Abstract: The purpose of this study was to define guidelines for endometrial cancer staging with MRI. The technique included critical review and expert consensus of MRI protocols by the female imaging subcommittee of the European Society of Urogenital Radiology, from ten European institutions, and published literature between 1999 and 2008. The results indicated that high field MRI should include at least two T2-weighted sequences in sagittal, axial oblique or coronal oblique orientation (short and long axis of the uterine body) of the pelvic content. High-resolution post-contrast images acquired at 2 min +/- 30 s after intravenous contrast injection are suggested to be optimal for the diagnosis of myometrial invasion. If cervical invasion is suspected, additional slice orientation perpendicular to the axis of the endocervical channel is recommended. Due to the limited sensitivity of MRI to detect lymph node metastasis without lymph node-specific contrast agents, retroperitoneal lymph node screening with pre-contrast sequences up to the level of the kidneys is optional. The likelihood of lymph node invasion and the need for staging lymphadenectomy are also indicated by high-grade histology at endometrial tissue sampling and by deep myometrial or cervical invasion detected by MRI. In conclusion, expert consensus and literature review lead to an optimized MRI protocol to stage endometrial cancer.
Abstract: The number of circulating monocytes increases after stroke. In this study, we assessed the time course and phenotype of monocyte subsets and their relationship with the clinical course and outcome in 46 consecutive stroke patients and 13 age-matched controls. The proportion of the most abundant 'classical' CD14(high)CD16- monocytes did not change after stroke, whereas that of CD14(high)CD16+ monocytes increased and CD14(dim)CD16+ monocytes decreased. CD14(high)CD16+ monocytes had the highest expression of TLR2, HLA-DR and the angiogenic marker, Tie-2; CD14(dim)CD16+ monocytes had the highest expression of costimulatory CD86 and adhesion molecule CD49d. Platelet-monocyte interactions were highest in CD14(high)CD16- monocytes and lowest in CD14(dim)CD16+ monocytes. In adjusted models, 1/CD14(high)CD16- monocytes were associated with poor outcome (OR: 1.38), higher mortality (OR: 1.40) and early clinical worsening (OR: 1.29); 2/CD14(high)CD16+ monocytes were inversely related to mortality (OR: 0.32); and 3/CD14(dim)CD16+ monocytes were inversely related to poor outcome (OR: 0.74) and infarction size (r=-0.45; P=0.02). These results illustrate that the predominant monocyte subtype conveys harmful effects after stroke, which include stronger interaction with platelets. Alternatively, rarer subpopulations of monocytes are beneficial with a phenotype that could promote tissue repair and angiogenesis. Therefore, monitoring of monocyte subtypes may emerge as a useful tool at the bedside for stroke patients.Journal of Cerebral Blood Flow & Metabolism advance online publication, 18 March 2009; doi:10.1038/jcbfm.2009.25.
Abstract: ABSTRACT BACKGROUND AND PURPOSE Preoperative differentiation of astrocytomas from oligodendrogliomas is clinically important, as oligodendrogliomas are more sensitive to chemotherapy. The purpose of this study was to assess the role of proton magnetic resonance spectroscopy in distinguishing astrocytomas from oligodendrogliomas. METHODS Forty-six patients [astrocytomas (n= 17) and oligodendrogliomas (n= 29)] underwent magnetic resonance imaging and multi voxel proton magnetic resonance spectroscopic imaging before treatment. Peak areas for N-acetylaspartate (NAA), creatine (Cr), choline (Cho), myo-inositol (mI), glutamate/glutamine (Glx), and lipids + lactate (Lip+Lac) were analyzed from voxels that exhibited hyperintensity on fluid-attenuated inversion recovery images and were normalized to Cr from each voxel. The average metabolite/Cr ratios from these voxels were then compared between astrocytomas and oligodendrogliomas. Receiver-operating curve analyses were used as measures of differentiation accuracy of metabolite ratios. A threshold value for a metabolite ratio was estimated by maximizing the sum of sensitivity and specificity. RESULTS A significant difference in mI/Cr was observed between astrocytomas and oligodendrogliomas (.50 +/- .18 vs. 0.66 +/- 0.20, P < .05). Using a threshold value of .56 for mI/Cr ratio, it was possible to differentiate oligodendrogliomas from astrocytomas with a sensitivity of 72.4% and specificity of 76.4%. CONCLUSION These results suggest that mI/Cr might aid in distinguishing oligodendrogliomas from astrocytomas. J Neuroimaging 2008;XX:1-6.
Abstract: Cardiac function analysis is critical in the management of patients with cardiovascular diseases. The two most common non-invasive techniques used nowadays to evaluate cardiac function are ultrasonography and magnetic resonance imaging (MR). The parameters to be determined with both techniques include the systolic volume of the left ventricle, the cardiac mass, myocardial thickness and ejection fraction. Ultrasound images have high resolution and they do not need any cardiac or respiratory gating. It has limitations in obese patients, patients with pulmonary obstructive disease or patients after thoracic surgery. MR has a high spatial and temporal resolution. There are different sequences we can use to determine cardiac function parameters, Gradient Echo sequences are used to analyze the ventricular volume and the ejection fraction. Myocardial tagging sequences are used to quantify the myocardial wall motion. Computed Tomography constitutes other alternative that can be used in patients with claustrophobia or pace markers to evaluate cardiac function.
Abstract: Multicystic dysplasia of the kidney is the second most common cause of renal masses in newborns after hydronephrosis and the most frequent cause of cystic masses in childhood. We present the case of a cystic renal mass in an infant that was definitively diagnosed at histological examination to be segmental cystic dysplasia. Cystic renal dysplasia usually involves an entire kidney, and segmental multicystic renal dysplasia is rare. We review the etiology and pathogenesis of this entity, the radiological findings, and the main differential diagnoses with the aim of establishing the correct diagnosis and differentiating this entity from other focal cystic kidney lesions affecting children.
Abstract: Sarcoidosis is a multisystemic granulomatose disease of unknown origin that most often affects the lung parenchyma and the mediastinal lymph nodes. Although less common, involvement of the abdominal organs and the central nervous is also possible. We present the radiological findings observed in two patients diagnosed with sarcoidosis with systemic involvement. In one case, the disease affected the lung, spleen, mediastinal and abdominal lymph nodes, whereas in the other case it affected the lung, spleen, abdominal lymph nodes and central nervous system. The aim of this report is to review the radiologic manifestations of this disease.
Abstract: We present the magnetic resonance imaging (MRI) findings in two males clinically diagnosed with iliotibial band friction syndrome (IBFS), a frequent cause of pain in the lateral compartment of the knee. Coronal T2-weighted images with fat saturation show an ill-defined area of high signal intensity in the soft tissues situated immediately below the iliotibial band lateral to the external condyle of the femur. No thickening of the iliotibial band or changes in its signal intensity were observed. Osseous edema and subchondral osseous erosion in the external condyle of the femur were observed in both cases. Pain in the lateral compartment of the knee might be due to multiple causes that should be included in the differential diagnosis and MRI can play a significant role in reaching the definitive diagnosis.
Abstract: OBJECTIVE: To evaluate the sequences and maneuvers recommended for the study of the thoracic outlet syndrome (TOS) and the usefulness of magnetic resonance imaging (MRI) in demonstrating its etiology. MATERIAL AND METHODS: We present a study of eight patients with clinical presentation suggestive of TOS. All underwent MRI, gadolinium-enhanced angio-MRI with the arms extended along the body and with postural maneuvers of abduction and elevation of the arms, plain-film chest x-rays, and digital angiography. The anatomic characteristics of the superior aperture of the thorax were analyzed on both sides before and during postural maneuvering. Likewise, the permeability of the vessels and integrity of the brachial plexus was studied. RESULTS: In two cases, angio-MRI demonstrated thrombosis, of the subclavian artery in one case and of the subclavian vein in the other, caused by a cervical rib, which was confirmed at plain-film chest x-ray. In one case, angio-MRI demonstrated stenosis of the subclavian artery on abduction, secondary to hypertrophy of the anterior scalene muscle, and digital angiography showed the same findings. In two cases, angio-MRI showed vascular thrombosis, arterial in one case and venous in the other, without evidence of anatomic anomalies; these findings were confirmed at digital angiography. In two cases, no pathological findings were observed at MRI, angio-MRI, or digital angiography. In one case, MRI showed the presence of a cervical rib without vascular repercussions. CONCLUSION: Gadolinium-enhanced angio-MRI is useful in the evaluation of TOS. It is important to examine patients at rest and during different postural maneuvers. In many cases it is possible to determine the cause of vascular compression.
Abstract: OBJECTIVE: The objective of our study was to evaluate the accuracy of true fast imaging with steady-state precession (FISP) in the diagnosis of venous thrombosis using gadolinium-enhanced 3D T1-weighted gradient-echo images and correlative imaging as the gold standard. MATERIALS AND METHODS: Twenty-five MR examinations were retrospectively reviewed independently by two radiologists to rule out thrombosis in the central veins of the body. The presence of venous thrombus was assessed separately in 80 veins using true FISP and gadolinium-enhanced T1-weighted images. Diagnosis was confirmed by another imaging technique (sonography, CT, and/or conventional venography) in all positive cases. Negative examinations were confirmed using imaging, clinical follow-up, or both. RESULTS: Venous thrombosis was present in 25 veins in 18 patients. True FISP images had a lower sensitivity (66%) and specificity (70.9%) for the diagnosis of venous thrombosis than gadolinium-enhanced MR images (p < 0.01). CONCLUSION: True FISP images have lower sensitivity and specificity in the diagnosis of venous thrombosis than gadolinium-enhanced T1-weighted gradient-echo images. True FISP images should not be used exclusively for the diagnosis of venous thrombosis.
Abstract: Magnetic resonance imaging (MRI) artifacts have been described in many articles published in the literature.We present the case of a 72 year old man who was admitted due to left inferior limb weakness. MRI imaging demonstrated an acute right infarction of the right posterior cerebral artery. In the right frontal lobe a metallic artifact was demonstrated as well. The artifact showed a central signal void and it was surrounded by a high signal intensity rim. His aortic valve had been replaced 12 years earlier. This indicates that the artifact is in fact due to a small metallic fragment embolization during cardiac surgery.
Abstract: We report two cases of superficial siderosis of central nervous system. In one case it was idiopathic and in the other secondary to an unidentified subarachnoid hemorrhage. The symptoms that characterized the clinical picture of both were gait disturbance and hypoacusis. The MRI study showed a superficial rim of hypointensity that covered the cerebellum and brainstem, and extended along the cranial nerves and the brain surface. The findings were clearer in the T2 spin echo series. Due to the high sensitivity for hemosiderin deposits, MRI made it possible to make the final diagnosis of this rare disease.
Abstract: Background: Spinal dural arteriovenous fistulae (SDAVF) are elusive to an early diagnosis. Otherwise, there is no agreement regarding the best treatment.Aim: To review our series of spinal arteriovenous malformations to illustrate the treatment and outcome of FAVDE.Patients and Methods: Descriptive series of cases diagnosed and treated at our hospital within the last ten years. Ten suspicious MRI, followed by angiograms, got the next diagnosis: 3 intraspinal malformations, 2 cavernoms and 5 FAVDE, reported here.Results: Four out of 5 FAVDE were men. Mean age was 61year (53-77), and mean interval to diagnosis 10.8 months (1-24). The clinical course consisted of progressive paraparesis, wich was acute in one case, with wheelchair confinement. Sensory involvement and sphinter dysfunction were also always present; severe pain affected 2 cases. MRI revealed the FAVDE at low thoracic or lumbar levels, with tortuous flow voids over the surface of the affected area. Angiograms disclosed the single feeding vessel between D8-L3. Laminectomy and interruption of the draining vein was the chosen treatment. Postoperative complications were not found. Improvement followed until full recovery, that occurred in 4 cases. One patient, previously embolized, was the only one with just modest recovery, although the angiogram proved that deferred surgery ran well. Mean follow-up was 3.8 years (1.5-6); neither clinical deterioration nor suspicious MR finding were found. Postoperative angiogram, performed in two cases, confirmed the fistulae as occluded.Conclusions: FAVDE mainly involves old males with progressive paraparesis. Suitable MR findings and characteristic angiograms allow the diagnosis. Novel patients are subsidiary to selective and simple surgery, that is usually curative without recurrencies.
Abstract: We report a 44-year-old patient with right-breast morphea. Mammography, MRI and needle biopsy were used for assessment of the case. Mammography demonstrated thickening of the skin and the subcutaneous tissue. The MRI showed replacement of the subcutaneous and breast fat by a low signal intensity, non-enhancing tissue. Skin biopsy confirmed the histological features of scleroderma.
Abstract: We present an 8-year-old boy with thyroid follicular carcinoma. Differentiated thyroid follicular carcinoma is very uncommon in childhood and is not usually suspected as the explanation of a thyroid nodule during infancy. The purpose of our paper is to demonstrate the imaging findings in a child and to emphasise the importance of including this tumour in the differential diagnosis of thyroid nodules in children.
Abstract: A case of meningioangiomatosis occurring in a 15-year-old boy is reported. The patient did not show signs of neurofibromatosis on physical examination, and his medical history included only one previous episode of loss of consciousness, which was accompanied by a self-limited focal seizure. The lesion was associated with an oligodendroglioma and was incidentally discovered during the macroscopic sampling of the neurosurgical specimen. The literature relating to this uncommon entity is reviewed and discussed. To the best of our knowledge, the concurrence of meningioangiomatosis and oligodendroglioma has not been documented previously.
Abstract: To assess the accuracy of magnetic resonance (MR) imaging in the evaluation of the shoulder after surgery, MR examinations were performed in 31 patients before repeated surgery, and MR findings were correlated with the subsequent operative findings. In addition, the MR findings associated with prior surgery were reviewed, including altered structure of the acromion, soft-tissue metal artifacts, a surgical trough in the humeral head, nonvisualization of the subacromial-subdeltoid fat stripe, and intermediate signal intensity within the substance of the rotator cuff on images obtained with all pulse sequences. The MR criteria for full-thickness tears in the shoulder after surgery are the presence of fluidlike signal intensity on T2-weighted images that extends through an area of the rotator cuff or the nonvisualization of a portion of the rotator cuff. With use of these criteria, six of seven full-thickness rotator cuff tears were identified at MR imaging, with an accuracy of 90%. Partial cuff tears were indistinguishable from repaired tendons. Findings at MR imaging were 74% accurate concerning the presence of impingement.
Abstract: Early results are reported of hepatic neoplasms studied with dynamic gadolinium-diethylenetriaminepentaacetate (Gd-DTPA)-enhanced magnetic resonance imaging (MRI). The purpose of this study was to evaluate the potential of the Gd enhancement pattern for characterizing these neoplasms and to compare the performance of spin-echo (SE) to SE plus dynamic Gd-enhanced gradient-echo (GRE) pulse sequences. Forty-two patients with hepatic neoplasms were examined at 1.5 T field strength. In each patient, short and long repetition time/echo time (TR/TE) SE images were obtained, followed by pre- and post-Gd-DTPA (0.1 mmol/kg body wt), single-slice, breath-hold (13 s/scan) GRE images, which were serially acquired less than or equal to 12 min postinjection. The patterns of contrast enhancement of the various hepatic lesions were documented and analyzed. The time to peak Gd signal enhancement-to-noise ratio (SE/N), contrast-to-noise ratio (C/N), contrast (defined as the signal intensity ratio [SIR]), as well as the peak values of these quantities, were determined. The C/N and SIR values on the short and long TR/TE SE and pre-Gd GRE images for all hepatic neoplasms were also obtained. The discriminating abilities (hemangiomas vs. malignant neoplasms) of these quantities were analyzed statistically. In addition, the impact of lesion characterization on the SE versus the SE plus the Gd-enhanced GRE scans was assessed by means of a blinded reader study. Malignant hepatic neoplasms could be differentiated from hemangiomas by visual inspection of their enhancement patterns (p = 0.0009), by the time to peak C/N on Gd-enhanced images (p = 0.0002), and by the magnitude of such peak (p = 0.02). Combined SE + Gd-enhanced GRE scans afforded minor, though statistically significant (p less than 0.01), improvement of the accuracy in differentiating benign from malignant hepatic neoplasms. Late scans (12 min post-Gd) may be particularly useful in identifying hemangiomas that, unlike other neoplasms, have a significant high signal of their enhancing portions on such images.
