCKS IN JIU-JITSU FIGHTERS.

ABSTRACTObjective:The objective of this study was to analyze elbow injuries and their probable mechanism in Jiu-Jitsu fighters resulting from the armbar-type armlock. Methods:We evaluated 5 high-performance Jiu-Jitsu fighters from the Gracie Elite gym who were injured during a tournament. All were healthy males with a mean age of 28.8 years. The right arm was involved in three patients (60%). The athletes were followed for approximately 4.6 months, and pain was present in all cases. Clinical examination of the elbow was performed immediately after the injury and when magnetic resonance imaging (MRI) was performed. The radiography showed no changes. Clinical examination detected specific tender points on the medial and anterior topography of the elbows, but no ligamentous instability of the elbow was seen during dynamic testing. Results:The main MRI findings were injury to the common flexor tendon and the ulnar collateral ligament, bone contusion of the distal humerus and olecranon, and joint effusion. Conclusion:The main pattern of injury indicated by the MRI in the athletes was injury to the medial elbow complex. The primary mechanism that determined the injury was most likely elbow hyperextension applied with the forearm in neutral position of forearm. Level of Evidence IV, Case Series.

Annual Evaluations of MRI Findings of Hemophilia Arthropathy in 7 Years

ObjectiveRecently, hemophilia care has been advanced with regular factor VIII replacement (prophylaxis) to prevent or postpone joint damage. It have been needed an accurate monitoring system for the evaluation of hemophilic arthropathy. Conventional radiography has been used to objectively evaluate hemophilic arthropathy. However, it visualizes primarily bone lesions that appear late in the process of hemophilic arthropathy. Magnetic resonance imaging (MRI) had been considered to accurately evaluate the early changes of these joint damages in hemophilic arthropathy.We present our experiences of 7 years annual MRI assessment of arthropathy of the Japanese children with hemophilia, who were treated with sencondary prophylaxis or on demand therapy in comparison with conventional radiographic assessment.MethodsFrom 2007 to 2013, 10 children , 7 hemophilia A and 3 hemophilia B ,were enrolled in this study. One patient was treated with primary prophylaxis , 6 pts with secondary prophylaxis, 4 pts with on demand therapy. We made annual MRI and X ray examinations to of hemophilic arthropathy assessments of 37 joints (bilateral knees and ankles of every patient). We used a complete MRI protocol, including T1-weighted, T2*-weighted and short tau inversion recovery (STIR), GRE (gradient echo) T2*) sequences in all the joints. Assessmen of MRI was done with according to the compatible MRI scoring system (Haemophilia 2005, 11, 116 - 122), and X-ray radiographic assesment was according to the Pettersson system.ResultsThe damage grade of MRI findings were severe damage grade ; 5 joints, moderate grade ; 4 joints, mild grade ; 21 joints, no damage ; 7 joints. The damage grade of two joint were reduced and that of one joint was increased in 7 years. The progressive joint damage was found in 11 years boy with severe hemophilia A and he had been treated with on demand therapy .Of the 173 studied joints, 49 (29.5%) had normal MRI findings, and 124 (70.5%) showed a various ranges of abnormalities. 58 joints (35.3%) had progressive damages in 7 years. Synovial hyperplasia and/or hemosiderin deposition was the main MRI findings in the affected joints (105/116, 90.5%). Cysts and/or erosions were the second in order finding (66/116, 56.9%). Although synovial hyperplasia was present, hemosiderin was not observed in 17 of 105 (16.2 %) joints, which suffered a few hemarthroses within the last 2 years. On X-ray radiographic evaluations, 57 of the 173 studied joints (34.3%) had a zero Pettersson score (0); however, 50% of them (29/57) presented with MRI alterations. The remaining 108 joints had radiological scores ranging between 2 and 13 points, nonetheless, in 70% (72/108) of cases MRI revealed more profound alterations than those observed by X-ray findings.ConclusionWe considered that MRI assessment of patients' joints could identify the early changes of hemophilic arthropathy. But, this study is consisting of small numbers of joints observation, further studies are needed to confirm these findings. DisclosuresNo relevant conflicts of interest to declare.

Pyogenic and tuberculous discitis: magnetic resonance imaging findings for differential diagnosis

Spondylodiscitis represents 2%–4% of all bone infections cases. The correct diagnosis and appropriate treatment can prevent complications such as vertebral collapse and spinal cord compression, avoiding surgical procedures. The diagnosis is based on characteristic clinical and radiographic findings and confirmed by blood culture and biopsy of the disc or the vertebra. The present study was developed with Clementino Fraga Filho University Hospital patients with histopathologically and microbiologically confirmed diagnosis of spondylodiscitis, submitted to magnetic resonance imaging of the affected regions. In most cases, pyogenic spondylodiscitis affects the lumbar spine. The following findings are suggestive of the diagnosis: segmental involvement; ill-defined abscesses; early intervertebral disc involvement; homogeneous vertebral bodies and intervertebral discs involvement. Tuberculous spondylodiscitis affects preferentially the thoracic spine. Most suggestive signs include: presence of well-defined and thin-walled abscess; multisegmental, subligamentous involvement; heterogeneous involvement of vertebral bodies; and relative sparing of intervertebral discs. The present pictorial essay is aimed at showing the main magnetic resonance imaging findings of pyogenic and tuberculous discitis.

Occult Distal Femoral Physeal Injury With Disruption of the Perichondrium

The authors describe a case of distal femoral physeal injury with disruption of the perichondrium in a 9-year-old girl after a sledding accident. The patient presented with knee pain, limited range of motion, and inability to bear weight. Initial radiographs were normal. A magnetic resonance imaging of the knee demonstrated abnormal signal and widening of the distal femoral physis with elevation of the posterior distal femoral periosteum. This case illustrates the main magnetic resonance imaging findings in an occult Salter Harris type I injury: increased physeal thickness and signal intensity on water-sensitive sequences, perichondrial disruption, and intracartilaginous fracture.

Síndrome do impacto do tornozelo na ressonância magnética: ensaio iconográfico

A síndrome do impacto do tornozelo é uma condição dolorosa causada por atrito de tecidos articulares, que é tanto causa quanto consequência de uma biomecânica alterada desta articulação. A sua principal causa são as lesões pós-traumáticas, principalmente lesões ligamentares, resultando em dor crônica no tornozelo. Do ponto de vista anatômico e clínico, estas síndromes são classificadas em: ântero-lateral, anterior, ântero-medial, póstero-medial e posterior. A ressonância magnética é um ótimo método diagnóstico para demonstrar as alterações ósseas e as partes moles dos vários tipos de impacto do tornozelo, fornecendo dados que auxiliam não só na comprovação desse diagnóstico, como na diferenciação com outras causas de dor articular. Os autores objetivam ilustrar os principais achados de ressonância magnética na síndrome do impacto do tornozelo.

Ressonância magnética na endometriose do trato urinário baixo: ensaio iconográfico

Endometriose é definida como a presença de tecido endometrial funcionante fora da cavidade endometrial e do miométrio. É uma doença comum, de causas multifatoriais, porém o envolvimento do trato urinário baixo é raro. A ressonância magnética tem elevada sensibilidade, especificidade e acurácia no diagnóstico da endometriose do trato geniturinário baixo, principalmente por permitir a identificação das lesões de permeio a aderências e a avaliação da extensão das lesões subperitoneais. Neste estudo são ilustrados, sob a forma de ensaio iconográfico, os principais achados à ressonância magnética do envolvimento por endometriose do trato urinário baixo.

Ressonância magnética na endometriose pélvica profunda: ensaio iconográfico

A endometriose caracteriza-se pela presença de tecido endometrial funcionante heterotópico. Em pacientes com endometriose pélvica profunda pode haver acometimento dos ligamentos útero-sacros, reto, septo retovaginal, vagina ou bexiga. Os sintomas podem ser variados e incluem dor pélvica, dismenorréia, dispareunia, sintomas urinários e infertilidade. O padrão-ouro para o tratamento é a ressecção completa dessas lesões. Assim, é muito importante a avaliação pré-operatória dessas pacientes, sendo esta avaliação, em geral, limitada em relação aos dados clínicos e ultra-sonográficos. A ressonância magnética tem grande importância no diagnóstico da endometriose, principalmente por permitir a identificação das lesões de permeio a aderências e a avaliação da extensão das lesões subperitoneais. Neste estudo são ilustrados, na forma de ensaio iconográfico, os principais achados da endometriose pélvica profunda à ressonância magnética.

Cognitive Profiles and Visuoperceptual Abilities in Preterm and Term Spastic Diplegic Children With Periventricular Leukomalacia

Although relations between the extent of periventricular leukomalacia and neuropsychological performance in preterm children with spastic diplegia have been extensively investigated, studies on term children with spastic diplegia are rare. The authors examined 15 preterm children and 9 term children with spastic diplegia, all of whom had periventricular leukomalacia as a main magnetic resonance imaging (MRI) finding (excluding full-term spastic diplegic children with other MRI findings). Cognitive abilities (Griffith scale) and visuoperceptual abilities (Developmental Test of Visual Perception) were compared in the 2 groups and related to periventricular leukomalacia severity. Cognitive performance was substantially similar in the 2 groups. However, the overall Developmental Test of Visual Perception scores were below normal in the preterm and were normal in the term children; furthermore, visuoperceptual abilities were differentially affected in the preterm children, with visuomotor abilities more compromised than nonmotor visuoperceptual abilities. These children had similar cognitive performance and MRI findings, so the greater visuoperceptual compromise in the preterm group suggests a direct influence of prematurity, which may have adversely influenced the reorganization of visual centers and pathways following the initial developmental insult. The strabismus present in most preterm children would also have contributed to their greater visuoperceptual compromise. The authors conclude that the management of preterm and term children should differ, with concentration on visuoperceptual skills and rehabilitation in the former.

A clinicopathological and brain MRI study in Egyptian children with mitochondrial disorders

AbstractThis prospective study was undertaken to focus on the clinicopathological aspects as well as the value of brain magnetic resonance imaging (MRI) in children suffering from mitochondriopathies. Thirty-one patients [15 males (48.4%) and 16 females (51.6%)] gathered from the neuropediatric and metabolic clinic of Cairo University Children Hospital were included in this study. All patients were subjected to a thorough history and a meticulous clinical examination, computerized tomography and (MRI), electromyography and nerve conduction velocity. Muscle biopsies were performed in 18/31 patients and were subjected to both cytochrome c oxidase (COX) staining and electron microscopic (EM) examination. Laboratory tests including serum lactate and pyruvate, serum creatine kinase (CK), urine and plasma aminogram, urine organic acid profile, acyl carnitine profile, enzymatic analysis for arylsulfatase, galactocerebrosidase, very long chain fatty acids, acetyl aspartase were also performed when needed. Patients were classified according to their clinical phenotypes into: mitochondrial leukoencephalopathy (3/31), Leigh syndrome (7/31), neuropathy, ataxia and retinitis pigmentosa (2/31), mitochondrial encephalomyopathy (6/31), Leber’s hereditary opticneuropathy (4/31), mitochondrial encephalopathy, red ragged fibers (MERRF) (1/31). Mitochondrial encephalopathy, lactic acidosis (MELAS) (1/31), familial dystonia (4/31), and mitochondrial myopathy (3/31). The main neurological manifestations in their order of frequency were global developmental delay (20; 64.5%), spasticity (16; 51.6%), hypotonia (12; 38.7%), convulsions (10; 32.3%), sensory neural deafness (7; 22.6%), dystonia (7; 22.6%) optic atrophy (5; 16.1%), proximal muscle weakness (3; 9.7%), retinitis pigmentosa (2; 6.5%) and ataxia (2; 6.5%). Electromyography and nerve conduction study were normal in 18/31 (58%), myopathic in 7/31 (22.6%) and neuropathic in 6/31 (19.4%) patients. CK was significantly increased in only 3/31 (9.7%) patients. The main MRI findings were basal ganglia abnormalities appearing as bilateral and symmetrical high signal intensity lesions on T2 weighted MRI (11/28; 39.3%). Magnetic resonance spectroscopy (MRS) was performed in 7 patients and all were showing an increase lactate peak. EM examination revealed a subsarcolemmal aggregation of mitochondria in (12/18; 66.7%) and or a large and bizarre shaped mitochondria in (8/18; 44.4%), nonspecific myopathic changes in (3/18; 16.7%). Histochemical analysis of muscle biopsies using COX staining revealed a COX- vein (5/11; 45.5%), COX + vein (6/11; 54.5%), and myopathic changes in (3/18; 16.7%) patients. In conclusion, MRI and MRS are proved a promising tool in the diagnosis of mitochondrial cytopathies. MRS is a sensitive, non-invasive tool to evaluate the pathological lactate production in metabolic brain disease with disturbed energy production.