Helical CT and dynamic Mr features of an adrenal ganglioneuroma

We report a case of a young female patient with an adrenalganglioneuroma and describe the helical CT and dynamic MRI features that can be suggestive for the diagnosis.

Conventional dental radiology: what the general radiologist needs to know

This article aims to provide an overview of intraoral and orthopantomographic radiographs, including technique, indications, artefacts, relevant anatomy, current notation and common dental pathology. The normal anatomy is emphasised, because it is required for effective radiographic interpretation. Dental pathology, i.e. caries, periodontal disease, periapical inflammatory lesions and dental anomalies are illustrated.

The role of dental CT imaging in dental implantology

The jaw has traditionally been evaluated by dentists and oral surgeons using conventional panoramic and intraoral films. During the past decade, dental computed tomography (CT) has become the method of choice for preimplantation assessment of jaw anatomy. This has urged the radiologist to take a more active role in evaluating the jaw. The aim of this article is to provide the reader with knowledge that should facilitate him to evaluate implant sites, dental related inflammatory diseases and augmentation procedures on dental CT scans.

Imaging of extraspinal musculoskeletal tuberculosis

Tuberculosis (TB) is still a major cause of significant morbidity and mortality despite universal availability of effective chemotherapy. The emergence of multidrug-resistant mycobacteria along with a worldwide increase in HIV infection has led to a recent surge in the number of patients with TB. TB involves both pulmonary and extrapulmonary sites. Tuberculous spondylitis is the most common form of musculoskeletal TB and accounts for approximately 50% of cases. Extraspinal musculoskeletal TB is among the least common manifestations of TB. It shows a predilection for joints and para-articular areas while isolated soft tissue TB occurs extremely rare. A non-specific, often indolent clinical presentation in conjunction with its low prevalence constitutes obstacles for diagnosis. The differential diagnosis of extraspinal musculoskeletal TB consists of degenerative processes, inflammatory and infectious conditions, primary neoplasms, and metastatic lesions. Early diagnosis and treatment is of utmost importance to prevent serious joint and bone destruction. Radiological assessment of patients with musculoskeletal TB is often the key to adequate diagnosis and early treatment. The purpose of this manuscript is to review the imaging features of extraspinal musculoskeletal TB and to focus on the magnetic resonance imaging (MRI) characteristics of this pathology.

Comparison of MRI features of different grades of DCIS and invasive carcinoma of the breast

The purpose of the study is to compare mammography and magnetic resonance (MR) mammography in detection and assessment of extent, of histologically proven ductal carcinoma in situ (DCIS) and to compare MR features of DCIS, with features of invasive carcinoma. Forty histopathologically proven and MR detected pure DCIS lesions were described and compared with 213 enhancing invasive carcinomas. Histopathological examination revealed 49 pure DCIS, MR detected 40 of them (81.6%). There was a good correlation between diameter measured on mammography, MR and histopathology. MR was able to detect additional foci. Ductal enhancement, a focal area or a mass were perceived in respectively 8 (20%), 8 (20%) and 24 (60%) DCIS and in 0, 6 (2.8%) and 207 (97.2%) invasive lesions. Maximal contrast enhancement after 3 minutes was seen in 60.9% of DCIS and before 3 minutes in 61% of invasive masses. Signal intensity increase of more than 100% was seen in 76.9% of DCIS and in 91.1% of invasive carcinomas. DCIS had a wash out in 53.8% and invasive carcinomas in 65.3%. MR was able to detect 81.6% of DCIS. Diameter prediction was good on mammography and MR mammography. The only MR feature exclusively seen in DCIS was ductal enhancement.

Bone marrow changes in sports injuries

This paper will briefly discuss the value of MRI in the detection and follow-up of bone marrow edema resulting from acute and chronic trauma in sports injuries. A meticulous pattern approach of the distribution of bone marrow changes around a joint can reveal in most instances the underlying mechanism of trauma. The use of fatsuppressed T2-weighted or STIR images is most appropriate to detect bone marrow edema.

Proceedings of the SRBR-KBVR osteoarticular section meeting of June 29, 2004 in Antwerp. The variable imaging appearance of osteosarcoma

The purpose of this brief review is to give an overview of the different imaging features of the various types of osteosarcoma, based on their macroscopic location within the musculoskeletal system. Further subdivision can be made by histological criteria and/or more specific location. Standard radiographic features allowing their differentiation will be highlighted. The value of cross-sectional imaging in the pre-operative staging, assessment of local extension, monitoring of response to treatment and guiding biopsy will be emphasized as well.

Paraperitoneal indirect inguinal bladder hernia: MR demonstration

Inguinal or inguinoscrotal herniation of the bladder is not uncommon and has been estimated to comprise 1% to 3% of all inguinal hernias. The appearance of hernias on ultrasonography, intravenous pyelography, cystography, and computed tomography has been described previously but no instance of correlation with magnetic resonance (MR) imaging has been documented. Nevertheless, herniated bladders can be encountered fortuitously during abdominal MR imaging, and the radiologist should be familiar with their appearance. We present a case of unsuspected paraperitoneal indirect inguinal bladder herniation demonstrated by MR. Appearance on MR is characteristic, and this modality may be useful for differentiating the several types of inguinal hernias of the bladder because of its superior soft tissue contrast. In addition, MR imaging can be used to perform imaging in any plane and dynamic examinations during straining.

New developments in the neuroradiological diagnosis of craniocerebral trauma

Accurate radiographic diagnosis is a cornerstone of the clinical management and outcome prediction of the head-injured patient. New technological advances, such as multi-detector computed tomography (MDCT) scanning and diffusion-weighted magnetic resonance imaging (MRI) have influenced imaging strategy. In this article we review the impact of these developments on the neuroradiological diagnosis of acute head injury. In the acute phase, multi-detector CT has supplanted plain X-ray films of the skull as the initial imaging study of choice. MRI, including fluid-attenuated inversion recovery, gradient echo T2* and diffusion-weighted sequences, is useful in determining the severity of acute brain tissue injury and may help to predict outcome. The role of MRI in showing diffuse axonal injuries is emphasized. We review the different patterns of primary and secondary extra-axial and intra-axial traumatic brain lesions and integrate new insights. Assessment of intracranial hypertension and cerebral herniation are of major clinical importance in patient management. We discuss the issue of pediatric brain trauma and stress the importance of MRI in non-accidental injury. In summary, new developments in imaging technology have advanced our understanding of the pathophysiology of brain trauma and contribute to improving the survival of patients with craniocerebral injuries.

MR imaging in the diagnosis and management of inheritable musculoskeletal disorders

Although the initial identification of a congenital skeletal malformation is usually made by a combination of clinical examination, conventional radiology and genetic tests, this review illustrates the additional value of magnetic resonance imaging (MRI) in the diagnosis, determination of the extent of the disease, demonstration of associated abnormalities, therapy planning, disease monitoring and prognosis evaluation.

Ankylosing spondylitis: what remains of the standard radiography anno 2004?

In this review, the radiographic features of ankylosing spondylitis of the axial skeleton will be discussed shortly. Three pathologic processes, including inflammation, bony repair and ossification occurring consecutively or simultaneously, will contribute to the radiographic picture of ankylosing spondylitis. Typical target sites at which these processes take place are the synovial joints, discovertebral joints and ligamentous attachments or entheses of the axial skeleton.

Congenital abnormalities of the osseous spine: a radiological approach

The spine may act as a useful window to the diagnosis of many congenital malformations syndromes and skeletal dysplasias. However, radiological identification of these syndromes remains a difficult task, because there are so many syndromes and dysplasias to remember. Moreover, many spinal abnormalities are non-specific and there is much overlap between different genetic and congenital disorders. Consequently, many radiologists cringe when these topics are discussed. The purpose of this short review is to provide the general radiologist a workable primer for systematic analysis of spinal abnormalities encountered in genetic disorders, which may be helpful in (differential) diagnosis.

Does the location of a vascular loop in the cerebellopontine angle explain pulsatile and non-pulsatile tinnitus?

The purpose was to investigate patients with unexplained pulsatile and non-pulsatile tinnitus by means of MR imaging of the cerebellopontine angle (CPA) and to correlate the clinical subtype of tinnitus with the location of a blood vessel (in the internal auditory canal or at the cisternal part of the VIIIth cranial nerve). Clinical presentation of tinnitus and perceptive hearing loss were correlated. In 47 patients with unexplained tinnitus, an MR examination of the CPA was performed. Virtual endoscopy reconstructions were obtained using a 3D axial thin-section high-resolution heavily T2-weighted gradient echo constructive interference in steady state (CISS) data-set. High-resolution T2-weighted CISS images showed a significantly higher number of vascular loops in the internal auditory canal in patients with arterial pulsatile tinnitus compared to patients with non-pulsatile tinnitus (P<0.00001). Virtual endoscopy images were used to investigate vascular contacts at the cisternal part of the VIIIth cranial nerve in patients with low pitch and high pitch non-pulsatile tinnitus. A significantly different distribution of the vascular contacts (P=0.0320) was found. Furthermore, a correlation between the clinical presentation of non-pulsatile tinnitus (high pitch and low pitch) and the perceptive hearing loss was found (P=0.0235). High-resolution heavily T2-weighted CISS images and virtual endoscopy of the CPA can be used to evaluate whether a vascular contact is present in the internal auditory canal or at the cisternal part of the VIIIth cranial nerve and whether the location of the vascular contact correlates with the clinical subtype of tinnitus. Our findings suggest that there is a tonotopical structure of the cisternal part of the VIIIth cranial nerve. A correlation between the clinical presentation of tinnitus and hearing loss was found.

Unusual musculoskeletal manifestations of Lyme disease

We report on the imaging features of musculoskeletal abnormalities in a 52-year-old woman suffering from Lyme disease presenting with acrodermatitis chronica atrophicans (ACA). The patient developed recurrent attacks of migratory asymmetrical oligoarthritis, involving articular and peri-articular structures, including the metatarsophalageal (MTP) joints, scapular bone, thoracic spine, elbow, gluteal area, knee, ankle and metacarpophalangeal (MCP) joints. Six months after the first symptoms, Magnetic Resonance Imaging (MRI) showed bone marrow oedema within the proximal phalanx of the right fifth toe, adjacent to an ACA rash. A year after the onset of the disease, swelling at the right scapular region occurred, and MRI showed osseous, periosteal and soft tissue involvement of the superior margin of the right scapula and adjacent rib. On MRI of the spine, there was bone marrow infiltration with irregular delineation of the anterior corner of the thoracic vertebrae 4 to 6, corresponding to an osteoblastic bony lesion on radiographic examination. This case report is unique, because MRI documentation of bony abnormalities and periarticular soft tissue swelling, accompanying an attack of ACA has never been reported previously. Moreover, involvement of the osseous spine and the scapular bone have never been described in the radiological literature.

Accessory navicular bone: not such a normal variant

The accessory navicular is often erroneously considered as a normal anatomic and roentgenographic variant. Three distinct types of accessory navicular bones have been described. The type 2 and 3 variants have been associated with pathologic conditions such as posterior tibial tendon tear and painful navicular syndrome and therefore should not be arbitrarily dismissed as a roentgenologic variant in a symptomatic patient. The pathogenesis and radiologic findings are discussed and illustrated.

Imaging of tumours of the foot and ankle

The general presentation of osseous and soft-tissue neoplasms of the foot and ankle is not different from lesions encountered in other parts of the body and imaging features may be nonspecific. Some lesions, however, have a predilection for the foot and ankle and may have typical imaging features, such as plantar fibromatosis or intraosseous lipoma. This presentation aims to give an overview of bone and soft-tissue tumours of the foot and ankle and to discuss the strength of each imaging modality in the diagnosis.

Spinal tumors

Spinal tumors are uncommon lesions but may cause significant morbidity in terms of limb dysfunction. In establishing the differential diagnosis for a spinal lesion, location is the most important feature, but the clinical presentation and the patient's age and gender are also important. Magnetic resonance (MR) imaging plays a central role in the imaging of spinal tumors, easily allowing tumors to be classified as extradural, intradural-extramedullary or intramedullary, which is very useful in tumor characterization. In the evaluation of lesions of the osseous spine both computed tomography (CT) and MR are important. We describe the most common spinal tumors in detail. In general, extradural lesions are the most common with metastasis being the most frequent. Intradural tumors are rare, and the majority is extramedullary, with meningiomas and nerve sheath tumors being the most frequent. Intramedullary tumors are uncommon spinal tumors. Astrocytomas and ependymomas comprise the majority of the intramedullary tumors. The most important tumors are documented with appropriate high quality CT or MR images and the characteristics of these tumors are also summarized in a comprehensive table. Finally we illustrate the use of the new World Health Organization (WHO) classification of neoplasms affecting the central nervous system.

3D time-of-flight MR angiography of the intracranial vessels: optimization of the technique with water excitation, parallel acquisition, eight-channel phased-array head coil and low-dose contrast administration

The aim of this study is three folds: to compare the eight-channel phased-array and standard circularly polarized (CP) head coils in visualisation of the intracranial vessels, to compare the three-dimensional (3D) time-of-flight (TOF) MR angiography (MRA) techniques, and to define the effects of parallel imaging in 3D TOF MRA. Fifteen healthy volunteers underwent 3D TOF MRA of the intracranial vessels using eight-channel phased-array and CP standard head coils. The following MRA techniques were obtained on each volunteer: (1) conventional 3D TOF MRA with magnetization transfer; (2) 3D TOF MRA with water excitation for background suppression; and (3) low-dose (0.5 ml) gadolinium-enhanced 3D TOF MRA with water excitation. Results are demonstrating that water excitation is a valuable background suppression technique, especially when applied with an eight-channel phased-array head coil. For central and proximal portions of the intracranial arteries, unenhanced TOF MRA with water excitation was the best technique. Low-dose contrast enhanced TOF MRA using an eight-channel phased-array head coil is superior in the evaluation of distal branches over the standard CP head coil. Parallel imaging with an acceleration factor of two allows an important time gain without a significant decrease in vessel evaluation. Water excitation allows better background suppression, especially around the orbits and at the periphery, when compared to conventional acquisitions.

Massive infarction of a recurrent phyllodes tumor of the breast: MRI-findings

We report the imaging findings in an infarcted phyllodes tumor of the breast. A 40-year-old woman presented ten months after surgery for a benign phyllodes tumour with a palpable lump under the scar. We performed clinical examination, mammography, sonography, and MRI. The radiological diagnosis was a postoperative hematoma with granulation tissue. Surgery was performed. Histological diagnosis revealed an infarcted phyllodes tumour. This case illustrates the radiological presentation of a completely infarcted phyllodes tumour. As far as we know, imaging findings of an infarcted phyllodes tumour have not been reported yet.