Present Magnetic Resonance Imaging Findings Research Articles

MRI findings of chronic distal tendon biceps reconstruction and associated post-operative findings.

Rupture of the distal biceps tendon is becoming increasingly diagnosed due to an active aging population and an increase in diagnostic imaging opportunities. While physical exam may help in diagnosis, magnetic resonance imaging (MRI) is particularly useful in evaluating chronic rupture. Although partial tears can be managed conservatively, the gold standard treatment for a chronic distal biceps tear is anatomic reinsertion with additional use of an allograft or autograft. No study has highlighted the normal appearance and postsurgical complications seen on MRI associated with allograft or autograft usage. Clinicians and radiologists may be unaware of the normal and abnormal post-operative imaging findings and their clinical relevance. The purpose of this manuscript is to discuss the epidemiology, clinical presentation, and preoperative MRI findings of distal biceps ruptures necessitating reconstruction, to explain distal biceps tendon surgical reconstruction technique with allograft or autograft usage, to display the normal and abnormal post-operative MRI findings, and to review the clinical outcomes associated with the procedure.

Multidetector computed tomography and magnetic resonance imaging findings in pulmonary hydatid cysts

Aim: Computed tomography (CT) and magnetic resonance imaging (MRI) are diagnostic modalities in pulmonary hydatid disease. We aimed to present CT and MRI findings in pulmonary hydatid disease. Material and Methods: CT and MRI findings of pulmonary hydatid cysts from January 2011 through June 2018 were evaluated retrospectively. CT images of 112 patients and MRI images of 27 patients were evaluated. Patients’ gender and ages, lesion number and distribution, concomitant organ involvement, complications, HU density of lesions on CT and signal characteristics of lesions on MRI were analyzed. T2 hypointense rim, T1 and T2 signal intensity, daughter vesicle and detached membranes were the evaluated parameters on MRI.Results: 147 hydatid cyst lesions of 119 (66 female, 53 male) patients with a mean age of 39.4±19.6 years were included in the study 62 (52.1%) of patients had isolated lung involvement. 79 of 119 patients (66.4%) had solitary lung lesion. Mean CT density of cysts were 16 HU. 25 of 32 cysts showed T2 hypointense rim on MRI. Conclusion: Imaging plays important role in diagnosis and presurgical evaluation of pulmonary hydatid disease. CT is mostly used in diagnosis; MRI should be a choice particularly in pediatric population.Keywords: Computed tomography; pulmonary; hydatid cyst; magnetic resonance.

Perianal fistülün tanısında, sınıflandırılmasında ve değerlendirilmesinde Manyetik Rezonans Görüntüleme’nin önemi

Aim: Magnetic resonance imaging (MRI) is a non-invasive and high reliability procedure for evaluation of perianal area. In this study, our purpose is to present preoperative MRI findings and classification with images in diagnosed perianal fistula patients. Methods: Contrast enhanced (CE) conventional MRI images, diffusion weighted MRI images and demographics of 57 patients were retrospectively evaluated. Perianal fistula classification is based on St James University Hospital (SJUH) classification system. Results: 57 patients (44 men and 13 women, average of 18 to 72 years, average age of 45.7 year) were included in this study. Most of the patients had symptoms of rectal pain and discharge. Some patients had additional complaints like rectal itching, swelling and erythema. 37 patients had grade 1, nine patients had grade 2, four patients had grade 3, five patients had grade 4 and two patients had grade 5 fistula. Fistula opening positions into anal canal were 6 o'clock in 21 patients, 7 o'clock in 10 patients. Fistula tract, its opening position into anal canal, presence of abscess and its relationship with sphincters or neighboring anatomical structures were clearly appreciated with conventional and diffusion weighted MRI in all patients. Conclusion: Perianal fistula is the abnormal connection between anal canal and perinea. It is usually a complication of anorectal abscess. It could occur secondary to inflammatory processes like Crohn's disease, tuberculosis or malignancy. Surgery is considered as the primary treatment. Recurrence due to surgical inadequacy is common. Recurrence rates could be minimized with a good knowledge of MRI findings and well informing the surgeon.

Application of Breast Ultrasound Elastography to Differentiate Intracapsular Collection from Silicone-Induced Granuloma of Breast Implant Capsule Complementarily to Contrast-Enhanced Breast Magnetic Resonance Imaging.

Background:To determine whether there is correlation between magnetic resonance imaging (MRI) findings and breast elastography to differentiate seroma/hematoma from silicone-induced granuloma of breast implant capsule (SIGBIC).Methods:Prospective study of 99 patients with breast implants submitted to breast MRI during the period from February 1 to May 1, 2017. Patients who present MRI findings of seroma/hematoma or SIGBIC were submitted to a complementary ultrasound elastography study to evaluate the correlation of the results. The criteria adopted for the diagnosis of granuloma by MRI were heterogeneous hypersignal in the T2-weighted sequences, late contrast enhancement, and black drop sign. Lesions that did not enhance after the use of contrast were considered as seroma/hematoma. By elastography, the results were considered positive for granuloma when presented as hard lesions, whereas seroma/hematoma presented as soft lesions.Results:Of the 99 patients evaluated, 15 were included in the study. Of the 15 patients, 9 had solid intracapsular MRI masses, whereas 6 presented collections without contrast enhancement. The complementary elastography study showed correlation with MRI results in all cases of SIGBIC and seroma/hematoma, being elastography able to differentiate lesions from solid to cystic.Conclusions:Elastography of intracapsular masses in breast implants presented results compatible with those found by MRI to differentiate solid lesions from collections.

Misdiagnosed spontaneous intracranial hypotension complicated by subdural hematoma following lumbar puncture

IntroductionSpontaneous intracranial hypotension is an infrequent cause of secondary headache due to cerebrospinal fluid (CSF) hypovolemia.ObjectiveTo describe a case of headache revealing spontaneous intracranial hypotension complicated by subdural hematoma following lumbar puncture.ObservationA 34-year-old man presented with acute postural headache. The first cerebral computed tomography scan was normal. Lumbar puncture showed hyperproteinorachy at 2 g/L with six lymphocytic cells. The headache became very intense. At admission, clinical examination was normal. Ophthalmological examination did not show any abnormalities. Encephalic magnetic resonance imaging (MRI) showed bilateral subdural hematoma with tonsillar descent simulating Chiari type I malformation. After surgical drainage and symptomatic treatment, the patient was discharged with no recurrence.ConclusionSpontaneous intracranial hypotension is associated with simple clinical presentation, orthostatic headache, and characteristic MRI findings. Misdiagnosed, it leads to unnecessary procedures.

MRI Findings of Mucinous Adenocarcinoma Arising From Perianal Fistula: Report of Two Cases

Mucinous adenocarcinoma may develop on the chronic setting of a perianal fistula. Magnetic resonance imaging (MRI) is the choice of imaging technique for the diagnosis of mucinous adenocarcinoma arising from perianal fistula. T2-weighted, and contrast enhanced MR images may provide important diagnostic information. In this report, we present MRI findings of two cases with mucinous adenocarcinoma arising from chronic perianal fistula with a brief review of the literature.

Diversity of Stroke Presentation in CADASIL: Study from Patients Harboring the Predominant NOTCH3 Mutation R544C

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a single-gene disorder of the cerebral small blood vessels caused by mutations in the NOTCH3 gene. Several characteristic population-specific clinical phenotypes and neuroimaging features have been reported in CADASIL. This study investigated the clinical stroke presentation and cranial magnetic resonance imaging (MRI) findings in a group of patients with CADASIL. We reviewed the clinical stroke presentation and brain MRI findings in 73 consecutive Korean patients aged >18 years diagnosed with CADASIL between May 2004 and April 2009. Brain MRI images were also scored for lacunar infarction and cerebral microbleeds. Intracranial atherosclerosis (ICAS) was assessed by magnetic resonance angiography. Disability was measured with the modified Rankin scale (mRS) and classified as good (mRS score 0-2) or poor (mRS score 3-5). In this study, 65 of the 73 patients (90.3%) had the same R544C genotype. A total of 40 episodes of cerebral infarction were confirmed in 31 patients, with a mean age at onset of 58.8 ± 11.4 years (range, 38-76 years). Twelve patients (16.9%) had ICAS, and 5 of these patients had symptomatic stenoses. Intracerebral hemorrhage occurred in 9 patients (12.3%). Both intracerebral hemorrhage and ICAS were associated with poor clinical outcome. Our data demonstrate the diversity of clinical stroke presentation according to ethnicity and vascular risk factors.

Cervical MRI of subacute myelo-optico-neuropathy

Case study. Subacute myelo-optico-neuropathy (SMON) is a severe neuro-degenerative disorder caused by poisoning due to over-dose and prolonged oral administration of clioquinol; this disorder was more frequent during 1957-1970. It is characterized by axonal degeneration and gliosis in the cervical gracile fasciculus. Recently, copper-deficient myelo-neuropathies presenting similar symptoms (that is, painful dysesthesia/paresthesia in the lower limbs, ataxia, spastic paraplegia, autonomic disorders and visual impairment) were reported. Magnetic resonance imaging (MRI) of these patients detected T2-weighted hyperintensities in the cervical spinal cord. An unbalanced zinc-copper metabolism was suggested as one of the candidate pathogenesis of clioquinol toxicity because of its metal-chelating ability. The aim of this study was to present MRI findings of old SMON patients and to compare them with those of current copper-deficient myelo-neuropathies. Japan. We conducted and analyzed cervical and brain MRIs of seven old SMON patients who contracted the disorder during the 1960s. Serum iron, magnesium, copper, zinc and ceruloplasmin levels were also measured. Cervical T2-weighted MRIs showed mild volume loss and faint hyperintensities in the dorsal columns, which might reflect residual gliosis. Brain fast fluid-attenuated inversion-recovery images and tractography were normal. Current levels of serum copper and zinc were within almost normal ranges. Although fainter, the abnormal T2 MRI signals we observed were similar to and occurred in the same locations as those reported in copper-deficient myelo-neuropathy patients. We suggest that these findings are useful to study the mechanism of clioquinol toxicity before using it to treat neurodegenerative diseases such as Alzheimer's disease.

Rare pattern of aortic arch branching in a patient with operated congenital heart disease

Magnetic resonance imaging (MRI) has become one of the state-of-the-art examinations for the primary diagnostics and follow-up of patients with congenital cardiac defects. The evaluation of the altered cardiovascular system, however, remains a diagnostic challenge. We present MRI findings in a boy with a complex congenital heart defect. To reveal postoperative changes in blood flow dynamics, time-resolved contrast-enhanced 3D MR angiography (CE-MRA) was performed, providing information on altered vessel anatomy and vascular dynamics using spatio-temporal image acceleration. Additionally, an exceptional and rarely described supraaortic vessel variation was detected, consisting of five independent supraaortic arteries. The knowledge of this unusual vessel anomaly detected by CE-MRA might be significant in the case of future therapeutic interventions.

MRI of the neonatal and paediatric spine and spinal canal

Today several modalities for imaging the spine, the spinal canal and the spinal cord are available. Since children represent one of the most vulnerable patient groups, care has to be taken and imaging assessment should start always with less invasive procedures. Thus, in neonates and infants ultrasound should be used as first line imaging procedure due to their unique features of more cartilaginous parts of the yet non-ossified bones. Beyond this age group Magnetic Resonance Imaging (MRI) represents the modality of choice for radiological assessment of the spine, the spinal canal and the spinal cord. The purpose of this review is to present MRI and common MRI findings of typical diseases in children—ranging from congenital to acquired conditions. In addition, general imaging details will be given as well as a brief embryological description of the spine and spinal canal.

Familial Mediterranean fever mimicking septic arthritis: distinguishing with diffusion weighted imaging

FMF arthritis is generally monoarticular in origin. The affected joint is hot, tender, red and mimics septic arthritis. Conventional imaging findings, including magnetic resonance imaging (MRI) and ultrasound, do not help differentiate between these two entities. The final diagnosis depends on culture of the synovial fluid, and therefore initiation of proper drug therapy can be delayed. Diffusion weighted imaging (DWI), with its ability to detect altered water-proton mobility, might play an important role as a fast and non-invasive problem-solving tool in this setting. We here present MRI and DWI findings of a case of FMF arthritis mimicking septic arthritis.

Intravascular malignant lymphomatosis: diffusion‐weighted magnetic resonance imaging characteristics

Intravascular malignant lymphomatosis is an unusual condition in which malignant lymphoma cells form microscopic masses within the blood vessels of the central nervous system. Occlusion of the involved blood vessels can lead to multifocal cerebral infarcts. Diffusion-weighted magnetic resonance imaging (MRI) reveals a subacute infarction pattern (bright high signal intensity on b = 1000 s/mm2 images and intermediate apparent diffusion coefficient values) in the cerebral deep white matter. We present MRI findings of a 68-year-old woman with intravascular malignant lymphomatosis involving the cerebral white matter and the thoracic cord.

MRI findings in Tolosa–Hunt syndrome before and after systemic corticosteroid therapy

Tolosa–Hunt syndrome (THS) is characterized by painful ophthalmoplegia due to a granulomatous inflammation in the cavernous sinus. Corticosteroid therapy dramatically resolves both the clinical and radiological findings of THS. We present MRI findings of six patients with a clinical history of at least one episode of unilateral or bilateral orbital-periorbital pain, clinical findings of associated paresis of one or more of 3rd, 4th, 5th or 6th cranial nerves. All of the patients revealed an enlargement of the symptomatic cavernous sinus on magnetic resonance imaging (MRI) scans. Five patients revealed total resolution of the clinical findings within 1–8 weeks, following systemic corticosteroid treatment. One patient revealed only minor regression of clinical findings within 2 weeks after the initiation of the treatment, so the cavernous sinus lesion was reevaluated as meningioma on MRI, and the patient underwent surgical resection of the mass with resultant histopathological finding of cavernous sinus meningioma. A follow-up MRI scan was performed for five patients at the end of 8-weeks of steroid therapy. Three of these five patients showed total resolution of the cavernous sinus lesions whereas two of them revealed a partial regression of the cavernous sinus lesions. MRI findings before and after systemic corticosteroid therapy are important diagnostic criteria to put the definitive diagnosis of THS and to differentiate it from other cavernous sinus lesions that simulate THS both clinically and radiologically.

Cockayne syndrome: MRI correlates of hypomyelination

Two siblings with Cockayne syndrome are reported who had most of the stigmata characteristic of the syndrome as it was initially described in 1936. Unusual findings are emphasized, such as the early onset of cataracts and the early detection of peripheral neuropathy. The previously reported autopsy abnormalities in this condition are correlated with the present magnetic resonance imaging findings of mild ventricular enlargement and delay in myelination of the cerebrum and cerebellum. Properly myelinated structures included the basal ganglia, thalamus, internal capsule, splenium, and genu of the corpus callosum.