The spleen in systemic disorders.
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Collagen Diseases↗
Biomedical subjects
A M De Schepper
Publications and source records attributed to A M De Schepper.
Vascular pathology of the spleen.
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Aneurysm↗
Metachronous eosinophilic granuloma of bone.
We present the case of a 4-year-old girl who developed a metachronous osseous lesion of the left distal femur five months after successful surgical treatment of an eosinophilic granuloma in the left proximal femur. After treatment of the second lesion with curettage, no further recurrence occurred during a follow-up interval of 17 months. Radiologists should be aware that additional eosinophilic granulomas of bone, occurring in up to four years after the initial diagnosis, should still be interpreted as a localized form of Langerhans'cell histiocytosis with a more favorable prognosis than the multifocal disseminated form, with involvement of organ systems other than the skeletal system.
Bone Diseases↗
MR imaging of the shoulder: imaging techniques and anatomy.
Since the development of dedicated surface coils and the more widespread use of state-of-the-art arthrographic techniques, MR imaging of the shoulder has come to maturity. In this article the imaging techniques of conventional MR imaging and MR arthrography of the shoulder are reviewed. The complex anatomy, the many anatomic variations and diagnostic variants and pitfalls and discrimination of pathologic entities from normal findings are discussed. Familiarity with the normal anatomy is a prerequisite to achieve a high diagnostic accuracy in the detection of a variety of pathologic conditions of the shoulder joint.
Arthrography↗
Imaging findings in Langerhans' cell histiocytosis of the liver and the spleen in an adult.
We present a case of Langerhans' cell histiocytosis (LCH) of the liver and spleen in an adult. The imaging features are different from those in the few previously reported cases of individual organ involvement by LCH.
Adult↗
Dysplasia epiphysealis hemimelica of the scaphoid bone.
We report a rare case of dysplasia epiphysealis hemimelica (DEH) in the wrist of a 7-year-old boy. Clinical, radiological and histopathological manifestations are discussed. The correct diagnosis of DEH, however, was made by the confrontation of the radiological and pathological data. The radiologist should inform the pathologist correctly about the imaging findings in order to avoid misdiagnosis of the lesion as osteochondroma.
Carpal Bones↗
Intestinal stenosis from mesenteric injury after blunt abdominal trauma.
We report a case in which blunt abdominal trauma resulted in injury to the mesentery with subsequent ischemic stricture of the adjacent small bowel. We present CT images at the time of trauma and 5 weeks later when clinical signs of intestinal obstruction occurred. We include images of enteroclysis and angiography of this uncommon sequela of blunt abdominal trauma. At surgery, a stenotic small bowel loop was found adjacent to a healed defect in the mesentery. Histological examination of the resected segment showed mucosal and submucosal ischemia with mucosal ulceration, mural inflammation, and fibrosis. Posttraumatic intestinal stenosis subsequent to a mesenteric tear should be included in the differential diagnosis in a patient with a history of blunt abdominal trauma and signs of intestinal obstruction.
Abdominal Injuries↗
Radiographic manifestations of intestinal obstruction in the newborn.
Intestinal obstruction in the newborn infant may be due to a variety of conditions, including atresia and stenosis, annular pancreas, malrotation, duplication cyst, meconium ileus, meconium plug syndrome and neonatal small left colon syndrome, and Hirschsprung's disease. Neonates with unrecognised intestinal obstruction deteriorate rapidly, show an increase of associated morbidity and appropriate surgical treatment becomes more hazardous. Early diagnosis depends largely on the prompt detection of obstructive manifestations by the clinician and the subsequent accurate interpretation of radiographic findings by the radiologist. Plain film of the abdomen is often helpful in determining the level of obstruction and usually dictates, together with clinical symptoms, the choice of the contrast study firstly to perform. In this article we will review the clinical and radiological signs of different pathological conditions causing intestinal obstruction in the newborn.
Colon↗
Imaging in patients with vertigo.
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Brain Neoplasms↗
Imaging findings in diffuse axonal injury after closed head trauma.
Even in patients with closed head trauma, brain parenchyma can be severely injured due to disruption of axonal fibers by shearing forces during acceleration, deceleration, and rotation of the head. In this article we review the spectrum of imaging findings in patients with diffuse axonal injuries (DAI) after closed head trauma. Knowledge of the location and imaging characteristics of DAI is important to radiologists for detection and diagnosis. Common locations of DAI include: cerebral hemispheric gray-white matter interface and subcortical white matter, body and splenium of corpus callosum, basal ganglia, dorsolateral aspect of brainstem, and cerebellum. In the acute phase, CT may show punctate hemorrhages. The true extent of brain involvement is better appreciated with MR imaging, because both hemorrhagic and non-hemorrhagic lesions (gliotic scars) can be detected. The MR appearance of DAI lesions depends on several factors, including age of injury, presence of hemorrhage or blood-breakdown products (e. g., hemosiderin), and type of sequence used. Technical aspects in MR imaging of these patients are discussed. Non-hemorrhagic lesions can be detected with fluid attenuated inversion recovery (FLAIR), proton-density-, or T2-weighted images, whereas gradient echo sequences with long TE increase the visibility of old hemorrhagic lesions.
Adolescent↗
Subcutaneous granuloma annulare: MR imaging and literature review.
Subcutaneous granuloma annulare (SGA) is little known to radiologists. Better knowledge of this lesion may prompt accurate diagnosis. A typical case is presented with plain radiography, ultrasound and MR imaging, and is confirmed by histology. When an otherwise healthy child presents with a rapidly growing, solitary, nontender, subcutaneous soft tissue mass, located on the scalp or extensor aspect of the limbs, that radiologically presents as an indistinct radiodense and hypoechoic mass, isointense to muscle on T1- and slightly hypointense to fat on T2-weighted MR images, without calcifications, bone involvement or extracompartmental invasion, SGA should be suspected.
Biopsy↗
Patterns of framework invasion in patients with laryngeal cancer: correlation of in vitro magnetic resonance imaging and pathological findings.
Total laryngectomy for laryngeal squamous cell carcinoma means a drastic change in the way of living for a patient. New surgical techniques such as laser surgery attempt to save the voice. To be oncologically correct, an accurate assessment of the tumor extent is necessary. Imaging is especially important in determining tumor extent in the regions where conventional and endoscopic ENT examinations are less accurate. Correlations of CT, in vivo MRI and pathological findings after surgery have demonstrated that MRI is more sensitive than CT, but that it overestimates the degree of cartilage invasion. Cartilage invasion is believed to be a contraindication to radiation therapy and voice-sparing surgery. In a prospective study, Gd-enhanced in vitro MRI of 10 total laryngectomy specimens was correlated with subsequent pathological examination. Good correlation of the anatomical relationships of the tumor between the in vitro images and gross pathology were found. Important is the absence of false negatives in our study, indicating that cartilage invasion can be ruled out when a normal signal intensity on in vitro MRI of the cartilage is seen. This has important oncological implications for partial voice-sparing laryngeal surgery.
Aged↗
Insulinoma associated with liver lesions: value of MR imaging.
We report on a middle-aged woman who presented with clinical and biochemical findings of insulinoma. Preoperative evaluation by ultrasound, CT, and angiography located the pancreatic lesion but also revealed two focal liver lesions. The latter were interpreted as metastases. MR imaging with injection of superparamagnetic iron oxide particles not only localized the insulinoma but proved to be the only noninvasive technique capable to exclude presence of liver metastases preoperatively. This reversed management to minimal laparoscopic surgery. Recent literature of preoperative imaging evaluation of insulinoma and focal liver lesions is discussed.
Adult↗
Chronic recurrent multifocal osteomyelitis.
The case of a 17-year-old boy with Chronic Recurrent Multifocal Osteomyelitis (CRMO) is presented. Clinical manifestations included a three month history of marked antalgic scoliosis, thoracic and mid-sternal pain, mild fever, elevated erythrocyte sedimentation rate, and skin lesions such as acne and psoriasis. Radiologically, osteolytic lesions were seen in the sternum and the thoracic spine. Histopathological examination of the sternal lesion revealed chronic osteomyelitis. Bone cultures of the resected specimen were negative for known pathogens. The combination of the clinical, radiological, histopathological and microbiological features was the clue to the diagnosis of CRMO.
Acne Vulgaris↗
Effects of a nursing pain programme on patient outcomes.
The effectiveness of a continuing pain education program, directed to surgical cancer nurses, was investigated in a pretest posttest controlled intervention study. ANCOVA for repeated measures revealed that the programme resulted in a lower pain intensity of surgical colon and breast cancer patients (p = 0.02). However, no effects were found on pain duration, sleepless hours as a result of pain, state anxiety, mood disturbances, and duration of hospitalization. It is assumed that because the pain CE programme had a moderate impact on pain intensity, this had no consequences for the other outcome variables mentioned.
Affect↗
Distribution and incidence of degenerative spine changes in patients with a lumbo-sacral transitional vertebra.
The purpose of this prospective study was to determine the overall incidence and distribution of lumbo-sacral degenerative changes (i.e. disc protrusion or extrusion, facet degeneration, disc degeneration, nerve root canal stenosis and spinal stenosis) in patients with and without a lumbo-sacral transitional vertebra (LSTV). The study population consisted of 350 sequential patients with low back pain and/or sciatica, referred for medical imaging. In all cases CT scans of the lumbo-sacral region were obtained. In 53 subjects (15%) and LSTV was found. There was no difference in overall incidence of degenerative spine changes between the two groups. We did find, however, a different distribution pattern of degenerative changes between patients with and those without an LSTV. Disc protrusion and/or extrusion occurred more often at the level suprajacent to the LSTV than at the same level in patients without LSTV (45.3% vs 30.3%). This was also the case for disc degeneration (52.8% vs 28%), facet degeneration (60.4% vs 42.6%) and nerve root canal stenosis (52.8% vs 27.9%). For spinal canal stenosis there was no statistically significant difference between the two categories. In conclusion, our findings indicate that an LSTV does not in itself constitute a risk factor for degenerative spine changes, but when degeneration occurs, it is more likely to be found at the disc level above the LSTV.
Case-Control Studies↗
The influence of MR field strength on the detection of focal liver lesions with superparamagnetic iron oxide.
The purpose of this study was to compare the value of low- vs high-field MR systems in the detection of focal liver lesions after IV administration of iron oxide particles. A prospective study was undertaken which included 20 patients with focal liver lesions on CT or US, or strong clinical suspicion of focal liver disease. Iron oxide particles were administered in an IV drip infusion over 30 min. Magnetic resonance imaging was subsequently performed on a 0.2 and a 1.5-T system. Both examinations were performed in one session. Turbo spin-echo T2-weighted sequences were used for further analysis (at 0.2 T: TR 4050 ms, TE 96 ms; 1.5 T: TR 3000 ms, TE 103 ms). After randomisation, images were analysed by two blinded readers. The evaluation included lesion counts, determination of lesion conspicuity and overall image quality (both graded on a scale 1-5). Quantitative analysis was performed on 29 lesions. Lesion-to-liver signal intensity and contrast-to-noise ratios (CNRs) were calculated. The total lesion count (cumulative counts for two observers) was 59 on the high-field system and 63 on the low-field system. Statistical analysis showed no significant difference. On both systems median value for lesion conspicuity was 3. No statistically significant difference was found. Global image quality was rated higher on the high-field system: 3 vs 2 for the low-field system (p = 0.0017). Quantitative analysis showed no significant difference for lesion-to-liver signal intensity ratios or CNRs. Although subjective image quality is significantly better on the high-field system, this does not result in better lesion detection or better lesion conspicuity. No significant difference in objective quantitative parameters was found in our series.
Adult↗