An exceptional radiographic presentation of bilateral insufficiency fractures of the proximal tibia in a patient with rheumatoid arthritis.
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Biomedical subjects
Publications and source records attributed to J Vandevenne.
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Our objective was to describe the imaging features of lymphadenopathy at the medial epitrochlear region as frequently seen in cat-scratch disease (CSD) and to compare these features with those seen in non-CSD. Ten patients (four males and six females) presented with a subcutaneous soft tissue mass at the medial epitrochlear region. Three patients were younger than 15 years. Magnetic resonance imaging was performed in all patients. All lesions turned out to be regional lymphadenopathy instead of soft tissue neoplasm. They were caused by benign disorders in eight cases, including seven CSD and one other infection, and in two cases by metastatic disease. All lesions, except for three benign ones, were solitary. On MRI, high signal intensity (SI) strands in the surrounding soft tissue on T2-weighted images (WI) were present in all cases. Three cases of CSD showed homogeneous SI on both T1- and T2WI. After contrast administration, a moderate, homogeneous enhancement was seen. The other seven lesions, except for one metastasis, had both solid and liquid components. Liquid components showed high SI on T2WI without enhancement, whereas solid components had intermediate SI on T2WI and marked enhancement after contrast administration. Pathological findings in seven patients, including four with CSD, supported the tentative diagnosis made on MRI. One of two patients with CSD had positive serological test. Cat-scratch disease is a major cause of a soft tissue swelling at the medial epitrochlear region. Identification of lymphadenopathy and its presentation on MRI may be helpful in eliciting an animal-scratch history and achieving diagnostic and therapeutic aims in patients without primary cancer.
This article outlines the ability of MR imaging in staging, grading, tissue characterization, and posttherapeutic surveillance of soft tissue tumors. Well-known staging parameters, such as extent, relationship with adjacent structures, and detection of intralesional necrosis, are used in the MR protocol for locoregional staging. Bone scintigraphy and high-resolution CT scan of the lungs are best methods for ruling out metastatic spread. A variety of (solitary or combinations of) grading parameters are described in the radiological literature. The role of MR imaging is to afford recognition of these lesions that need further aggressive work-up, excluding all others. Despite controversial reports, the definite role of MR imaging in grading of soft tissue tumors seems to become established. As for grading, a lot of individual imaging characteristics used for tissue characterization have low sensitivity, but combinations of parameters (age, site, signal intensities) are more useful and often allow to predict a specific diagnosis or to narrow down the list of differential diagnoses. Local recurrences of soft tissue tumors are frequent and can be detected accurately by an easy-to-use MR algorithm.
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The high incidence of osteoarthritis and the recent advent of several new surgical and non-surgical treatment approaches have motivated the development of quantitative techniques to assess cartilage loss. Although magnetic resonance (MR) imaging is the most accurate non-invasive diagnostic modality for evaluating articular cartilage, improvements in spatial resolution, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) would be valuable. Cartilage presents an imaging challenge due to its short T(2) relaxation time and its low water content compared with surrounding materials. Current methods sacrifice cartilage signal brightness for contrast between cartilage and surrounding tissue such as bone, bone marrow, and joint fluid. A new technique for imaging articular cartilage uses driven equilibrium Fourier transform (DEFT), a method of enhancing signal strength without waiting for full T(1) recovery. Compared with other methods, DEFT imaging provides a good combination of bright cartilage and high contrast between cartilage and surrounding tissue. Both theoretical predictions and images show that DEFT is a valuable method for imaging articular cartilage when compared with spoiled gradient-recalled acquisition in the steady state (SPGR) or fast spin echo (FSE). The cartilage SNR for DEFT is as high as that of either FSE or SPGR, while the cartilage-synovial fluid CNR of DEFT is as much as four times greater than that of FSE or SPGR. Implemented as a three-dimensional sequence, DEFT can achieve coverage comparable to that of other sequences in a similar scan time. Magn Reson Med 42:695-703, 1999.
We report a case of malignant maxillar ameloblastoma. A review of literature is presented. The unusual clinical behavior and the non specific presentation on CT of our case are discussed.
Diffusion-weighted (DW) magnetic resonance imaging (MRI) has already gained status in the neuroradiological MRI approach of a patient suffering from a variety of neurological diseases. The clinical application of DW MRI in the evaluation of renal disease is not standard. This manuscript describes preliminary results of the application of DW imaging in renal infection to aid differential diagnosis and/or lesion detection in clinical MRI. Three patients with acute pyelonephritis and two patients with renal abscess (one with xanthogranulomatous pyelonephritis, the other with a solitary pyogenic renal abscess) were examined with MRI. Areas of acute pyelonephritis and abscedation have restricted proton diffusion and are demonstrated on the DW images. Refinement of the technique, in-depth investigation of the pathological background of the MR findings and evaluation of its true clinical value need further investigation. This manuscripts shows preliminary findings of DW imaging in patients with renal infectious disease.
MR imaging using ultrafast MR sequences is a useful method in assessing pregnancies at risk. This is especially the case for fetal imaging. However, reports of imaging of the placenta or the uterus are rare. We report the MR findings in 8 pregnant patients with vaginal blood loss in whom the obstetrical ultrasound was equivocal. MR imaging was performed with a 1.5 T magnet and consisted of T2- (HASTE), fat-suppressed gradient echo T1- and gradient echo T2-weighted images. Adequate anatomical visualisation of the uterus, the placentary tissue and the intrauterine bleeding irrespective of size and location of the latter, were obtained in all cases.
We present the case of a 50-year-old man with a solitary mass lesion in the right kidney. Characteristics on ultrasound were a thick irregular hypoechoic wall and a slightly hyperechoic center. Computed tomography depicted the lesion as spontaneously hyperdense at its base. After administration of intravenous iodinated contrast only partial enhancement in the peripheral wall was seen. On MR imaging the lesion was hypointense on T1-weighted images, and T2-weighted images demonstrated a thick irregular hypointense peripheral wall and an intralesional fluid debris level. Gadolinium-chelates were not administered.
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