Resonance Imaging In Management Research Articles

3T magnetic resonance imaging in management of orbital venolymphatic malformations: two case reports

Vascular malformations may occur during the development of the arterial, venous, and lymphatic systems in isolation or in combination. Orbital venolymphatic malformations (OVLM) are particularly challenging to treat because they infiltrate and remodel normal structures within the tight orbital space and lead to substantial ocular discomfort, visual disability, and facial disfigurement. Herein, we report two cases of OVLMs with different presenting clinical features and treatment options. We compare the image qualities among computed tomography and 1.5T and 3T magnetic resonance imaging and discuss how better anatomical resolution in the latter aid in the management of OVLM.

A prospective study on role of magnetic resonance imaging in management of acute spinal trauma and assessing the extent of neurological deficit

Background: For Imaging neurological parts, like the spinal cord, magnetic resonance imaging (MRI) has been the gold standard. The use of magnetic resonance imaging (MRI) in the acute management of patients with spinal cord injuries has risen dramatically. Objectives: This study was conducted to evaluate the diagnostic role of magnetic resonance imaging in management of acute spinal trauma and to assess the extent of neurological deficit. Material and Methods: Thirty patients of spinal trauma. The patients undergoing MR imaging, magnetic resonance images were analysed and skeletal injuries, signal changes in vertebrae, ligaments, soft tissues were noted. Associated spinal cord injury findings were also noted, which helped in assessing the initial neurological deficit and compared with (ASIA) impairment scale. Results: Out of 30 patients of spinal trauma. 53.3 % injuries were in cervical region and 46.6% in thoracolumbar region. Most of the traumatic spinal injuries in cervical spine were unstable. (68.75%) and thoracolumbar spine were stable injuries (42.85%). Unstable spinal injuries (56.66%) in cervical and thoracolumbar were operated and stabilised. Cord oedema (36.6%) and next cord compression (33.3%) were common presentations of cord injuries; cord transection and compression have worse neurological deficit and presented with ASIA score A/B at the time of admission. Conclusion: CT provides superior depiction of bony anatomy but important limitation of this technique is inability to provide screening for ligamentous injury and spinal cord lesions. MRI is superior in this regard. Because of its high contrast resolution, absence of bony artifacts, multiplanar ability, and variety of pulse sequences, MRI allows for a more precise diagnosis of spinal trauma.

Perioperative ultrasound imaging versus magnetic resonance imaging in management of lumbosacral spinal dysraphisms

ObjectivesThe purpose of this study was to correlate lumbosacral spinal ultrasound (LUS) and magnetic resonance imaging (MRI) findings in patients with lumbosacral spinal dysraphisms to evaluate the value of LUS in diagnosis, intraoperative use, and during follow-up of those patients.MethodsA total of 24 patients aged up to 6 years old were operated for lumbosacral spinal dysraphisms at the Neurosurgery Department of Zagazig University hospitals during the period from January 2017 to August 2018. All patients were investigated preoperatively, intraoperatively, and on follow-up by LUS to compare the data with preoperative and follow-up MRI of the spine.ResultsThe median age was 11 months at the time of surgery. The most common anatomical description from the LUS study was thickened filum (18 cases). Using MRI findings as the standard reference, the sensitivity of LUS in detecting a thickened filum was 77.8% preoperatively and 62.5% postoperatively, with a specificity of 100%. The sensitivity and specificity of detecting conus level, solid masses, and cystic masses were 100%.ConclusionsLumbosacral spinal dysraphisms can be evaluated well by ultrasound imaging in age group up to 6 years old with 100% specificity (true negative) in comparison with MRI.

OP20.06: Added value of fetal magnetic resonance imaging in management of suspected bowel obstruction beyond the duodenum

OP20.06: Added value of fetal magnetic resonance imaging in management of suspected bowel obstruction beyond the duodenum

The Use of Magnetic Resonance Imaging in Management of Minimally Displaced or Nondisplaced Lateral Humeral Condyle Fractures in Children.

Fractures of the lateral humeral condyle are common in children. Nondisplaced fractures are managed with cast immobilization and frequent radiographic follow-up. Possibility of assessing the displacement and stability of such fractures may be helpful in planning the initial treatment and survey. Magnetic resonance imaging (MRI) could be a useful tool in determining the stability of lateral condyle in children. We propose to investigate the use of MRI in such indication. Fourteen patients presenting with a minimally displaced or nondisplaced fracture were initially treated with a long arm cast and had an MRI within 5 days of injury. The MRI showed that 10 patients had an incomplete fracture without disruption of the cartilage hinge and 4 patients had a complete fracture with extension of the fracture through the cartilaginous epiphysis into the elbow joint. Three patients with such complete fracture had no evidence of lateral condyle displacement on MRI, and 1 patient had a displacement of the lateral condyle. The patients with incomplete fractures had a conservative treatment. The patient with a complete and displaced fracture had an open reduction and internal fixation. The 3 patients with a complete fracture and no evidence of lateral condyle displacement on MRI had a control MRI, 6 to 10 days after cast application, to detect a secondary displacement of the fracture. Because it seems difficult in minimally displaced or nondisplaced fractures to detect further displacement with radiographs, MRI was found mandatory to improve complete fracture visualization during the first phase of conservative treatment. In incomplete fractures, initial MRI investigation was consistent with a stable fracture and avoided further early radiographs or clinical survey. In such cases, we recommend a conservative treatment with late radiographs after long arm cast removal. We propose MRI routine use in the early evaluation of minimally displaced or nondisplaced lateral condyle fractures in children.

The role of magnetic resonance imaging in management of patients with nonlobar hypertensive intracerebral hemorrhage.

Despite the increased use and availability of magnetic resonance imaging (MRI), its role in hypertensive intracerebral hemorrhage (ICH) remains uncertain. In this retrospective study, we assessed the utility of MRI in diagnosis and management of patients with hypertensive ICH. We retrospectively reviewed the charts of patients with ICH presenting to our hospital over an 18-month period. We included patients who presented with hypertensive ICH in typical locations and excluded lobar hemorrhages. We further isolated cases that had undergone MRI. Collected data included mean age, gender, location of hematoma, neuroradiologist's interpretative report of the MRI, and management steps taken in response to the results of the MRI. Logistic regression was used to determine whether the overall yield of MRI in these patients was significant. We found 222 patients with ICH in our database. Forty-eight patients met our inclusion criteria, of which 24 had brain MRI done as a part of their hospital workup. Brain MRI obtained in 2 (8%) of the 24 patients revealed abnormalities that led to a change in management. The diagnostic yield of MRI and the management decisions that followed were both insignificant. The diagnostic yield of brain MRI in patients with nonlobar hypertensive ICH is low and does not result in significant changes in management.

Diffusion-weighted magnetic resonance imaging in management of bladder cancer, particularly with multimodal bladder-sparing strategy.

Bladder-sparing strategy for muscle-invasive bladder cancer (MIBC) is increasingly demanded instead of radical cystectomy plus urinary diversion. Multimodal therapeutic approaches consisting of transurethral resection, chemotherapy, radiotherapy and/or partial cystectomy improve patients' quality of life by preserving their native bladder and sexual function without compromising oncological outcomes. Because a favorable response to chemoradiotherapy (CRT) is a prerequisite for successful bladder preservation, predicting and monitoring therapeutic response is an essential part of this approach. Diffusion-weighted magnetic resonance imaging (DW-MRI) is a functional imaging technique increasingly applied to various types of cancers. Contrast in this imaging technique derives from differences in the motion of water molecules among tissues and this information is useful in assessing the biological behavior of cancers. Promising results in predicting and monitoring the response to CRT have been reported in several types of cancers. Recently, growing evidence has emerged showing that DW-MRI can serve as an imaging biomarker in the management of bladder cancer. The qualitative analysis of DW-MRI can be applied to detecting cancerous lesion and monitoring the response to CRT. Furthermore, the potential role of quantitative analysis by evaluating apparent diffusion coefficient values has been shown in characterizing bladder cancer for biological aggressiveness and sensitivity to CRT. DW-MRI is a potentially useful tool for the management of bladder cancer, particularly in multimodal bladder-sparing approaches for MIBC.

Impact of Magnetic Resonance Imaging in Management of Pediatric Crohn's Disease

Crohn's disease (CD) is a chronic illness and radiographic evaluation is frequently used. Consequently, pediatric patients with CD who are diagnosed in childhood are at risk for high levels of radiation exposure during their lifetimes. We sought to evaluate the impact of magnetic resonance enterography (MRE) in management of pediatric patients with known or suspected Crohn's disease. A retrospective review of patients with known or suspected CD who underwent MRE for new onset of symptoms was conducted. All demographic data, clinical history, and results of all radiographic, endoscopic, and pathology studies were recorded. Twenty-eight patients with known or suspected CD underwent 31 MRE examinations. MRE showed active disease in 16 (52%), fistula or abscess in seven (22%), and no evidence of active disease in eight (26%). Sixty-five per cent of patients underwent MRE with no other radiation-based imaging used. Surgical intervention was deemed necessary after the MRE in 16 per cent. In all cases, surgical findings were consistent with MRE results. Nearly 60 per cent of patients with CD are managed based on the findings of MRE without additional radiographic evaluation. Based on the results of this retrospective study, we propose a clinical pathway for use of MRE in patients with known or suspected CD with new onset of symptoms.

Clinical application of magnetic resonance imaging in management of breast cancer patients receiving neoadjuvant chemotherapy.

Neoadjuvant chemotherapy (NAC), also termed primary, induction, or preoperative chemotherapy, is traditionally used to downstage inoperable breast cancer. In recent years it has been increasingly used for patients who have operable cancers in order to facilitate breast-conserving surgery, achieve better cosmetic outcome, and improve prognosis by reaching pathologic complete response (pCR). Many studies have demonstrated that magnetic resonance imaging (MRI) can assess residual tumor size after NAC, and that provides critical information for planning of the optimal surgery. NAC also allows for timely adjustment of administered drugs based on response, so ineffective regimens could be terminated early to spare patients from unnecessary toxicity while allowing other effective regimens to work sooner. This review article summarizes the clinical application of MRI during NAC. The use of different MR imaging methods, including dynamic contrast-enhanced MRI, proton MR spectroscopy, and diffusion-weighted MRI, to monitor and evaluate the NAC response, as well as how changes of parameters measured at an early time after initiation of a drug regimen can predict final treatment outcome, are reviewed. MRI has been proven a valuable tool and will continue to provide important information facilitating individualized image-guided treatment and personalized management for breast cancer patients undergoing NAC.

Role of dynamic magnetic resonance imaging in management of obstructed defecation case series

Aims Surgical treatment of obstructed defecation (OD) carries frequent recurrences. The aim of the study was to evaluate the role dynamic magnetic resonance imaging defecography, and to elucidate the underlying anatomic and pathophysiologic background of pelvic floor disorders in these patients in order to minimize failures. Patients and methods Forty consecutive constipated patients with OD symptoms (31 females) with mean age 48.15 ± 14.29 years. They underwent perineal examination, proctoscopy, anorectal manometry and Dynamic MRI defecography. The different pelvic floor morphology was recorded. The type and outcome of treatment whether conservative or surgical were also recorded. Results The dynamic MRI of the pelvic floor showed 23 patients with descending perineum, 32 rectoceles (28 females), 12 cystoceles (10 females), 6 enteroceles (4 females), 18 intussusceptions (14 females), and 7 dyskinetic puborectalis muscle (3 females). The diagnosis of combined pelvic floor disorders with dynamic MRI defecography was consistent with clinical results in 70% and there were additional diagnostic parameters in 30% of patients. Dynamic MRI findings changed treatment decision in 8 patients 20% with surgical treatment performed in 25 patients (8 stappled trans-anal rectal resection, 11 trans-anal Delorme's, 6 trans-abdominal combined repair), and conservative treatment in 15 patients. Conclusions Dynamic magnetic resonance imaging represents a convenient diagnostic procedure in females and to a lesser extent in males, especially in terms of dynamic imaging of pelvic floor organs during defecation. In addition to the clinical assessment, dynamic magnetic resonance imaging had clinical impact in OD and interdisciplinary treatment.