Acute stroke: evaluation with serial proton MR spectroscopic imaging

PURPOSE

To investigate the evolution of metabolic changes detectable with proton magnetic resonance (MR) spectroscopic imaging in acute stroke and to compare these findings with those of conventional MR imaging.

MATERIALS AND METHODS

A patient with middle cerebral artery stroke underwent conventional proton-density (PD)- and T2-weighted MR imaging, MR angiography, and multisection proton two-dimensional MR spectroscopic imaging over a period of 3 hours to 5 months after symptom onset.

RESULTS

On 3-hour MR images, no abnormal signal intensity change was detectable. Spectroscopic images obtained at 24 hours showed localized elevation of cerebral lactate levels. In most regions with high lactate levels, infarction subsequently occurred. In the chronic stage (5 months), the infarct was associated with reduced N-acetylaspartate levels, increased choline levels, and absence of lactate.

CONCLUSION

Spectroscopic imaging enables mapping of ischemic and infarcted brain regions with greater sensitivity than does conventional MR imaging.

Osmotic Demyelination Syndrome in End-Stage Renal Disease After Recent Hemodialysis:MRI of the Brain

OBJECTIVE

Osmotic demyelination syndrome has been reported in patients with end-stage renal disease, but the specific MRI findings in this patient group have not been documented in detail. Our aims were to present the brain MRI findings during an episode after hemodialysis and at follow-up, and to identify possible factors that may contribute to lesion development.

MATERIALS AND METHODS

Seventeen patients with osmotic demyelination syndrome who had undergone hemodialysis at least once and had brain MRI examinations were retrospectively reviewed. Neurologic and MRI examinations were performed during a clinical episode. Serum levels of sodium, creatinine, blood urea nitrogen, and glucose were assessed, and serum osmolality and the ratio of blood urea nitrogen to creatinine (BUN:Cr) were calculated. Follow-up MRI was performed in nine cases. Laboratory and imaging findings were evaluated.

RESULTS

An altered level of consciousness and convulsions were the most common neurologic symptoms. The pons was involved in 11 patients (65%) and extrapontine sites in 12 (71%). Four patients had dysequilibrium syndrome. Follow-up MRI showed complete resolution in six patients and lesion reduction in three within a short time. The most common biochemical changes at the time of MRI were hyponatremia and low BUN:Cr in the blood. Only one patient showed rapid correction of hyponatremia and a rapid change in osmolality during the acute stage.

CONCLUSION

In patients who develop osmotic demyelination syndrome after hemodialysis, the lesions may involve the pons or the pons and extrapontine sites. Most lesions that were followed up resolved rapidly and almost completely, favoring transient edema rather than demyelination. Blood chemistries suggested underlying changes in osmolality, particularly as a result of urea shift from the extracellular fluid.

Value of computed tomography and magnetic resonance imaging for assessing severity of liver cirrhosis secondary to viral hepatitis

PURPOSE

The aim of this study was to assess the value of abdominal CT and MRI in determining the severity of cirrhosis secondary to hepatitis compared to Child-Pugh classification.

MATERIALS AND METHODS

The study included 23 patients who were clinically and histologically diagnosed with chronic liver disease secondary to viral hepatitis. Each patient underwent dynamic abdominal CT imaging and MRI within the same week. CT and MRI findings were retrospectively reviewed. The same parameters were used from the CT and the MR images for each patient. The parameters included liver volume index (posterior segment of the right lobe, medial and lateral segments of the left lobe), spleen volume index, ascites, portosystemic collaterals, contour irregularities of the liver and confluent fibrosis within the liver. The findings were compared with the patients' Child-Pugh grades. Multiple regression analysis was used for statistical analysis.

RESULTS

On MRI, liver volume index (P = 0.0001), and ascites (P = 0.009) were strongly correlated with Child-Pugh grades. With CT, only ascites was correlated with Child-Pugh grades (P = 0.002).

CONCLUSION

This study indicates that liver volume index on MRI, and ascites on CT and MRI are good indicators of clinical severity of cirrhosis secondary to hepatitis. To show the effect of the other parameters, more research is needed with larger patient groups.

Chondromyxoid fibroma of the temporal bone: CT and MRI findings

We present the case of a 44-year-old woman with chondromyxoid fibroma of temporal bone origin. Since this is the least common bone tumor of cartilaginous origin, it is highly unusual to find this tumor in the skull. In fact, the literature describes 18 cases of this form of neoplasia arising in the skull, only 4 of these having originated in the temporal bone. To date, the radiological features of these tumors, and especially features detected using the latest imaging modalities, have not been described in detail. This report is unique in that it is the first to present a case of chondromyxoid fibroma of the temporal bone accompanied by detailed CT and MRI findings.

Evaluation of neurologic complications by brain MRI in kidney and liver transplant recipients

The aim of this study was to retrospectively analyze brain magnetic resonance imaging (MRI) findings in patients who developed neurologic complications after liver and kidney transplantation. The results in 216 organ transplant recipients, who had brain MRI were evaluated retrospectively. We performed 187 brain MRI on kidney recipients and 29 liver recipients. Neuroradiologic findings were classified in three groups: group 1 findings were related to transplantation; group 2 findings, to chronic parenchymal disease; and group 3 to neither transplantation nor chronic parenchymal disease. In group 1, six patients (20.6%) after liver and three (1.6%) after kidney transplantation had posterior reversible encephalopathy syndrome; two patients (1.1%) after renal and one (3.4%) after liver transplantation had tuberculosis granulomas; one patient (0.5%) after renal transplantation had osmotic demyelination syndrome; one patient (0.5%) had a Nocardia abcess and one (0.5%) focal cerebritis after renal transplantation. Among group 2, 38 patients (20.3%) had brain atrophy; 37 (20%), white matter changes; 3 (1.6%), sinus thrombosis; 8 (4.3%), lacunar infarct; 1 (0.5%), had renal osteodystrophy in the cranial bones; and 4 (2.2%), had intracranial hemorrhage secondary to end-stage renal disease. Brain atrophy in nine patients (31%), hyperintensity in the globus pallidus on T1-weighted MR images owing to manganese deposits in nine patients (31%), hyperintensity in basal ganglia on T2-weighted MR images owing to copper depositions in one patient (3.4%) were seen secondary to chronic liver disease. In group 3, three patients (1.6%) had intracranial lipomas; one (0.5%), mesial temporal sclerosis; and one (0.5%), an anterior cerebral artery aneurysm in renal transplant patients. Periventricular and subcortical white matter hyperintensities were observed on T2-weighted MR images in six liver transplant patients (20.7%). Neurologic complications after organ transplantation may be secondary to transplantation itself, to chronic parenchymal disease, or to neither transplantation nor chronic parenchymal disease.

Basal cell adenoma of the parotid gland: dynamic CT and MRI findings

Imaging findings in basal cell adenoma (BCA) of the parotid gland have been rarely reported. We report dynamic CT and MRI findings of BCA in the parotid gland in a 78-year-old woman. Dynamic CT study demonstrated strong multinodular contrast enhancement in the early phase which decreased gradually in the later phases. The mass was isointense on T(1) weighted and hyperintense on T(2) weighted MR images with a central haemorrhagic-necrotic component. The microscopic findings were consistent with membranous type BCA.

Thoracic CT findings in long-term hemodialysis patients

PURPOSE

To evaluate thoracic CT findings of long-term hemodialysis patients.

MATERIAL AND METHODS

Thoracic CT findings of 117 uremic patients (61 men, 56 women) with complaints of cough, dyspnea, low-grade pyrexia, malaise, weight loss, and profuse perspiration were retrospectively documented.

RESULTS

Atelectasis (60%), cardiomegaly (60%), pleural effusion (51%), vascular congestion (44%), parenchymal consolidation (38%), parenchymal scarring-fibrosis (31%), and lymphadenopathy (29%) were the most common CT findings in the thoraces of the long-term hemodialysis patients. Staphylococcus aureus was detected in 13 patients (11%) who had parenchymal infiltration. Thoracic tuberculosis was identified in 15 patients (13%), 11 of these cases being confined to the lung parenchyma, 3 to the pleura, and 1 involving the pleura and pericardium.

CONCLUSION

In patients under long-term hemodialysis treatment, parenchymal consolidation, secondary to infectious agents such as S. aureus and Mycobacterium tuberculosis, is the most important CT finding since these lesions can be detected and treated successfully if they are considered as etiologic factors early on.

Brain Abscess Associated with Isolated Left Superior Vena Cava Draining into the Left Atrium in the Absence of Coronary Sinus and Atrial Septal Defect

A previously healthy 12-year-old girl presented with severe headache for 2 weeks. On physical examination, there was finger clubbing without apparent cyanosis. Neurological examination revealed only papiledema without focal neurologic signs. Cerebral magnetic resonance imaging showed the characteristic features of brain abscess in the left frontal lobe. Cardiologic workup to exclude a right-to-left shunt showed an abnormality of the systemic venous drainage: presence of isolated left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect. This anomaly is rare, because only a few other cases have been reported.

Clinical and radiological follow-up results of patients with untreated TMJ closed lock

The purpose of this study was to compare clinical and radiological findings of untreated closed lock patients at least 22 months after initial diagnosis. Ten patients with closed lock in at least one joint who had received no treatment were included in the study. Clinically maximum mouth opening, joint pain and joint sounds were recorded. Radiologically position of the disc, disc morphology, bone degeneration and presence of fluid were determined on magnetic resonance imaging. Clinical and radiological examinations were repeated 2-5 years after initial examinations. Results were statistically compared using either the non-parametric McNemar test or the Wilcoxon signed-rank test. There were significant improvements in both mouth opening capacity and prevalence of joint pain, while no significant change in radiological examination. The results of this study suggested that closed lock patients undergo active adaptation in clinical symptoms.

Cerebellar vermis hypoplasia in a patient with Bardet-Biedl syndrome

Laurence-Moon-Bardet-Biedl syndome is an autosomal recessive condition characterized by retinal dystrophy, obesity, mental retardation, distal limb anomaly, hypogonadism, and renal dysfunction. The symptoms vary among families and even among affected siblings. Certain clinical signs have been used to identify subgroups of patients with this complex condition. Laurence-Moon syndrome as a distinct entity is rare and features paraplegia in the absence of polydactyly or obesity. Bardet-Biedl syndrome is characterized by distal limb anomaly, obesity, and renal involvement, but neurologic symptoms are very unusual. We report a patient exhibiting characteristic features of Bardet-Biedl syndrome in addition to cerebellar vermis hypoplasia and mega cisterna magna.

Sonoelastographic qualitative analysis for management of salivary gland masses

OBJECTIVES

Our aim was to investigate whether the use of a qualitative elasticity scoring method by sonoelastography is beneficial for management of salivary gland masses.

METHODS

Thirty-six patients with salivary gland masses (30 parotid and 6 sub-mandibular) were prospectively included in this study. For each lesion, B-mode sonographic and sonoelastographic images were obtained. Elasticity scores were determined by a 4-point scoring method. Differences among scores for benign and malignant masses were assessed by the Mann-Whitney U test. Qualitative variables were compared by the Pearson χ² test. The findings were compared with histopathologic diagnoses.

RESULTS

The score values of 28 benign masses ranged from 1 to 4, whereas the values of 8 malignant masses ranged from 2 to 4. The mean scores ± SD were 2.25 ± 0.92 for benign lesions and 3.0 ± 0.75 for malignant lesions (P < .05). When we considered scores 1 and 2 as benign and scores 3 and 4 as malignant, 10 false-positive results were determined by the 4-point scoring method, and 64.2% of benign masses were diagnosed.

CONCLUSIONS

Sonoelastography might be regarded as another sonographic parameter for management of salivary gland masses in terms of detecting benign masses.

Posterior leukoencephalopathy syndrome in children and adolescents

Posterior leukoencephalopathy syndrome is a recently identified clinical and radiologic entity. The characteristic radiologic findings are bilateral gray and white matter edema in the posterior regions of the cerebral hemispheres. This article reports clinical and radiologic findings in 10 consecutive episodes of posterior leukoencephalopathy syndrome that were diagnosed in 9 children and adolescents. The causes were immunosuppressive therapy in 7 patients and a combination of renal failure and hypertension in 3. The most common presenting symptoms were seizure and altered consciousness; others included headache, sixth nerve palsy, and cortical blindness. Imaging demonstrated abnormalities in the parietal and occipital lobes in all 10 episodes. The signs and symptoms resolved after immunosuppressive agents were reduced or discontinued, or after uremia and hypertension were corrected. Four patients underwent follow-up cranial imaging, and the images showed nearly complete or complete resolution. The syndrome was clinically reversible in all patients.

MR rectography evaluation of rectoceles with oral gadopentetate dimeglumine and polyethylene glycol solution

BACKGROUND

We assessed the value of magnetic resonance (MR) rectography in diagnosing rectocele by using a combination of oral gadopentetate dimeglumine and polyethylene glycol solutions.

METHODS

T1-weighted, breath-hold, fast low-angle shot sequences were made in 22 patients in resting and straining states in the supine position before and after administration of oral paramagnetic contrast. Twelve patients received polyethylene glycol solution in addition to contrast, and 10 received contrast only. The pubococcygeal line was the reference used for diagnostic measurements. The quality of each sequence was graded. Paired t test, chi-square test, and the Kolmogorov-Smirnov test were applied for statistical analysis.

RESULTS

The results of noncontrast images were inconclusive. There was a statistically significant difference between MR imaging diagnosis of rectocele in patients in the straining position without and with contrast ( p < 0.05), and the difference was more prominent in patients using polyethylene glycol solution ( p < 0.001). Using oral contrast plus polyethylene glycol produced significantly better MR examinations in the resting and straining positions ( p < 0.05).

CONCLUSION

The combination of oral contrast and polyethylene glycol solution improves the diagnostic value of MR rectography and is particularly useful when noncontrast examinations are inconclusive.

MRI evaluation of cranial bone marrow signal intensity and thickness in chronic anemia

BACKGROUND AND PURPOSE

The aim is to assess the magnetic resonance imaging (MRI) findings for cranial bone marrow (CBM) signal intensity and thickness in patients with chronic anemia and compared these with findings in healthy subjects. We also investigated the relationships between CBM changes and age, type of anemia (hemolytic versus non-hemolytic), and severity of anemia.

METHODS

We quantitatively evaluated CBM signal intensity and thickness on images from 40 patients with chronic anemia (20 with congenital hemolytic anemia (HA) and 20 with acquired anemia) and compared these to findings in 28 healthy subjects. The intensity of CBM relative to scalp, white matter (WM), gray matter (GM), and muscle intensity was also investigated in patients and subjects in the control group. The sensitivity and specificity of CBM hypointense to GM and CBM hypointense to WM as markers of anemia were evaluated. Relationships between age and CBM thickness/intensity, and between anemia severity (hemoglobin (Hb) level) and CBM thickness/intensity were evaluated.

RESULTS

Cranial bone marrow signal intensity was lower in the chronic anemia patients than in the controls (P<0.001). In the control group, CBM intensity was higher than GM intensity, whereas the opposite was true in the patient group. The finding of CBM hypointense to GM was 85% sensitive and 67% specific as a marker of anemia. The corresponding statistics for CBM hypointense to WM were 90 and 46%. The patients had thicker CBM than the controls (temporal, P<0.05; parietal, P<0.005). The subgroup with hemolytic anemia had thicker parietal CBM than the subgroup with non-hemolytic anemia (NHA) (P<0.05) and exhibited thicker temporal and parietal CBM than the controls (temporal, P<0.05; parietal, P<0.001). The CBM thicknesses in the non-hemolytic anemia subgroup were similar to control values (P>0.05 for both). There were no correlations between age and CBM intensity or thickness, or between anemia severity and CBM intensity or thickness.

CONCLUSION

Patients with chronic anemia exhibit lower CBM signal intensity on MRI than healthy subjects. Patients with hemolytic anemia have thicker CBM than patients with non-hemolytic anemia or healthy individuals. Decreased CBM intensity may indicate that the patient has anemia, and increased CBM thickness may specifically point to hemolytic anemia. These MRI findings may signal the need for further evaluation for the clinician.

Unusual presentation of an infected primary hydatid cyst of biceps femoris muscle

Hydatid cysts of the musculoskeletal system are rare. Unusual magnetic resonance imaging (MRI) findings of an infected primary hydatid cyst of the biceps femoris muscle are presented in a 40-year-old man on hemodialysis for chronic renal failure. No daughter cysts were present within the mother cyst cavity, but there was a fatty nodule which has not previously been described in a muscular hydatid cyst. Although the cyst was infected secondarily, no surrounding soft tissue inflammatory reaction was noted. Hydatid cysts should be included in the differential diagnosis of unusual soft-tissue masses in regions where the disease is endemic.

Bilateral double testis: Evaluation by magnetic resonance imaging

Bilateral double testis, a varient of polyorchidism, is a rare malformation of which six cases have been reported in the published literature. Magnetic resonance imaging was used in the presented case to confirm the diagnosis without surgical exploration.

Central pontine myelinolysis secondary to cytomegalovirus hepatitis in a 10-month-old child

We present a 10-month-old child with central pontine myelinolysis (CPM) secondary to chronic active hepatitis due to cytomegalovirus (CMV) infection. A total of 35 paediatric cases of pontine and/or extrapontine myelinolysis are reported and, to our knowledge, CPM secondary to CMV hepatitis in an infant has not been previously reported. The MRI findings are highlighted.

HASTE MRCP and MRI findings in alveolar echinococcosis of the liver

Alveolar echinococcosis is a rare mass-producing inflammatory process of the liver. Experience with MRI, and particularly magnetic resonance cholangiopancreatography (MRCP), demonstrates that features of this disease are limited. The HASTE (half-Fourier acquisition single-shot turbo spin echo) MRCP and MRI findings of alveolar echinococcosis of the liver are presented in this report. HASTE MRCP was used to define the biliary system and the biliary system-mass relationship. It was found that results were comparable with those of invasive techniques such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography.

Sclerosing stromal tumor of the ovary with torsion. MRI features

Sclerosing stromal tumors are rare benign ovarian neoplasms that are usually diagnosed in the second or third decade of life. Most patients with these tumors present with menstrual irregularities and pelvic pain. We present the magnetic resonance imaging (MRI) findings of a left ovarian sclerosing stromal tumor with torsion that was located in the right parauterine area, and discuss the differential diagnosis for this entity based on MRI findings. In this case, MRI demonstrated a well-defined, predominantly solid mass with a pseudolobular pattern, and showed a shift of the uterus to the left. The surgical and histopathologic aspects of the case are also described.

[Papilloedema and brain abscess associated with isolated left superior vena cava draining in to the left atrium]

BACKGROUND

Papilloedema and brain abscess associated with persistent left superior vena cava draining into the left atrium without sinus coronarius and atrium septum defect is rare and until now in only few cases have been reported.

PATIENT

A 12 year-old girl was admitted because she had suffered from headache and blurred vision for 2 weeks. Fundus examination revealed papilloedema with peripapillary intraretinal haemorrhages. Pupillary reaction to light was normal. An afferent pupillary defect was negative. Neurological examination was without any focal neurological signs. Cerebral magnetic resonance imaging showed the characteristic features of a brain abscess in the left frontal lobe (3.5 x 3.0 x 2.8). Cardiological examination showed the presence of an isolated left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septum defect.

CONCLUSION

Congenital heart disease such as LSVC is rare. The association of LSVC with papilloedema and brain abscess is very rarely seen. However, the complications of LSVC can be life-threatening. Therefore in children with papilloedema, intraocular and intraorbital reasons as well as congenital heart disease as the underlying reason should be included in the differential diagnosis.