MR Findings In Patients Research Articles

Patterns of MRI Findings in Patients with Chronic Headache: A Retrospective Study from a Private Diagnostic Center in Addis Ababa, Ethiopia.

Headache is one of the most common complaints that lead the patient to seek medical advice however only a few patients with recurrent headaches have a secondary cause like intracranial mass. The appropriate utilization of neuroimaging is important to rule-out secondary cause of headache in resource-limited regions. The objective of this study is to describe the patterns of MRI findings in the evaluation of patients with chronic headache and to determine the clinical variables helpful in identifying patients with intracranial lesions. This cross sectional study was conducted among 590 selected patients who underwent an MRI scan of the head from September 2016 to January 2018 at Wudassie Diagnostic center in Addis Ababa, Ethiopia. Siemens Magnetom 0.35T MRI was used. Out of 590 patients, 372 (63.1%) were females and 218 (36.9%) were males; 300 (50.8%) patients with the mean age of 38.6 ± 0.5 years and a median of 37 ± 16.7years have normal brain MRI and 290(49.2%) have abnormal brain MRI reports. The abnormal findings further divided into non-significant findings were 166(28%) that did not alter patient management and clinically significant findings were 124 (21%) which included by decreasing order of frequency tumors, infection, hydrocephalus, hemorrhage, and vascular abnormalities. It was 1.3 times higher rate of positive brain MR findings in patients who had headaches plus abnormal neurologic findings as compared to patients without neurologic abnormality (P-value = 0.01). There is a high rate of significant abnormal MRI findings in this study as compared to studies from developed nations.

Wall morphology, blood flow and wall shear stress: MR findings in patients with peripheral artery disease

To investigate the influence of atherosclerotic plaques on femoral haemodynamics assessed by two-dimensional (2D) phase-contrast (PC) magnetic resonance imaging (MRI) with three-directional velocity encoding. During 1year, patients with peripheral artery disease and an ankle brachial index <1.00 were enrolled. After institutional review board approval and written informed consent, 44 patients (age, 70 ± 12years) underwent common femoral artery MRI. Patients with contra-indications for MRI were excluded. Sequences included 2D time-of-flight, proton-density, T1-weighted and T2-weighted MRI. Electrocardiogram (ECG)-gated 2D PC-MRI with 3D velocity encoding was acquired. A radiologist classified images in five categories. Blood flow, velocity and wall shear stress (WSS) along the vessel circumference were quantified from the PC-MRI data. The acquired images were of good quality for interpretation. There were no image quality problems related to poor ECG-gating or slice positioning. Velocities, oscillatory shear stress and total flow were similar between patients with normal arteries and wall thickening/plaque. Patients with plaques demonstrated regionally increased peak systolic WSS and enhanced WSS eccentricity. Combined multi-contrast morphological imaging of the peripheral arterial wall with PC-MRI with three-directional velocity encoding is a feasible technique. Further study is needed to determine whether flow is an appropriate marker for altered endothelial cell function, vascular remodelling and plaque progression. • Femoral plaques are associated with altered dynamics of peripheral blood flow. • Multi-contrast MRI can investigate the presence and type of atherosclerotic plaques. • Three-dimensional velocity-encoding phase-contrast MRI can investigate flow and wall shear stress. • Atherosclerotic peripheral arteries demonstrate increased systolic velocities and wall shear stress.

Brain MR Findings in Patients with Systemic Lupus Erythematosus with and without Antiphospholipid Antibody Syndrome

Antiphospholipid syndrome may affect the incidence and pathogenesis of cerebrovascular diseases in patients with systemic lupus erythematosus. We compared the spectrum of MR findings in patients with systemic lupus erythematosus with and without antiphospholipid syndrome. We identified 256 patients with systemic lupus erythematosus (45 with, 211 without antiphospholipid syndrome) who underwent MR studies; in 145 (57%), we detected abnormalities. These were categorized as large territorial, lacunar, localized cortical, and borderzone infarctions and as microembolisms, basal ganglia lesions, callosal lesions, hemorrhages, and white matter hyperintensity on T2-weighted and/or FLAIR images, and as stenotic arterial lesions on MR angiograms. Logistic regression analysis was performed to compare the MR findings in patients with systemic lupus erythematosus with and without antiphospholipid syndrome, with patient age and antiphospholipid syndrome as the covariates. Abnormal MR findings were more common in patients with systemic lupus erythematosus with antiphospholipid syndrome (73% versus 53%). Large territorial (P = .01), lacunar (P = .01), localized cortical (P < .01), borderzone infarcts (P < .01), basal ganglia lesions (P = .03), stenotic arterial lesions (P = .04), and the rate of positive findings on MR imaging (P = .01) were significantly associated with antiphospholipid syndrome. Irrespective of age, significantly more patients with antiphospholipid syndrome manifested lacunar infarcts in the deep white matter (P < .01), localized cortical infarcts in the territory of the MCA (P < .01), bilateral borderzone infarcts (P < .01), and anterior basal ganglia lesions (P = .01). Abnormal MR findings were more common in patients with systemic lupus erythematosus with than in those without antiphospholipid syndrome. Large territorial infarctions, lacunar infarctions in the deep white matter, localized cortical infarctions in the MCA territory, bilateral borderzone infarctions, anterior basal ganglia lesions, and stenotic arterial lesions are common MR findings in patients with systemic lupus erythematosus with antiphospholipid syndrome.

Diffusion-weighted MRI reveals epiphyseal and metaphyseal abnormalities in Legg-Calvé-Perthes disease: a pilot study.

Legg-Calvé-Perthes disease (LCP) is thought to be associated with ischemic events in the femoral head. However, the types and patterns of reperfusion after these ischemic events are unclear. We therefore determined whether (1) there would be any age-related diffusion changes; (2) diffusion-weighted MR imaging would reveal ischemic damage; and (3) diffusion changes are correlated with prognostic MR findings in patients with LCP. We prospectively performed conventional, perfusion, and diffusion-weighted MR imaging studies in 17 children with unilateral LCP. We then measured the apparent diffusion coefficient (ADC) values in the epiphysis and the metaphysis, and compared them with those of the contralateral normal side. Based on perfusion MR imaging, we assessed reperfusion to the epiphysis as either periphyseal or transphyseal. We studied T2-signal intensity changes in the metaphysis and the presence of focal physeal irregularity. We correlated diffusion changes with reperfusion to the epiphysis, T2-signal intensity change, and focal physeal irregularity. Normal diffusion decreased with age. In LCP hips, epiphyseal diffusion increased early and remained elevated through the healing stage. Six of the 17 patients who had a metaphyseal ADC greater than 50% over the normal side had 13 times greater odds of having an association with transphyseal reperfusion to the epiphysis. The increase of metaphyseal ADC also was associated with an increased T2-signal intensity in the metaphysis and presence of focal physeal irregularity. Diffusion-weighted MR imaging can be used as a complimentary modality to evaluate ischemic tissue damage with a potential prognostic value in patients with LCP.

MR findings in patients with disabling musculocutaneous chronic graft-versus-host disease

To describe musculocutaneous MR-findings responsible for disability in chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic cell transplantation (HCT). Between June 2005 and February 2008, we performed whole-body musculoskeletal magnetic resonance imaging (MRI; n = 12) or regional MRI (n = 4) in 16 consecutive patients presenting with disabling sclerodermatous cGVHD (e.g., skin edema, fixed deep dermal sclerosis, joint contractures, painful muscular contractures, or myalgia). In all patients, MRI showed musculocutaneous abnormalities reflecting different degrees of inflammation and collagen tissue involvement of the skin (n = 10), subcutaneous fat tissue (n = 13), muscle fasciae (n = 16), subfascial muscular septae (n = 6), or findings compatible with myositis (n = 3). The most frequently involved muscle fasciae comprised those of the vastus lateralis muscle (n = 12), biceps femoris muscle (n = 11), gastrocnemius medialis muscle (n = 8), serratus anterior muscle, and latissimus dorsi muscle (each, n = 5). Increased signal of involved tissues on STIR-images and fat-saturated postgadolinium T1-weighted images represented the most frequent MR-signal abnormalities. MR imaging of musculocutaneous cGVHD allows accurate evaluation including assessment of deep tissue infiltration and assists in the differential diagnosis.

Cervical spine fractures in ankylosing spondylitis: MR findings.

The purpose of this study is to evaluate the MR findings in patients with long-term ankylosing spondylitis (AS) and acute cervical spine fractures. The magnetic resonance imaging (MRI) studies of five patients with AS and acute cervical spine fractures were retrospectively reviewed for the presence of cervical spine instability, spinal cord compression, and epidural hematoma. Spinal fractures were unstable in all five patients. Three patients had neurological symptoms and abnormal signal within the spinal cord. All patients with neurological deficits had epidural hematomas posterior to the dural sac. MRI is useful for assessment of the integrity of intervertebral disks and spinal ligaments and, therefore, of the instability of the spinal fracture. MRI is mandatory in patients with neurological symptoms, especially in those with a symptom-free interval and those with neurological deterioration after established spinal cord injury, when suspicion for epidural hematoma is high.

MRI Helps in the Early Diagnosis of Corticobasilar Degeneration

We describe MR findings in patients with a clinical diagnosis of corticobasal degeneration (CBD). Five patients with different extrapyramidal symptoms were submitted to MRI. All patients were clinically followed-up for a minimum period of at least 12 months. MRI study was performed on a 0.5 T system (Philips NT 5 II), using conventional SE, TSE and t-FLAIR sequences on axial and coronal planes. In all cases MR showed bilateral parietal cortical atrophy. t-FLAIR sequences demonstrated cortical signal alteration on both parietal and frontal cortex in four cases and on the parietal cortex alone in 1 case. During the follow-up clinical evolution gave rise to the suspicion of CBD. MRI demonstrated parietal cortex atrophy even in those cases in which symptoms at onset were not specific for CBD, thus helping the diagnosis. Moreover MRI, using t-FLAIR sequences suggested CBD diagnosis even in the earlier phases of the disease, in which cortical damage has not yet become evident as atrophy.

Magnetic Resonance Imaging of Central Nervous System Involvement in Primary Sjögren's Syndrome

We reviewed clinical, laboratory and MR findings in patients with primary Sjogren's syndrome whose initial clinical manifestations were related to CNS involvement. MR is highly sensitive in detecti...

MR imaging of epicondylitis.

To systematically evaluate the MR findings in patients with epicondylitis compared with asymptomatic volunteers. We imaged 43 elbows: 24 with epicondylitis (22 lateral, 2 medial) diagnosed by clinical examination, and 19 in 16 normal volunteers. MRI was performed at 1.5 T using axial T1-weighted, axial fat-saturated FSE, and coronal or sagittal Fast STIR sequences. Two independent observers evaluated the images for intratendon signal, tendon thickening, periosteal reaction, fluid in the radial head bursa, and anconeus edema. All 24 patients with epicondylitis had increased signal on fat-saturated FSE and Fast STIR images. Twenty-two of these patients had increased intratendon T1 signal, and 19 had tendon thickening. No patient demonstrated fluid in the radial head bursa or periosteal reaction. Only two patients had subtle anconeus edema, while three patients unexpectedly had increased T2 signal within the involved epicondyle. One asymptomatic volunteer (high-performance athlete) had increased T1 and T2 signal with tendon thickening. An additional two asymptomatic volunteers had increased T1 signal only. MRI of epicondylitis demonstrates tendon thickening with increased T1 and T2 signal, but these findings may be seen in a small minority of asymptomatic individuals. Anconeus edema, previously demonstrated on MRI in epicondylitis, was only rarely found, and distension of the radial head bursa, surgically described, was not seen. Increased marrow T2 signal within the involved epicondyle is occasionally seen.

MR findings of Minamata disease--organic mercury poisoning.

We describe MR findings in patients with Minamata disease who have been followed for a long time. All patients examined were affected after daily eating of a large quantity of methylmercury-contaminated seafood, from 1955 to 1958, and showed typical neurological findings. On MR images, the visual cortex, the cerebellar vermis and hemispheres, and the postcentral cortex are significantly atrophic in Minamata disease. The visual cortex is slightly hypointense on T1-weighted images and hyperintense on T2-weighted images, probably representing the pathologic changes of status spongiosus. MRI can demonstrate the lesions located in the calcarine area, cerebellum, and postcentral gyri, which are probably related to three of the characteristic manifestations of this disease: the constriction of the visual fields, ataxia, and sensory disturbance, respectively.

MR imaging of lumbar spondylolysis: the importance of ancillary observations.

The purpose of this study was to determine the frequency of characteristic ancillary MR findings in patients with lumbar spondylolysis. The radiology reports and clinical records of 64 patients (16 female, 48 male; 12-77 years old) with 66 levels of lumbar spondylolysis who had undergone MR imaging were retrospectively reviewed. Spondylolysis was established by conventional radiography in all 64 patients and by CT in 18 patients. The proportion of patients with spondylolysis in whom sagittal MR images showed ancillary findings of an increased sagittal diameter of the spinal canal, reactive marrow changes in the pedicle, or abnormal wedging of the posterior aspect of the vertebral body was retrospectively determined. This proportion was then compared with the proportion of patients in whom spondylolysis was correctly diagnosed by the initial interpreters of the MR images, who used only direct visualization of defects of the pars interarticularis to make the diagnosis. Twenty (30%) of 66 levels of lumbar spondylolysis were misdiagnosed when the MR images were initially interpreted using direct visualization of defects of the pars interarticularis. An increased sagittal diameter of the spinal canal was the most common ancillary observation, occurring at 60 of 66 levels of lumbar spondylolysis. This finding was present in all patients with grade II, III, or IV spondylolisthesis, in 95% of patients with grade I spondylolisthesis; and in 77% of patients with no anterolisthesis. Thirty-two (48%) of 66 lumbar levels showed wedging of the posterior aspect of the vertebral body, which correlated significantly with the grade of spondylolisthesis. Reactive marrow changes in the pedicle distinct from normal adjacent levels were seen on MR images in 24(36%) of 66 levels of lumbar spondylolysis. On MR images, 97% of all levels of lumbar spondylolysis yielded one or more ancillary observations, including all 20 of the cases originally misdiagnosed. The combined use of ancillary observations and direct visualization of pars interarticularis defects makes MR imaging effective in revealing lumbar spondylolysis.

Computed tomography and magnetic resonance diagnosis of allergic fungal sinusitis.

The objective of this study was to describe CT and MR findings in patients with allergic fungal sinusitis (AFS). CT and MR images were examined from 10 patients with histologically proven AFS. All patients demonstrated CT evidence of central sinus high attenuation and T2-weighted MR signal void corresponding to surgically proven areas of thick inspissated allergic mucin. AFS is a distinct clinical entity with a highly specific radiographic appearance based on CT and MRI.

Urodynamic Findings in the Tethered Spinal Cord Syndrome: Does Surgical Release Improve Bladder Function?

We retrospectively reviewed 39 patients with a tethered spinal cord to evaluate whether surgical release positively influenced urological symptoms or urodynamic findings. The patients were divided into 2 groups: group 1-11 with occult spinal dysraphism and group 2-28 with secondary spinal cord tethering after previous closure of a myelomeningocele or resection of a lipomyelomeningocele. Diagnosis was confirmed in all cases by magnetic resonance imaging or spinal ultrasound. A comprehensive urodynamic evaluation was done immediately preoperatively and 2 to 21 months (mean 7) postoperatively. In group 1 the most common preoperative urodynamic finding was hyperreflexia, which improved or resolved after untethering in 62.5% of the patients. Four adults also reported improved bladder sensation or decreased urgency. In group 2 the most common urodynamic finding was impaired compliance, followed closely by detrusor hyperreflexia. Urodynamic patterns of detrusor hyperreflexia or compliance improved in only 30% of the patients, while 48% had worsened patterns. Only 14% of group 2 had improved symptoms of urinary control but 28% had improved lower extremity function. Urological symptoms and urodynamic patterns may be improved by early surgical intervention in patients with occult spinal dysraphism. However, untethering did not consistently benefit patients with secondary spinal cord tethering.

MR findings in patients with acute tibial plateau fractures

Objective. The purpose of this study was to demonstrate the MRI findings associated with acute tibial plateau fractures. Materials and Methods. MR scans of 29 patients with acute tibial plateau fractures were analyzed retrospectively. The images were evaluated for the presence of injuries involving the menisci, cruciate and collateral ligaments. The presence of a lipohemarthrosis or a simple joint effusion was also noted. The tibial plateau fractures were classified according to the scheme devised by Schatzker. Results. Evidence of internal derangement of the knee was found in 28 (97%) patients. Tibial collateral ligament (55%) injuries and lateral meniscus (45%) tears were noted most frequently. Medial meniscus tears were seen in 21% and fibular collateral ligment injuries were diagnosed in 34%. Forty-one percent had anterior cruciate ligament injuries while the posterior cruciate ligament was injured in 28%. Twelve (41%) patients demonstrated the characteristic MRI features of a lipohemarthrosis. Simple joint effusion were found in the remaining 17 (59%) patients. Conclusion. MR imaging in patients with acute tibial plateau fractures commonly demonstrates associated ligamentous and meniscal injuries. By imaging in multiple planes, MRI can aid in the accurate characterization of tibial plateau fracture patterns and severity.

MRI of dumbbell-shaped spinal tumors.

The purpose of our study is to review the clinical features and MR findings in patients with dumbbell-shaped spinal tumors that affect the intervertebral foramen. Two radiologists retrospectively evaluated a total of 19 tumors from the period 1989-1994 that exhibited dumbbell configuration. These included 11 benign tumors, including 9 neurogenic ones, and 8 malignant tumors. The time between onset of symptoms and admission was shorter in patients with malignant tumors (mean 3.9 months) than in patients with benign tumors (mean 41.1 months). There was a statistically significant difference (p < 0.05) in the short/long axis ratios (minimum tumor diameter divided by maximum tumor diameter) in the vertebral canal components between benign and malignant tumors. All malignant tumors in this study were extradural and paraspinal type (p < 0.05). Most benign tumors had regular margins and enlarged intervertebral foramina, while most malignant ones had irregular margins (p < 0.05). Many neurogenic tumors had regular margins and enlarged intervertebral foramina, while most malignant ones had irregular margins (p < 0.05> Many neurogenic tumors had cystic lesions (77.8%) and a string-of-beads structure (44.4%). Those tumors that surrounded the thecal sac in the vertebral canal and whose adjacent vertebral bodies had abnormal signal intensities were infiltrating and malignant. There are many kinds of dumbbell-shaped spinal tumors other than neurogenic ones. MRI is useful in diagnosing dumbbell-shaped spinal tumors, especially those of neurogenic origin, and aids in distinguishing benign from malignant tumors.

Magnetic resonance tomography in patients with Parkinson's disease and Parkinson-plus syndromes

To define characteristic MR-findings in patients with clinically typical extrapyramidal movement disorders. 15 patients with Parkinson's disease (PD), 9 with multisystem atrophy (MSA), and 6 with progressive supranuclear palsy (PSP) underwent MRI using a 1.5 T. Magnetom unit. Two investigators analysed the images with special regard to global and/or focal atrophy and to changes in signal intensity of the CNS in the consensus mode. Normal images of 10 subjects served as controls to patient's images. In all patients with PSP and MSA characteristic pathological findings on MRI were observed including regional changes within the extrapyramidal nuclei. In contrast all patients with PD had an unremarkable MRI study of the CNS. MRI enables us to define characteristic morphological changes of the brain in patients with extrapyramidal movement disorders. Early recognition of these findings avoids misdiagnoses in patients who are difficult to diagnose.

MR Imaging of Spastic Diplegia

Purpose: The MR findings in patients with spastic diplegia were investigated and the role of MR imaging in assessing the extent of brain injury was evaluated.Material and Methods: 39 male and 24 female patients (preterm/term 43/20) were imaged using a 0.5 T MR system.Results: The MR findings in term patients were quite different from those in preterm patients; 55% of the term patients showed normal and minimal changes on MR, whereas 90.7% of the 43 preterm children had periventricular leucomalacia. The deep cerebral white matter was the most frequently involved site. Objective measurements revealed significant reductions of the entire sagittal area of corpus callosum in diplegic patients in comparison with normal controls. The motor palsy severity correlated well with the extent of corpus callosum involvement.Conclusion: The corpus callosum appears to be a sensitive marker site for the assessment of the extent of white matter injury.

CT and MR Findings in Patients with Mild Head Injury

CT and MR Findings in Patients with Mild Head Injury

Ulnar collateral ligament of the thumb: MR findings in cadavers, volunteers, and patients with ligamentous injury (gamekeeper's thumb).

The ulnar collateral ligament bridges the ulnar aspect of the first metacarpal and the proximal phalanx and functions as a major stabilizer of the first metacarpophalangeal joint. Acute or chronic injury of this ligament is referred to as gamekeeper's thumb. The objectives of this study were to (1) determine the MR appearance of the ulnar collateral ligament of the thumb in cadavers and volunteers and (2) analyze the MR findings in patients with gamekeeper's thumb, especially with regard to the value of MR in detecting clinically significant displacement of the ligament (Stener lesion). MR imaging of the first metacarpophalangeal joint was performed in three volunteers, two cadaveric specimens, and 11 patients with acute injury. In the patients, the mechanism of injury was an abrupt abductive force on the thumb resulting in rupture of the ulnar collateral ligament. The diagnosis was confirmed by surgery in five patients and by clinical follow-up in the remaining six. Cryomicrotome sectioning of the cadaveric tissue blocks was performed to correlate pathologic and MR findings. Images were interpreted by one radiologist. MR images showed rupture of the ulnar collateral ligament in all 11 patients. Prospectively, Stener lesions (n = 3) could be differentiated from non-Stener lesions (n = 8) in eight of 11 patients. Retrospectively, the correct diagnosis could be made in all 11 patients once the importance of determining the position of the ulnar collateral ligament relative to the adductor aponeurosis was understood. MR imaging of the first metacarpophalangeal joint depicts the ulnar collateral ligament and adductor aponeurosis to good advantage. It can also accurately show tears of the ulnar collateral ligament and thus be used to differentiate a rupture without significant retraction from a Stener lesion. This information is important in determining whether surgical or conservative management is indicated.

Giant cell tumor of the tendon sheath: MR findings in nine cases.

The purpose of this study was to determine the MR findings in patients with giant cell tumors of the tendon sheath. MR imaging findings in nine surgically proved cases of giant cell tumors of the tendon sheath were evaluated on both T1- and T2-weighted images. Of nine lesions, three involved the foot, two involved the thumb, two involved the knee, one involved the proximal part of the tibia, and one involved the proximal part of the femur. All nine lesions were hypointense on T1-weighted images; the signal intensity of most of the tumors was approximately equal to that of skeletal muscle. On the T2-weighted images, three lesions were hypointense relative to skeletal muscle, two lesions were approximately isointense relative to skeletal muscle, and two lesions were slightly hyperintense relative to skeletal muscle but hypointense relative to fat. The remaining two lesions had a more heterogeneous appearance on T2-weighted images. On both T1- and T2-weighted images, giant cell tumor of the tendon sheath has a signal intensity similar to that of its pathologic counterpart, pigmented villonodular synovitis. The decreased signal intensity on both T1- and T2-weighted images is an uncommon appearance of extraarticular soft-tissue masses, in particular when they occur in the hands or feet, and this may suggest the diagnosis of giant cell tumor of the tendon sheath.