Subsequent Magnetic Resonance Imaging Examination Research Articles

Holocord syringomyelia caused by tethered cord syndrome: case report and literature review

BackgroundSyringomyelia is a rare disease with diverse etiologies, and the syrinx is typically confined to certain segments of the spinal cord. Case of syringomyelia affecting the whole cord due to tethered cord is extremely rare, and the underlying pathophysiological mechanisms remain poorly understood.Case presentationWe described an 18-year-old male patient who presented with progressive weakness in both lower extremities and bladder dysfunction over the past four years. Magnetic resonance imaging (MRI) of the entire spine revealed a tethered spinal cord with a large syrinx extending from C1 to L5. Common causes of syrinx such as Chiari malformation, intramedullary tumors and spinal cord injury were systematically ruled out, leading to a strong suspicion that the tethered cord was the primary etiology of the extensive syringomyelia. After undergoing un-tethering surgery, the patient experienced significant symptomatic improvement, and the subsequent follow-up MRI examinations demonstrated a remarkable reduction and eventual resolution of the large syrinx.ConclusionsAlthough rare, tethered cord syndrome can serve as the sole etiology for extensive syringomyelia. For such patients, performing un-tethering surgery can lead to complete resolution of the syrinx and achieve a satisfactory clinical outcome.

Ultrasound Versus Magnetic Resonance Imaging as First-Line Imaging Strategies for Rotator Cuff Pathologies: A Comprehensive Analysis of Clinical Practices, Economic Efficiency, and Future Perspectives.

Rotator cuff injuries are a prevalent cause of atraumatic chronic shoulder pain, imposing a significant healthcare burden. This articlereviews the clinical presentation, diagnostic imaging modalities, practice variations, and economic efficiency considerations in the evaluation of rotator cuff pathologies. Ultrasound (US) and magnetic resonance imaging (MRI) are the primary imaging methods for diagnosing rotator cuff injuries. US provides real-time visualization but has limited tissue penetration, while MRI offers detailed anatomical information but is not a dynamic process. Studies show that MRI is superior to US with higher sensitivity and specificity. MRI is the gold standard, particularly for surgical planning, but US remains relevant when MRI is not feasible. Both require standardized protocols for evaluating tear dimensions and muscle atrophy. With the operator-dependent nature of US, MRI offers a more comprehensive assessment of rotator cuff tears and predictive insights for clinical outcomes. Practice variations exist in the management of rotator cuff pathologies, with some countries favoring US as the primary imaging modality and others relying more on MRI. These variations are influenced by factors like resource availability and healthcare system nuances. In Australia, current guidelines lean towardconservative management, potentially leading to delayed diagnoses and increased costs. The United States often favors MRI, while Canada advocates for US as the initial choice. Economic considerations play a significant role in selecting imaging modalities. While US is cost-effective, it may necessitate subsequent MRI examinations, contributing to inefficiencies in the diagnostic process. Studies suggest that a combined approach of US and MRI is less efficient and cost-effective than MRI alone. However, the use of both modalities rather than MRI aloneis common in clinical practice, adding to healthcare expenses. In conclusion, the choice of imaging modality for rotator cuff pathologies should consider factors such as diagnostic efficacy, cost-effectiveness, and resource availability. Radiologists play a pivotal role in guiding this selection and ensuring comprehensive evaluations. Future considerations should include the revision of management guidelines and the potential inclusion of shoulder pathologies in healthcare coverage to optimize patient care and healthcare expenditure.

Longitudinal Magnetic Resonance Imaging Detects Onset and Progression of Chronic Rhinosinusitis from Infancy to School Age in Cystic Fibrosis.

Rationale: Chronic rhinosinusitis (CRS) contributes to morbidity in patients with cystic fibrosis (CF). However, longitudinal data on CRS onset and progression is lacking. Objectives: To longitudinally evaluate CRS in CF from infancy to school age with paranasal sinus magnetic resonance imaging (MRI). Methods: A total of 64 children with CF (mean age at baseline, 1.1 ± 1.6 yr; range, 0-5 yr) underwent a mean of 5.8 ± 2.2 (range, 3-11 yr) subsequent annual MRI examinations. Additional 24 children (9.2 ± 4.4 yr; range, 3-17 yr) homozygous for the F508del mutation underwent MRI before and at least 2 months after starting lumacaftor/ivacaftor. MRI was assessed using the previously evaluated CRS-MRI score. Results: In infancy, 65-87% of paranasal sinuses were opacified, and mucosal swelling was the dominant abnormality (58-97%). At preschool age (1-5 yr), 79-94% of sinuses were opacified (P < 0.05 vs. infancy), and mucosal swelling was the most dominant abnormality (79-94%; P < 0.05). At school age (at least 6 yr), almost all sinuses were opacified (71-99%; P < 0.001-0.357 vs. preschool age), and mucopyoceles were the dominant abnormality in maxillary and frontal sinuses (53-56%; P < 0.05-0.808). The CRS-MRI sum score increased from 22.4 ± 9.6 in infancy to 34.2 ± 9.6 in preschool age (P < 0.001) and was 34.0 ± 5.7 in school age (P = 0.052). In children under lumacaftor/ivacaftor therapy, the CRS-MRI sum score (-0.5 ± 3.3; P < 0.05) and maxillary sinus subscore (-0.5 ± 1.5; P < 0.05) improved. Conclusions: Longitudinal paranasal sinus MRI detects an early onset and progression of the severity of CRS from infancy to school age, and response to lumacaftor/ivacaftor therapy in children with CF. Our data support its role in the comprehensive noninvasive monitoring of CRS in children with CF. Clinical trial registered with www.clinicaltrials.gov (NCT02270476).

Accuracy of MRI-directed ultrasound and subsequent ultrasound-guided biopsy for suspicious breast MRI findings

To determine the accuracy of magnetic resonance imaging (MRI)-directed breast ultrasound and subsequent ultrasound-guided biopsy, and to evaluate patient and lesion factors associated with the detection of an ultrasound correlate for MRI findings. Health Insurance Portability and Accountability Act (HIPAA)-compliant, institutional review board-approved retrospective review of 7,332 consecutive contrast-enhanced MRI examinations from 1 January 2009 to 30 March 2012 was performed to identify MRI-detected lesions that underwent MRI-directed ultrasound, ultrasound-guided core-needle biopsy (USG-CNB), and follow-up MRI after benign biopsy. Examinations were reviewed in consensus. USG-CNB was considered accurate if the biopsy clip was within 1 cm of the MRI lesion on follow-up MRI. Medical records were reviewed for histopathology, patient demographics, and follow-up imaging. MRI-directed ultrasound was performed on 522 patients with MRI-detected findings. A presumed ultrasound correlate was identified in 298 cases and 221 (73.4%) underwent biopsy. Follow-up MRI after USG-CNB was performed for 90 benign concordant biopsied lesions. Seven lesions were excluded because the biopsy marker was not visible on the subsequent MRI examination. Of the remaining 83 lesions, the biopsy marker was accurate in 72 (87%) lesions on follow-up MRI and 11 were considered inaccurate (13%). Of these 11 lesions, five were considered benign based on stability/resolution at follow-up MRI, while six underwent subsequent tissue diagnosis (mean time to tissue diagnosis: 13 months), with 1/6 (16.7%) malignancies. Although MRI-directed ultrasound is a reliable and accurate method to evaluate MRI findings, a 13% inaccuracy rate for MRI-directed ultrasound-guided biopsy was found. Therefore, for cases with uncertain MRI-directed ultrasound correlation, MRI-guided biopsy should be performed for accurate and timely diagnosis.

Anatomical subgroup analysis of the MERIDIAN cohort: ventriculomegaly.

To assess the contribution of fetal magnetic resonance imaging (MRI) in fetuses of the MERIDIAN cohort diagnosed with ventriculomegaly (VM) as the only abnormal intracranial finding on antenatal ultrasound. This was a subgroup analysis of the MERIDIAN study of fetuses with only VM diagnosed on ultrasound in women who had a subsequent MRI examination within 2 weeks and for whom outcome reference data were available. The diagnostic accuracy of ultrasound and MRI was reported in relation to the severity of VM. The difference in measurements of trigone size on the two imaging methods and the clinical impact of adding MRI to the diagnostic pathway were also studied. In 306 fetuses with VM, ultrasound failed to detect 31 additional brain abnormalities, having an overall diagnostic accuracy of 89.9% for ultrasound, whilst MRI correctly detected 27 of the additional brain abnormalities, having a diagnostic accuracy of 98.7% (P < 0.0001). There were other brain abnormalities in 14/244 fetuses with mild VM on ultrasound (diagnostic accuracy, 94.3%) and MRI correctly diagnosed 12 of these (diagnostic accuracy, 99.2%; P = 0.0005). There was a close agreement between the size of trigones measured on ultrasound and on MRI, with categorical differences in only 16% of cases, showing that MRI did not systematically overestimate or underestimate trigone size. Complete prognostic data were available in 295/306 fetuses and the prognosis category changed after MRI in 69/295 (23.4%) cases. The overall effect of MRI on clinical management was considered to be 'significant', 'major' or 'decisive' in 76/295 (25.8%) cases. Our data suggest that a woman carrying a fetus with VM as the only intracranial finding on ultrasound should be offered an adjuvant investigation by MRI for further evaluation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Assessment of disease extent on contrast-enhanced MRI in breast cancer detected at digital breast tomosynthesis versus digital mammography alone

To compare the utility of breast magnetic resonance imaging (MRI) in determining the extent of disease in patients with newly diagnosed breast cancer detected on combination digital breast tomosynthesis (DBT) versus digital screening mammography (DM). Review of 24,563 DBT-screened patients and 10,751 DM-screened patients was performed. Two hundred and thirty-five DBT patients underwent subsequent MRI examinations; 82 to determine extent of disease after newly diagnosed breast cancer. Eighty-three DM patients underwent subsequent MRI examinations; 23 to determine extent of disease. MRI examinations performed to assess disease extent were considered true positives if additional disease was discovered in the contralateral breast or >2cm away from the index malignancy. Differences in cancer subtypes and MRI outcomes between the DM and DBT cohorts were compared using chi-squared tests and post-hoc Bonferroni-adjusted tests for equal proportions. No differences in cancer subtype findings were observed between the two cohorts; however, MRI outcomes were found to differ between the DBT and DM cohorts (p=0.024). Specifically, the DBT cohort had significantly (p=0.013) fewer true-positive findings (7/82, 8.5%) than did the DM cohort (7/23; 30%), whereas the false-positive rate was similar between the cohorts (not statistically significant). When stratifying by breast density, this difference in true-positive rates was primarily observed when evaluating women with non-dense breasts (p=0.001). In both the DM- and DBT-screened populations with new cancer diagnoses, MRI is able to detect additional cancer; however, in those patients who have DBT screen-detected cancers the positive impact of preoperative MRI is diminished, particularly in those women with non-dense breasts.

A Case of Legionella Pneumonia Causing Neurological Symptoms Related to a Reversible Corpus Callosum Lesion

A 51-year-old man presented at the emergency department with a one-day history of fever, altered mental status, slurred speech, worsening gait instability, nausea, vomiting, and diarrhea. The patient did not have a history of alcoholism or drug abuse. On physical examination, crackles were heard over the right lower lobe. Neurological findings revealed ataxic gait, dysarthria and bilateral dysmetria upon finger-nose testing. The results of laboratory tests revealed leukocytosis, renal failure, and hyponatremia. Chest radiography and lung computed tomography (CT) revealed right lower lobe infiltrates with air bronchograms. The result of a urinary Legionella antigen test was positive. The results of brain CT and cerebrospinal fluid (CSF) analyses did not reveal any signs of infection, but brain magnetic resonance imaging (MRI) revealed a corpus callosum lesion upon admission. The patient's symptoms began to resolve after the administration of intravenous levofloxacin. A subsequent brain MRI examination performed 9 days after admission showed the complete resolution of the lesion. He was discharged 11 days after admission without any neurological sequelae. He was finally diagnosed as having clinically mild encephalitis/ encephalopathy with a reversible splenial lesion (MERS).

Prenatal diagnosis of holoprosencephaly with proboscis and cyclopia caused by monosomy 18p resulting from unbalanced whole-arm translocation of 18;21

Abstract A case of holoprosencephaly (HPE) with proboscis, fused eyes in one orbit, and cyclopia was diagnosed by fetal ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). Ultrasonographic examination at 28 weeks of gestation showed fusion of the frontal part of the brain and ventricular dilation. Subsequent CT and MRI examinations confirmed this anomaly as alobar HPE. Amniocentesis followed by chromosome analysis demonstrated karyotype as de novo 45,XY, der (18;21)(q10;q10), with deletion of a short arm of chromosome 18. The pregnancy ended in a premature delivery of a male neonate weighing 1716 g at 34 weeks. Macroscopically, there were mid-frontal proboscis and single orbit with two eyes without normal nasal structures. He died 1 h after birth.

A Clinical Presentation of Tumefactive Multiple Sclerosis Mimicking Acute Ischemic Stroke on MRI

Tumefactive multiple sclerosis (MS) is characterized by a magnetic resonance imaging (MRI) finding of a large, inflammatory demyelinating lesion with or without contrast enhancement. The description of non-tumefactive MS lesions is well established for a variety of MRI sequences; however, explanation of MRI characteristics for tumefactive MS lesions is limited. The findings on diffusion weighted imaging and apparent diffusion coefficient in active MS plaques are well known, but little is known about these sequences in tumefactive MS. There is data to support the use of diffusion tensor imaging (DTI) in addition to basic MR sequences when differentiating tumefactive MS from other lesions such as non-tumefactive MS plaques. The patient in this case report presented with an acute right-sided hemiparesis with a discrete hypodensity on head computer tomography, which was thought to be an ischemic stroke. The initial MRI examination showed a finding that could be consistent with ischemic stroke having decreased apparent diffusion coefficient and increased diffusion restriction. However, a subsequent MRI examination clearly revealed a demyelinating process through development of other white matter lesions. The study attempts to underline that tumefactive demyelinating disease can mimic the clinical and imaging presentation of acute ischemic stroke; therefore, cautious interpretation with clinical correlation is required for correct diagnosis.

A case of infantile mumps meningitis with acute cerebellar ataxia and MERS

We report a patient with mumps meningitis and MERS (clinically mild encephalitis/encephalopathy with reversible splenial lesion) who exhibited flutter-like oscillations. A 7-year-old boy complaining of a headache, vomiting and dizziness consulted the Department of Pediatrics. Since he was positive for hemolytic streptococcus but did not exhibit cervical rigidity, an antibiotic was prescribed. He was brought back to the Department of Pediatrics after suffering from convulsions two days later. A high-intensity spot was found in the splenium of the corpus callosum on a diffusion-weighted magnetic resonance imaging (MRI) examination. The patient showed irregular horizontal eye movements and was referred to our department under a suspicion of peripheral vertigo. We found a horizontal pendular ocular movement with a small oscillation and a short duration and suspected flutter-like oscillations. No new lesions were found on a subsequent MRI examination, and the symptoms gradually improved without any additional treatment. The patient was discharged 20 days later. The diagnosis was mumps meningitis, acute cerebellar ataxia, and MERS based on a cerebrospinal fluid polymerase chain reaction (PCR) test and the MRI results. The patient's symptoms had disappeared at a follow-up examination performed in the outpatient department 47 days later.Flutter-like oscillations are an irregular ocular movement found in cases with an impaired brainstem or cerebellum. Flutter-like oscillations often occur with changes in fixation and are presumably caused by a malfunction in pause neurons in the brainstem.MERS is characterized by a reversible splenial lesion of high intensity on diffusion-weighted MRI in association with various diseases such as viral infection, epilepsy, renal failure and electrolyte imbalance. The cause is thought to involve inflammatory infiltrates or intramyelinic edema.The present report is thought to be the first description of a case of MERS exhibiting flutter-like oscillations. Since flutter-like oscillations may be confused with peripheral nystagmus, despite the distinctive ocular movement, a neurootologist consultation is desirable, especially in cases where central impairment is suspected.

Risk Factors for Bone Stress Injuries

The aim of the present study was to assess the risk factors for magnetic resonance imaging (MRI)-detected bone stress injuries in the pelvis, hip, thigh, and knee in a large cohort of Finnish conscripts during a follow-up of 102,515 person-years. An epidemiologic prospective cohort study of 152,095 conscripts, including 2345 (1.5%) females, was conducted. Localized pain in the pelvis, hip, thigh, or knee resulted in an orthopedic surgeon's consultation and subsequent MRI examination at the Central Military Hospital, Helsinki, Finland. Risk factors were systematically collected from 1998 to 2004, including data on conscripts' physical fitness and body composition measured at the beginning of their military service. Altogether, 319 MRI-detected bone stress injuries of the pelvis, hip, thigh, or knee were identified in our cohort; thus, the incidence was 311 (95% CI: 277-345) per 100,000 person-years. The female:male ratio varied substantially, depending on the anatomic location of the injury; it was highest for sacral injuries (female:male ratio = 51.1) and lowest for injuries of the femoral condyle (female:male ratio = 0.8). In univariate Cox regression analysis, poor muscle strength and a poor result in a 12-min run were significantly associated with bone stress injuries. In multivariable analysis, the strongest risk factors for bone stress injuries were female gender (hazard ratio 8.2; 95% CI: 4.8-14.2) and higher age (hazard ratio 2.1; 95% CI: 1.4-3.1). Female military trainees have a highly increased risk of bone stress injuries of the pelvis and hip compared with male conscripts. Sacral stress fractures are typical bone stress injuries in female military recruits. Physicians should remember the possibility of bone stress injury, especially when examining stress-related pain symptoms of the pelvic area in physically active young adult females.

Three-dimensional versus two-dimensional sonography of the temporomandibular joint in comparison to MRI

Aim To compare clinical feasibility of static two-dimensional (2D) to three-dimensional (3D) sonography of the temporomandibular joint (TMJ) in assessment of disk dislocation and joint degeneration compared to magnetic resonance imaging (MRI). Method Thirty-three patients, 66 TMJ were prospectively sonographed 2D and 3D (8–12.5 MHz step motor scan), in occlusion and maximum opening with a probe position parallel inferior to the zygomatic arch. Axial 2D images were judged independent from the 3D scans; 3D volumes were cut axial, sagittal, frontal and rotated in real-time. Disk position and joint degeneration were assessed and compared to a subsequent MRI examination. Results The specific appearance of the disk was hypoechogenic overlying a hyperechogenic condyle in axial (2D) or sagittal and frontal (3D) viewing. Specificity of 2D sonography for disk dislocation was 63%, sensitivity 58%, accuracy 64%, positive predictive value 46%, negative predictive value 73%; for joint degeneration synonymously 59/68/61/38/83%. 3D sonography for disk displacement reached synonymously 68/60/69/51/76%, for joint degeneration 75/65/73/48/86%. 2D sonographic diagnoses of disk dislocation in the closed mouth position and of joint degeneration showed significantly different results from the expected values (MRI) in χ 2 testing; 3D diagnoses of disk dislocation in closed mouth position, of joint degeneration, 2D and 3D diagnoses in open mouth position were nonsignificant. Conclusions Acceptable was the overall negative predictive value, as specificity and accuracy for joint degeneration in 3D. 3D appears superior diagnosing disk dislocation in closed mouth position as for overall joint degeneration. Sensitivity, accuracy and positive predictive value will have to ameliorate with future equipment of higher resolution in real-time 2D and 3D, if sonographic screening shall be clinically applied prior to MRI.

Spontaneous regression of congenital cystic adenomatoid malformation of the lung: Longitudinal examinations by magnetic resonance imaging

We report a case of large cystic adenomatoid malformation of the lung (CCAM), which occupied almost the entire left lung with a prominent mediastinal shift at 24 weeks of gestation. The volume of the lesion, determined by magnetic resonance imaging (MRI), was 27.0 cm3. Subsequent MRI and ultrasound examinations revealed a spontaneous resolution of the lesion at 32 and 36 weeks of gestation without a mediastinal shift, when the lesion volume was 12.8 cm3 and 5.6 cm3, respectively. At 37 weeks of gestation, a mature male baby weighing 2638 g with an Apgar score of 7 was delivered by elective cesarean section. A lobectomy of the left upper lobe of the lung was carried out at 3 days of age, due to an enlargement of the CCAM after birth.

Spontaneous craniospinal hypotension

Spontaneous cerebrospinal fluid (CSF) leak has been called "spontaneous intracranial hypotension," emphasizing the intracranial symptoms and imaging findings. We present a patient with spontaneous CSF leak whose initial spinal magnetic resonance imaging (MRI) findings were thought to represent epidural tumor or infection. Subsequent MRI examinations showed an improvement of both intracranial and spinal CSF hypotension findings coinciding with clinical symptom resolution. We propose the term "spontaneous craniospinal hypotension" to better emphasize this syndrome's unifying intracranial and spinal pathophysiology and imaging findings.