Total Body MRI Research Articles

Research

The April 2024 Research Roundup360 looks at: Prevalence and characteristics of benign cartilaginous tumours of the shoulder joint; Is total-body MRI useful as a screening tool to rule out malignant progression in patients with multiple osteochondromas?; Effects of vancomycin and tobramycin on compressive and tensile strengths of antibiotic bone cement: a biomechanical study; Biomarkers for early detection of Charcot arthropathy; Strong association between growth hormone therapy and proximal tibial physeal avulsion fractures in children and adolescents; UK pregnancy in orthopaedics (UK-POP): a cross-sectional study of UK female trauma and orthopaedic surgeons and their experiences of pregnancy; Does preoperative weight loss change the risk of adverse outcomes in total knee arthroplasty by initial BMI classification?.

Research

The October 2023 Research Roundup360 looks at: Gut microbiota in high-risk individuals for rheumatoid arthritis associated with disturbed metabolome and initiates arthritis by triggering mucosal immunity imbalance; International Consensus on Anaemia Management in Surgical Patients (ICCAMS); Sleep disturbance trends in the short-term postoperative period for patients undergoing total joint replacement; Achilles tendon tissue turnover before and immediately after an acute rupture; Quadriceps or hip exercises for patellofemoral pain? A randomized controlled equivalence trial; Total-body MRI for screening in patients with multiple osteochondromas.

Is total-body MRI useful as a screening tool to rule out malignant progression in patients with multiple osteochondromas? Results in a single-center cohort of 319 adult patients.

To evaluate the results of total-body (TB) MRI used as a screening tool for assessment or exclusion of malignant transformation in patients with hereditary multiple osteochondromas (HMO). In a single-institute cohort of MO patients, 366 TB-MRI examinations, including T1-weighted and STIR images, were performed for screening and follow-up purposes to rule out the malignant transformation, and retrospectively analyzed. In each patient, the presence and location of osteochondromas in the axial and appendicular bones were recorded. Forty-seven patients underwent a second TB surveillance in this period. STIR sequences were used to identify sites of increased signal intensity that could represent suspicious thickened cartilage caps or indeterminate reactive changes related to osteochondromas. In 82% of patients, one or more OC locations were determined in one or more flat bones. In 366 exams, nine OC (2,5 %) with suspicious imaging features were identified. These proved to be peripheral chondrosarcomas after targeted MRI and resection were performed. All nine malignant lesions were in flat bones (pelvis 5, ribs 3, scapula 1). Three of these patients were 19 years of age. In 12 patients who had peripheral or intraosseous low-grade chondrosarcoma in their history, before their first TB-MRI, no new lesions were identified. Twenty-three additional TB-MRI exams, demonstrating focal high T2 signal intensity, also gave rise to performing additional targeted MRI. One OC of the distal femur was excised and appeared benign. No suspicious cartilage caps were depicted on the remaining 22 targeted MRI exams but instead increased T2 signal was clarified by reactive changes (frictional bursitis, soft tissue edema) in close relation with benign osteochondromas. No malignant lesions were found in 47 patients who had a second TB surveillance (mean interval between exams 3.2 years, range 2-5 years). TB-MRI can identify malignant transformation of osteochondromas in HMO patients. All peripheral chondrosarcomas occurred in flat bones (ribs, scapula, pelvis) in our study. TB-MRI might assist in triage between higher risk patients with a high burden of OC, including the location of OC in main flat bones vs lower risk patients without OC of the flat bones.

Concurrent intraosseous cartilaginous lesions in patients with multiple osteochondromas identified on total-body MR imaging.

To assess the prevalence of intraosseous cartilaginous lesions in patients with multiple osteochondromas based on total-body (TB) MRI examinations, used for screening purposes. Between 2013 and 2020, TB-MRI examinations were performed in 366 patients with proven multiple osteochondromas syndrome, to rule out malignant progression. For this study, presence, or absence of intraosseous central or eccentrical chondroid lesions, defined as lobulated lesions with low signal intensity on T1-weighted images, replacing bone marrow and high signal intensity equal to fluid on T2-weighted images in the bone marrow of the meta-diaphysis of (one of) the long bones, were recorded in the long bones as part of a TB-MRI protocol. In 62 patients out of the 366 MO patients (17%), one or more intraosseous chondroid lesions (either enchondroma or atypical cartilaginous tumor) were detected. The age of the patients at time of diagnosis ranged from 17 to 61years (mean, 36). Size of the lesions varied from 4 to 69mm (mean, 16.3mm). The most common location was the proximal femur (n = 29), followed by the distal femur and proximal humerus (n = 18 and n = 10, respectively). In nine of the patients with an intraosseous chondroid lesion, a second and/or third TB-MRI were available during the period of evaluation (mean interval, 2.7years between the exams). In none of these patients increase of these intraosseous lesions was noticed. Intraosseous chondroid lesions (enchondroma and ACT) appear to occur more frequently in MO patients than in the general population. TB-MRI allows to detect these, besides the identification of OC with suspicious features.

Multiple oral and cerebral relapses of a Granular cell tumor (Abrikossoff Tumor) in a young girl affected by congenital dyserythropoietic anemia type II.

A 14-year-old girl presented with 1 cm large whitened lesion on the ventral surface of the tongue, appeared from 1 month. Past history showed congenital dyserythropoietic anemia type II. The lesion was excised and microscopic and immunohistochemical analyses were compatible with benign Abrikossoff tumor. Total body MRI was negative. After six months the patient presented a second tongue lesion and four months later another large painful lesion in the soft palate, with the same istological diagnosis. In addition, she had other multiple lesions: two apperead at pharyngeal level (not biopsied) that remain stable over time, and one at the pituitary gland. Granular cell tumors, with or without multiple lesions, are rare in children. About 50% of cases involve the head and neck region, with the tongue being the most affected site. Therapy is based on the surgical excision of the lesions; however some tumor forms, although their histological aspect of benignity, often have an important infiltrative power, making the therapeutic approach difficult, as in our case.

Chronic nonbacterial osteomyelitis: description of three pediatric cases.

Chronic recurrent multifocal osteomyelitis (CRMO) or also called chronic non-bacterial osteomyelitis (CNO) is the most common autoinflammatory bone disease. It is characterized by the presence of symptomatic and non-symptomatic bone lesions, mono or multifocal. The main sites involved are the metaphyses of the long bones, the bones of the pelvis, the vertebrae, the clavicle, the mandible. Local symptoms include pain, swelling, and warmth in the absence or presence of fever. The inflammatory process can involve the skin (palmoplantar pustulosis or acne) and the intestine. Diagnosis is complex and uses imaging techniques (X-ray, total-body MRI, scintigraphy) as well as common laboratory tests aimed at identifying an inflammatory state. In doubtful cases, especially in the monofocal forms, it is mandatory to perform a biopsy examination to rule out malignancy. The differential diagnosis includes neoplastic diseases, chronic infections, metabolic diseases, traumatic outcomes. Treatment is not standardized and involves the use of non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, sulfasalazine, methotrexate, TNF inhibitors and bisphosphonates based on the experience of the individual centers. We report the experience of our Center (Operative Unit of Pediatrics S. Anna Hospital in Ferrara) with the description of 3 clinical cases, diagnosed from 2016 to 2018, treated with bisphosphonates with good clinical response and remission in two of them, while one patient had an adverse reaction to pamidronate and was subsequently successfully treated with methotrexate.

RARE-17. SURVIVAL BENEFIT FOR INDIVIDUALS WITH CONSTITUTIONAL MISMATCH REPAIR DEFICIENCY SYNDROME AND BRAIN TUMORS WHO UNDERGO SURVEILLANCE PROTOCOL. A REPORT FROM THE INTERNATIONAL REPLICATION REPAIR CONSORTIUM

BACKGROUNDConstitutional mismatch repair deficiency syndrome (CMMRD) is a severe cancer predisposition syndrome resulting in early onset central nervous system (CNS) and other cancers. International guidelines for surveillance exist but no study has systematically evaluated the efficacy of this protocol.METHODSWe surveyed all confirmed CMMRD patients in the International Replication Repair Deficiency Consortium. A surveillance protocol consisting of frequent biochemical, endoscopic and imaging (CNS and total body MRI) studies were employed. Survival analyses and efficacy of each method were assessed.RESULTSSurveillance data were collected from 105 CMMRD individuals from 41 countries. Of the 193 malignant tumors, CNS malignancies were the most common (44%). The surveillance protocol uncovered 49 asymptomatic tumors including 16 glioblastomas and medulloblastomas. Five-year overall survival was 89% for tumors discovered by surveillance, and 61% for symptomatic tumors (p<0.004). Similarly, 5-year survival was 82+/-11% and 24+/-6% for surveillance and non-surveillance of brain tumors (p=0.005). Yearly total body and q6 month brain MRI detected asymptomatic cancers in all but 3 symptomatic CNS gliomas. These were tumors uncovered when time between scans was >6 months as per protocol. Finally, of the low grade tumors identified asymptomatically, 5 were low grade gliomas. All of the low grade gliomas, which were not resected transformed to high grade tumors at a median of 1.6 ± 0.9 years.CONCLUSIONThese data support a survival benefit in CMMRD patients undergoing a surveillance protocol. Adherence to protocol and resection of lower grade lesions may improve survival for patients with CNS tumors.

MM-098: A Case Report: Acquired Pure Red Cell Aplasia Associated with Monoclonal Gammopathy of Undetermined Significance

Background: Pure Red Cell Aplasia (PRCA) is a rare disorder characterized by profound anemia and absence of erythroid precursor in the bone marrow, and it can be genetic or acquired; the acquired form can be idiopathic or secondary and one of these causes is monoclonal gammopathy (MG). In review of the literature, we found a few cases that were treated in different ways. Case Presentation: We will report a case of pure red cell aplasia associated with monoclonal gammopathy of undetermined significance; the patient admitted for severe anemia with hemoglobin 5.4 g/dl, MCV 120 fl, and white blood count (WBC) was 3750/mm3 with 67% neutrophils and a normal platelet count. The workup was done and showed a reticulocyte count of 0.03%, negative coombs (direct and indirect), negative ANA, and anti-double stranded DNA (dsDNA). Vitamin B12 was 900 pg/ml and folate 7.66 ng/ml; serology for HIV, HBV, and HCV found to be negative. TSH, LDH, liver function tests were all normal. Erythropoietin level was 11.79 IU/L. Bone marrow aspirate revealed a cellular bone marrow (60-70%) with less than 5% plasma cells expressing excess lambda light chain. Immunohistochemistry using CD138 confirmed the result and flow cytometry revealed a small population of plasma cells with aberrant phenotype. Serum protein electrophoresis showed a monoclonal gamma peak and immunofixation showed high light lambda chains. Total body MRI showed diffuse infiltrative marrow disorder. Patient was treated with Lenalidomide 25 mg daily on days 1-21 of repeated 28-day cycles and Dexamethaxone 8 mg twice weekly with excellent response. After 6 months of treatment and follow-up, patient had normal bone marrow cytology, normal hemoglobin, and normal reticulocyte count.

Automated segmentation of MR imaging to determine normative central nervous system cerebrospinal fluid volumes in healthy volunteers

An accurate non-invasive method to determine total body cerebrospinal fluid volume has a number of potential diagnostic and therapeutic applications. Herein we describe a technique for automated segmentation of total body MRI data to determine cranial and spinal CSF volume in 15 healthy adults. These in vivo estimates of CSF volume exceed the standard reported volume of 150mL in human adults and provide normative data for diagnosis of disease states such as hydrocephalus and therapy including pharmacologic dosimetry. No correlation was observed between patient height or weight and total body CSF volume.

Plaque-type glomuvenous malformations in a child

In July, 2014, a healthy 1-month-old boy attended for evaluation of lesions on his back that had been present since birth. He had no relevant family history. On examination he had pink plaques on his back with central bluish colouration and depression and some prominent ectatic vessels, surrounded by a dusky halo (fi gure). The plaques were soft, poorly compressible, painless, and more prominent during crying. Musculoskeletal examination was normal, as were blood count, liver enzymes, renal function, and coagulation. The plaques were consistent with a vascular malformation. In infancy, such diff use skin lesions usually result from venous malformations. Common venous malformations usually aff ect the muscles and joints of the lower limbs, head, and neck. Blue rubber bleb naevus syndrome usually aff ects the upper limbs and trunk and is associated with gastrointestinal lesions. Glomuvenous malformations aff ect the limbs and back, with no extracutaneous involvement. Unlike common venous malformations and blue rubber bleb naevus, glomuvenous malformations have a hyperkeratotic cobblestone-like appearance, are not completely emptied by compression, and tend to become painful. Total body MRI showed several varicosities in the subcutaneous tissue of the back but no extracutaneous lesion. The diagnosis of glomuvenous malformation was confi rmed by examination of a biopsy sample, which showed dilated and irregular vascular channels lined by layers of glomus cells that stained positively for smooth muscle α-actin (fi gure). Laser therapy at 6 months old greatly reduced the lesions in size and colour. At last follow-up in March, 2015, the baby was well and had no new lesions. Plaque-type glomuvenous malformation can be sporadic or familial. Relatives of the aff ected individual often have minor lesions, such as one small nodule. The plaques usually appear during the fi rst month of life, grow rapidly, and enlarge to involve adjacent areas, although new lesions can present at diff erent sites during development or after trauma in previously unaff ected areas. Plaque-type glomuvenous malformations are limited to the skin, but can be a cause of concern to parents and are often a diagnostic challenge for physicians.

Total body MRI, a guide to diagnosis in patients with osteo-articular pain and inflammation

CRMO is an autoinflammatory bone disorder, characterized by aseptic multifocal osteitis. MRI is classically used in measuring the extent and activity of the bone lesions and possible soft tissue involvement. Additionally, MRI may help to exclude other causes of osteoarticular inflammation.

A86: Total Body MRI, A Guide to Diagnosis in Patients With Osteo‐Articular Pain and Inflammation

Background/Purpose:CRMO is an autoinflammatory bone disorder, characterized by aseptic multifocal osteitis. MRI is classically used in measuring the extent and activity of the bone lesions and possible soft tissue involvement. Additionally, MRI may be essential to exclude other causes of osteoarticular inflammation. We want to demonstrate the usefulness of MRI in the differential diagnosis of recurrent bone pain with inflammation in children.Methods:evaluation of 2 patients with osteoarticular pain and inflammation.Results:Two patients were referred to our pediatric rheumatology outpatient clinic with the presumed diagnosis of CRMO. Since several months, they experienced episodes of articular pain and joint swelling (patient 1) and recurrent back pain and fatigue (patient 2). In the first patient initial blood evaluation showed mildly increased inflammatory parameters (CRP 75 mg/L) with a mild microcytic anemia (Hb 11 g/dL) and thrombocytosis (557×10e6/μl) with a normal leukocyte count. Conventional X‐ray showed no abnormalities. MRI confirmed arthritis/synovitis of both ankles with presence of bone edema in ankle and tarsal bones. Initial treatment with NSAIDs was successful. In patient 2 additional investigations showed also increased inflammatory parameters (CRP 136 mg/L) with a mild anemia, slightly increased thrombocytosis and normal leukocyte count. Initial MRI showed mildly intense signaling of different vertebrae on STIR images. Bone scintigraphy demonstrated multifocal hypercaptation at the right skull, coracoied bone and multiple vertebrae. Additional bone marrow puncture was normal. NSAIDs were started systematically with success.In patient 1, pain returned. PET‐CT showed increased metabolism at multiple skeleton foci. Additional bone marrow puncture in the posterior iliac crest returned normal with no arguments for a lymphoproliferative disorder. Persistent and worsening of clinical symptoms prompted us to perform total body MRI which showed multiple, symmetric T1‐hypointens signals in the peripheral bones (lower legs, underarms, feet, knees and elbows). Guided by these findings, a targeted bone marrow puncture was performed in the tibia which showed a malignant lymphoproliferative disorder, namely a pre‐B ALL.Also in patient 2, pain returned and became progressive over a few weeks. A total body MRI showed a progressive disease with intermediate signal intensity on STIR and hypointense signaling on T1‐weighted images at different vertebrae and the sacral bone. A second bone marrow puncture at the crista returned to be negative. Guided by the MRI images a bone biopsy was performed in the sacral bone and was compatible with the diagnosis of an ALCL.Conclusion:CRMO remains a diagnosis of exclusion in patients with osteoarticular pain and inflammation. In case of persistent and/or progressive pain, the physician should keep a high index of suspicion for malignancy. Total body MRI can precisely define the characteristics and extent of the bone lesions (aspect and localization) as well as help in choosing the optimal localization for bone marrow puncture and/or bone biopsy.

Serous papillary adenocarcinoma probably arising from epithelial inclusions of the hepatic hilar lymph node

Only three cases of serous adenocarcinoma arising from Mullerian epithelial inclusions of the lymph node have been reported. Herein reported is a case of serous papillary adenocarcinoma arising probably from epithelial (Mullerian) inclusions of the hepatic hilar lymph node. A 73-year-old woman presented with peripheral neuropathy, which was thought to be a paraneoplastic syndrome associated with visceral malignancy. Total body examination, including X-P, US, CT, MRI, PET, and upper and lower gastrointestinal endoscopy was done. As the results, only lymph node swelling was detected in the hepatic hilus. Tumor was not identified in other sites. The physicians considered malignant lymphoma, and laparotomic excision of the hepatic hilar mass was performed. Cytological examination of abdominal cavity washing revealed no malignant cells. Grossly, the mass was firm and white and measured 4 × 5 × 5 cm. Microscopically, the mass showed carcinoma cells arranged in papillary and tubular patterns. The appearances strongly resembled serous papillary adenocarcinoma of the ovary. Lymph node structures were noted in some peripheral areas. No benign epithelial inclusions were recognized. Immunohistochemically, the carcinoma cells were positive for ER, PgR, CA125, WT1, p53. They were negative for TTF-1 and CDX-2. Because the positive ER, PgR, CA125, WT1, p53 and p16 are indicative of gynecologic malignancy, simple hysterectomy and bilateral salpingo-oophorectomy were performed, which showed no abnormalities. Cytological examination of abdominal cavity washing fluid revealed no malignant cells. The patient was treated by paclitaxel and carboplatin, and is now alive without metastasis 2 years after the first manifestation. The author reported a case of serous papillary adenocarcinoma arising probably from epithelial (Mullerian) inclusions of the hepatic hilar lymph node.

Is Deep-Vein Thrombosis Always the Origin of Pulmonary Embolism? Imaging of Veins with a Total-Body Direct Thrombus MRI Technique

Abstract 2297 IntroductionPulmonary embolism (PE) is thought to originate from embolisation of a deep-vein thrombosis (DVT), resulting in two clinical manifestations of one disease: venous thrombosis. However, in up to 50% of patients with PE, no DVT is found with ultrasound. A new technique in diagnosing DVT is ‘MR Direct Thrombus Imaging' (MRDTI), using methaemoglobin in the thrombus as endogenous contrast. We performed total body MRIs to visualize thrombi from calf veins to subclavian veins, to assess the origin of PE. MethodsConsecutive patients with a first PE diagnosed by Multi Detector CT scan are included. All patients undergo a 1.5 T MRDTI scan. In addition, blood is sampled for determination of genetic risk factors: the Factor V Leiden (FVL) and prothrombin G20210A (FII) mutations. Results99 patients have been enrolled in the study. In 44/99 (44%) a thrombus was identified on MR images. Most thrombi originated from the left side of the body (27/44). The upper leg was involved most often (22/44), with thrombi extending into the calf in 16 of these patients. Other thrombi were present in the pelvic veins (4/44), and deep calf veins alone (12/44). 6 patients had merely thrombophlebitis. The FVL mutation was present in 14% (95% CI 6–27) of patients with a thrombus on MRI, and in 7% (95% CI 3–18) of patients without a thrombus. For FII, the prevalence in the group with a DVT on MRI was 2% (95% CI 0.4–12) and without a DVT 4% (95% CI 1–13). ConclusionIn less than half of PE patients a thrombus can be found with total body MRI. When thrombi were present, they were mainly found in the upper leg, extending into the calf veins. Interestingly, 27% of PEs with a thrombus on MRI was related to isolated calf vein thrombosis and 14% to thrombophlebitis. In PE patients with no thrombus on MRI, a local origin of PE, a thrombus from cardiac origin or complete embolisation needs to be considered.Supported by Netherlands Heart Foundation grant number 2009B050 Disclosures:No relevant conflicts of interest to declare.

Effects of chemotherapy and lipopolysaccharide (LPS) on osteocytes: Possible mechanisms for osteonecrosis (ON) during treatment for childhood acute lymphoblastic leukaemia (ALL)

Background: Avascular necrosis of the bone (AVN) is a devastating complication in pediatric patients with acute lymphoblastic leukemia (ALL), and articular surface involvement is associated with progressive joint damage. Total body MRI (TBMRI) is a new, non-invasive imaging modality which can identify multiple sites with AVN, with increased STIR signal with corresponding hypointense borders on the T-1 weighted imaging corresponding to AVN lesions. Objectives: To report TBMRI data on 10 patients with pediatric ALL with recent onset of bone pain. Methods: 10 patients (7F, 3M) diagnosed with ALL at median (range) age of 6.2 (3–18) years, and recently developing bone pain were examined with X-ray imaging of the symptomatic region and with TBMRI. TBMRI with coronal T1 and STIR of entire body, with axial T2 fat saturated imaging was performed on each patient at a median (range) of 9 (2–49) months after ALL diagnosis. Results: None of the initial X-ray images revealed abnormal findings. TBMRI showed in 9 of 10 children bone marrow lesions compatible with AVN. In addition to a symptomatic site, all patients had multiple additional lesions. In total, there were a median (range) of 14.5 (5–17)AVN lesions per patient,with amedian (range) of 4.5 (0– 6) lesions per patient at articular surfaces: knee joints (n=8patients); humerus (n=6 patients); femoral heads (n=1 patient); and ankles (n=4 patients). 8/9 patients with articular surface involvement had bilateral lesions. The size varied from small focal lesions to lesions measuring over 95% of the whole transverse diameter of the bone. None of the patients to date have required surgical intervention, but each patient is followed by repeat TBMRI every 6 months. Conclusion: 1. Total body MRI allows early diagnosis of symptomatic as well as clinically non-apparent avascular necrosis (AVN) in pediatric patients with leukemia. 2. TBMRI can be used in planning for medical or surgical therapies.

Total body magnetic resonance imaging (TBMRI) as a diagnostic tool in diagnosing multi-site avascular necrosis (AVN) in patients with childhood onset leukemia and bone pain

Background: Avascular necrosis of the bone (AVN) is a devastating complication in pediatric patients with acute lymphoblastic leukemia (ALL), and articular surface involvement is associated with progressive joint damage. Total body MRI (TBMRI) is a new, non-invasive imaging modality which can identify multiple sites with AVN, with increased STIR signal with corresponding hypointense borders on the T-1 weighted imaging corresponding to AVN lesions. Objectives: To report TBMRI data on 10 patients with pediatric ALL with recent onset of bone pain. Methods: 10 patients (7F, 3M) diagnosed with ALL at median (range) age of 6.2 (3–18) years, and recently developing bone pain were examined with X-ray imaging of the symptomatic region and with TBMRI. TBMRI with coronal T1 and STIR of entire body, with axial T2 fat saturated imaging was performed on each patient at a median (range) of 9 (2–49) months after ALL diagnosis. Results: None of the initial X-ray images revealed abnormal findings. TBMRI showed in 9 of 10 children bone marrow lesions compatible with AVN. In addition to a symptomatic site, all patients had multiple additional lesions. In total, there were a median (range) of 14.5 (5–17)AVN lesions per patient,with amedian (range) of 4.5 (0– 6) lesions per patient at articular surfaces: knee joints (n=8patients); humerus (n=6 patients); femoral heads (n=1 patient); and ankles (n=4 patients). 8/9 patients with articular surface involvement had bilateral lesions. The size varied from small focal lesions to lesions measuring over 95% of the whole transverse diameter of the bone. None of the patients to date have required surgical intervention, but each patient is followed by repeat TBMRI every 6 months. Conclusion: 1. Total body MRI allows early diagnosis of symptomatic as well as clinically non-apparent avascular necrosis (AVN) in pediatric patients with leukemia. 2. TBMRI can be used in planning for medical or surgical therapies.

Reversal sign on ante- and postmortem brain imaging in a newborn: Report of one case

A 16-day-old female newborn was admitted to the emergency department after cardiopulmonary arrest. Total-body radiographs and non-enhanced CT of the brain showed fracture of the right clavicle, pericerebral hemorrhage and brain damage with reversal sign. The infant died on the day of her hospital admission. Because child abuse was suspected, a medicolegal autopsy was ordered by the legal authorities. Prior to autopsy, total-body MRI and CT were performed. Results of the ante- and postmortem investigations were compared with each other and then with the autopsy findings. Postmortem brain imaging showed persistence of the reversal sign. To the best of our knowledge, this is the first case describing hypoxic ischemic damage of the brain parenchyma on antemortem CT and persisting on postmortem imaging in a child abuse case.

Perspectives for preventive screening with total body MRI

Radiology has started to increasingly recognise its potential for screening with the advent of "whole-body" imaging techniques. This article briefly reviews prerequisites for successful screening, presents a quick summary of single-organ screening with magnetic resonance (MR) imaging, and introduces how this knowledge can be integrated into whole-body MR (wb-MR) screening. MR colonography has demonstrated its potential for screening. Wb-MR in the form of wb-MR angiography has already entered both clinical and screening settings; also, the search for metastases with wb-MR has been evaluated and has performed well when compared with other imaging modalities. But screening a group of healthy subjects requires more than feasibility and high accuracy of the screening test; thus, technical and ethical considerations are also presented. Wb-MR is only at its beginning and will in the near future certainly inspire many new research activities as well as transform the radiological market.

Use of total body MRI for the diagnosis of multifocal ON lesions: Case report

Use of total body MRI for the diagnosis of multifocal ON lesions: Case report

Total-body MR-imaging in oncology

Although MRI is an effective modality in oncology, state-of-the-art total-body MRI (TB-MRI) in the past was infeasible in the diagnostic work-up, due to the need for repeated examinations with repositioning and separate surface coils to cover all body parts. To overcome this limitation, either a moving table platform in combination with the body-coil or a special designed rolling table platform with one body phased-array coil have been implemented with promising results for both tumor staging and metastases screening. Since 2004, state-of-the-art TB-MR imaging with high spatial resolution has become feasible using a newly developed 1.5 Tesla TB-MRI system with multiple receiver channels. This review gives an overview based on the recent literature as well as our own experience concerning the possibilities, challenges, and limitations of TB-MRI in oncology, emphasizing both oncological staging and early tumor detection in asymptomatic subjects.