AJR teaching file: progressive polyradiculopathy.
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Biomedical subjects
Publications and source records attributed to Catherine C Roberts.
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The educational objectives for this self-assessment module on imaging of the pineal region and spine are for the participant to exercise, self-assess, and improve his or her understanding of the evaluation of patients with brain tumors, particularly solid masses of the pineal region; gain familiarity with the clinical entity of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and its radiologic appearance; and gain familiarity with the clinical entity of spinal dural arteriovenous fistula (DAVF) and its radiologic appearance.
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Ruptures of the tibialis anterior tendon are rare. We present the clinical histories and MRI findings of three recent male patients with tibialis anterior tendon rupture aged 58-67 years, all of whom presented with pain over the dorsum of the ankle. Two of the three patients presented with complete rupture showing discontinuity of the tendon, thickening of the retracted portion of the tendon, and excess fluid in the tendon sheath. One patient demonstrated a partial tear showing an attenuated tendon with increased surrounding fluid. Although rupture of the tibialis anterior tendon is a rarely reported entity, MRI is a useful modality in the definitive detection and characterization of tibialis anterior tendon ruptures.
STUDY DESIGN: Cervical spine computed tomograms were evaluated for neural foraminal stenosis in both the standard axial plane and the oblique reformatted plane. OBJECTIVE: To assess whether oblique reformation of cervical spine computed tomograms reduces interobserver variability in the evaluation of neural foraminal stenosis. SUMMARY OF BACKGROUND DATA: Radiographic assessment of neural foraminal stenosis is subjective, may vary among observers, and can affect surgical planning. METHODS: The cervical spine images from 19 patients with various degrees of neural foraminal stenosis were reformatted in an oblique plane perpendicular to the long axis of the right and left neural foramens. Seven independent observers graded the degree of foraminal stenosis (none, mild [1-25%], moderate [26-75%], or severe [>75%]) and their confidence level (definite, probable, possible) on both the axial images and the oblique reformations. RESULTS: The ages of the 12 male (mean, 67.5 +/- 13.24 years) and 7 female (mean, 62.7 +/- 14.79 years) patients ranged from 39 to 83 years. Interobserver variability was assessed with chi2 analysis. Rates of agreement on degree of stenosis (chi2 = 19.94; df= 9; P< 0.02) were significantly higher for oblique reformations. Confidence ratings also were significantly higher for oblique reformations (chi2 = 18.19; df= 7; P< 0.02). CONCLUSIONS: Oblique reformation of cervical spine images significantly reduces the degree of interobserver variability and increases observer confidence in the assessment of neural foraminal stenosis. Oblique reformations should be considered in the routine evaluation of neural foraminal stenosis.
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PURPOSE: To compare dynamic gadolinium-enhanced T1-weighted magnetic resonance (MR) imaging with nonenhanced T1-weighted and T2-weighted MR imaging and thin-section computed tomography (CT) for the demonstration of osteoid osteomas. MATERIALS AND METHODS: The images of 11 patients with pathologically proven osteoid osteomas who underwent nonenhanced MR imaging, dynamic gadolinium-enhanced MR imaging, and CT were retrospectively reviewed. Images obtained with all three techniques were scored for conspicuity of the osteoid osteoma relative to the surrounding bone. Time-enhancement curves were generated from signal intensity measurements of these lesions and the adjacent bone marrow. The mean imaging scores of the four techniques were compared, and the statistical significance was calculated by using a linear model with terms for method and patient. Pairwise comparisons were made by using the Tukey-Kramer adjustment for multiple comparisons. RESULTS: Compared with CT, dynamic gadolinium-enhanced MR imaging demonstrated the osteoid osteoma equally well in eight of 11 patients and with better conspicuity in three of 11 patients, although this difference was not statistically significant (P =.69). The dynamic gadolinium-enhanced MR images demonstrated the osteoid osteomas significantly better than the nonenhanced T1-weighted (P <.001) and T2-weighted (P <.001) MR images. On the dynamic gadolinium-enhanced MR images, nine (82%) of 11 patients had peak enhancement of the osteoid osteoma in the arterial phase with early partial washout, compared with slower, progressive enhancement of the adjacent marrow. This resulted in greatest lesion to marrow contrast material enhancement in the arterial phase. One osteoid osteoma had peak enhancement in the venous phase, and one showed progressive enhancement through all phases to 150 seconds. CONCLUSION: Osteoid osteomas can be imaged with greater conspicuity by using dynamic gadolinium-enhanced instead of nonenhanced MR imaging and with conspicuity equal to or better than that obtained with thin-section CT.
OBJECTIVE: The purpose of this study was to assess the MR imaging appearance of palpable fatty masses and to propose terminology for palpable subcutaneous fatty masses that are nonencapsulated on MR imaging. MATERIALS AND METHODS: We searched the past 7 years of our institution's radiology database for reports of MR images containing the word "lipoma." Medical records were reviewed to identify patients with palpable masses corresponding to fat. Two radiologists retrospectively reviewed the MR images for the presence of an encapsulated or nonencapsulated fatty mass in the region of the palpable abnormality. Pathologic specimens, when available, were also reviewed. RESULTS: Between 1995 and 2001, 184 palpable subcutaneous fatty masses were evaluated on MR imaging. Of these, 46% (85/184) were encapsulated lipomas and 54% (99/184) were nonencapsulated fatty masses on MR imaging. Four masses (three encapsulated and one nonencapsulated) were surgically resected and had pathology consistent with lipomas. CONCLUSION: Many palpable fatty masses do not have definable capsules on MR imaging. We propose that a palpable mass that corresponds to a nonencapsulated prominence of subcutaneous fat on MR imaging should be reported as a nonencapsulated lipoma. More definitive reporting of this relatively common lesion will assure the referring clinician of the benign nature.
OBJECTIVE: We compared the accuracy of the previously unevaluated "absent middle facet" sign with the more commonly used "talar beak" sign and C sign for the detection of coalition of the subtalar joint middle facets on lateral foot radiographs obtained with the patient standing. MATERIALS AND METHODS: Three musculoskeletal radiologists graded the visibility of these three signs on standing lateral radiographs of 32 feet that had been proven to have coalitions of the middle facets of the subtalar joint and 62 feet that had normal subtalar joints. The reviewers were unaware of the presence or absence of subtalar coalitions in these feet. RESULTS: The absent middle facet sign had a sensitivity, specificity, and accuracy of 75%, 98%, and 90%, respectively, for the diagnosis of subtalar joint coalition in this patient population, whereas these values were 56%, 100%, and 85% for the C sign and 53%, 90%, and 78% for the talar beak sign, respectively. A finding of either a positive absent middle facet sign or a positive C sign resulted in a sensitivity, specificity, and accuracy of 84%, 98%, and 94%, respectively. CONCLUSION: In this study population, the absent middle facet sign was more sensitive than and nearly as specific as the talar beak sign and C sign for diagnosing subtalar coalition on standing lateral foot radiographs. The highest accuracy was obtained when a finding of either a completely absent middle facet or a complete C sign was considered as a positive indicator of a subtalar coalition.