Biomedical subjects
Publications and source records attributed to A Jena.
Magnetic resonance (MR) findings in one case each of extradural and intradural arachnoid cyst are described. Thoracic segments were involved in both cases. The cysts were slightly more intense than cerebrospinal fluid in both cases on T1 weighted images. The nature and extent of the lesions were better demonstrated on MR images as compared with combined myelography and computed tomography.
Magnetic resonance (MR) imaging of the spine was performed as the initial imaging technique in 20 children when spinal dysraphism was suspected clinically and plain radiographs showed spina bifida. The correlation with surgical findings indicated that MR provided accurate information preoperatively in all the cases. Some unusual observations in cases with spina bifida cystica and occulta are discussed. It is concluded that plain radiograph and MR complete the preoperative radiologic evaluation of cases with spinal dysraphism.
Thirty-one patients with intracranial tuberculomas were diagnosed on the basis of magnetic resonance (MR) imaging. The diagnosis was confirmed in 30; one case was a false-positive. A total of 44 tuberculomas was found in these patients of which 41 were distributed in the cerebral hemispheres, two in the brainstem and one in the cerebellum. No correlation was found between the type of lesion seen on CT and those seen on MR imaging. CT was negative in one patient with a low brainstem tuberculoma. The final diagnosis was based on the response to antituberculous drug treatment as judged by serial MR imaging in 29 patients and by biopsy in one; and one was false-positive. Thirty-nine tuberculomas, all under 2.5 cm in size, showed complete resolution after 5-8 months of treatment. The remaining five lesions were larger than 2.5 cm; four showed a 50% reduction in size after 12 months of treatment and one was completely excised. Three types of response are described to the treatment with anti-tuberculous drugs. The diagnosis of intracranial tuberculomas can be made more objectively with MR imaging.
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An unusual case of primary mediastinal tuberculous abscess is presented in whom the diagnosis was obtained on magnetic resonance (MR) and ultrasound (US) guided aspiration cytology. Mycobacterium tuberculosis was isolated from direct smear as well as from culture of the "pus". Normal spine signal with MR and normal bone scintigraphy excluded any vertebral focus of infection. MR was helpful in, defining the extent and characterising the abscess, besides excluding a vertebral focus of infection.
Twelve cases of obstructive jaundice in whom ultrasound failed to demonstrate the site and/or the cause of obstruction of the biliary tract were examined with magnetic resonance imaging (MRI), correctly diagnosing the site and cause of obstruction in 10 of 12 surgically proven cases. In one case of cholangiocarcinoma, the site of obstruction was well shown on MR but a definite cause could not be ascertained. In another patient who developed intermittent jaundice following surgery for choledochal cyst, MR demonstrated a solitary stone in the common hepatic duct. Surgical confirmation could not be achieved as the patient was lost to follow up. There were 6 cases of choledocholithiasis, 3 cases of gall bladder carcinoma and one case each of pancreatic adenocarcinoma and cholangiocarcinoma. It is believed that MRI will provide obstructive jaundice and will be able to minimize the use of percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) in view of its ability to perform multiplanar imaging in multiple sequences.
Fifteen patients in whom the diagnosis of cysticercosis of the brain was suggested by computed tomography (CT) were further studied with magnetic resonance imaging (MRI). Besides lesions in the substance of the hemispheres, cysts were found adjacent to and within the ventricles, the brainstem, cerebellum and subarachnoid space. Magnetic resonance imaging showed brain involvement out of proportion to what was shown by CT. The eccentrically placed mural nodule within a cyst, the pathognomonic lesion of cysticercosis, was seen in all cases with MRI. The various stages of development of the cysticercus larva were seen in one individual. An attempt is made to illustrate the various stages of development by means of MR images, and a possible pathological explanation is offered. The authors believe that MRI provides diagnostic information in this disease and dispenses with the need for enhanced CT examination.
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The rare presentation of hyperthyroidism caused by an intrathoracic goiter with a normal-sized cervical thyroid gland is described. The toxic intrathoracic goiter demonstrated avid uptake of [131I] and [99mTc]pertechnetate, with comparatively faint isotopic accumulation seen in the cervical thyroid. A chest roentgenogram and radioisotope scan should be mandatory in cases of hyperthyroidism having no cervical thyroid enlargement to explore the possibility of a toxic intrathoracic goiter.
A computer-assisted radionuclide perfusion study was performed in 25 cases of solitary 'cold' thyroid nodules to assess their vascularity relative to that of normal adjoining thyroid tissue. Hypervascularity was seen in 3 malignant nodules; 1 follicular adenoma also showed increased vascularity. The 21 nodules demonstrating equal vascularity or avascularity with respect to normal thyroid tissue were benign in nature. Computer-generated time-activity curves were helpful in distinguishing hypervascular from equally vascular nodules. This technique, in conjunction with clinical evaluation, can be of value in deciding whether patients should undergo surgery or receive conservative management.
MR characteristics of iophendylate in spinal subarachnoid space are well known. Still, it is difficult to differentiate it from spilled contents of epidermoid on cranial MR imaging.
Eight patients with intracranial tuberculomas were studied with CT and magnetic resonance (MR) imaging. Large, ring enhancing, solid lesions on CT showed low intensity on T2-weighted images and intermediate intensity on T1-weighted images. Small lesions, with ring enhancement on CT, showed central bright signal on T2-weighted images with a peripheral low intensity rim surrounded by high intensity edema. The MR imaging features of the tuberculomas were found to be distinct from those of abscesses, metastases, and gliomas.
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