Treatment of isolated articular cartilage lesions of the medial femoral condyle. A clinical nad MR comparison of autologous chondrocyte implantation vs. microfracture

Microfracture (MFX) and Autologous Chondrocyte Implantation (ACI) have been utilized in an effort to promote the regeneration of articular cartilage in the knee. The purpose of this study is first, to determine which of these two treatments yields the best clinical results and, second, to determine whether the MR appearance of treated cartilage lesions correlates with clinical outcome. Thirty-five patients with isolated articular cartilage lesions of the medial femoral condyle (MFC) were treated either with ACI (17 patients) or with MFX (18 patients, 19 knees). Patients were evaluated clinically using the modified Cincinnati Knee Questionnaire and with a physical exam. MRs were graded using eight different criteria: an MR score of 100% represents normal cartilage. The average follow-up was 2,6 years for the ACI group and 2,8 years for the MFX group. The average size of the lesion was 472 mm2 for the ACI group and 326mm2 for the MFX group. The Cincinnati scores improves an average of 22% for the ACI patients and 42% for the MFX patients from preoperatively to postoperatively. The average MR score was 66% for the ACI group and 44% for the MFX group. Fifty-nine percent of the ACI patients required at least one additional procedure. This is the first clinical and MR comparison of ACI and MFX to treat full thickness cartilage lesions of the MFC. Clinical improvement was 2 times greater for the MFX patients compared to the ACI patients. The MR scores did not correlate with clinical outcome using our grading system.     

多囊性肾细胞癌超声、CT及MR影像学表现

目的 探讨多囊性肾细胞癌(MCRCC)超声、CT及MR影像学表现及多种影像学方法在诊断及鉴别诊断中的作用.方法 病理结果为多囊性肾细胞癌者18例,收集其超声、CT及MR的图像资料,观察肿块形态特征和超声、CT及MR图像特征.结果 18例均显示肿块为包膜完整、多囊、间隔薄.彩色多普勒超声、增强CT和增强MR显示肿块包膜及间隔有彩色血流信号或强化.结论 MCRCC有特征性影像学表现.超声、CT及MR成像有助于MCRCC的诊断及鉴别诊断.     

原发性支气管肺癌32例MRI表现分析

作者回顾复习了３２例原发性支气管肺癌的ＭＲＩ检查资料，讨论ＭＲＩ在肺癌诊断中的作用，并对ＴＳＥ＜快速自旋回波＞Ｔ２加权扫描序列在胸部的应用价值作了评价。     

Pediatric liver: focal masses

Imaging is a standard part of the evaluation of pediatric liver disease. Advances in MR imaging have improved detection, characterization, and staging of hepatic lesions. This article addresses the MR imaging appearances of various focal hepatic lesions that can present in children. Techniques for performing hepatic MR imaging also are reviewed.     

MR imaging of thoracic veins

The thoracic venous system can be visualized and characterized well with MR imaging. In this article, MR sequences that are suited for this purpose (including the more advanced techniques) are reviewed. The normal thoracic venous anatomy and a brief summary of its embryogenesis is provided. The appearances of congenital and acquired abnormalities of the systemic and pulmonary thoracic veins are described. This article also discusses recent applications of MR imaging in the evaluation of the pulmonary veins and the left atrium in patients who have atrial fibrillation.     

Spectrum of imaging findings on MRI and CT after uterine artery embolization

Uterine artery embolization (UAE) is an effective treatment for symptomatic uterine fibroids. Magnetic resonance (MR) imaging is typically employed to evaluate the uterus following UAE for fibroid infarction, size, location change, persistent enhancement, changes in adenomyosis, and uterine necrosis. Variable pattern of calcification on computed tomography (CT) can differentiate embolic particles and fibroid involution. CT following UAE may be requested because of acute pelvic pain or chest discomfort or pyrexia and/or for complications that may require treatment in acute phase. Visualization of gas in uterus and uterine vessels following UAE is an expected finding that should not be misinterpreted as a sign of infection. The MRI and CT appearances vary depending upon the time interval after UAE and success of the procedure. Radiologists should be familiar with the range of post-UAE appearances on MRI and CT to better aid clinicians in correct diagnosis and treatment. The main purpose of this pictorial review is to identify the spectrum of findings on MRI and CT performed after UAE, to illustrate UAE-associated common and uncommon MRI and CT appearances and discuss post-UAE complications that require urgent medical or surgical intervention.     

Evaluation of small bowel tumors: MR enteroclysis

Magnetic resonance imaging (MRI) of the small bowel has become widely accepted at centers dedicated to the diagnosis and treatment of inflammatory bowel disease, due to the method’s diagnostic efficacy. MR enteroclysis is an imaging modality that combines the advantages of enteroclysis and multiplanar MR and allows the detection and the manifestations of small bowel diseases wherever they are located (intraluminal, intramural, or extramural). Magnetic resonance enteroclysis (MRE) is an emerging technique used for the detection and evaluation of small bowel neoplasms. This article illustrates the imaging appearances of small bowel tumors on MRI and the usefulness of MR enteroclysis in the diagnosis and categorization of these tumors, also discussing the role of MRE in comparison with other diagnostic modalities.     

MR imaging of the accessory muscles around the ankle.

Familiarity with the accessory muscles around the ankle is crucial in preventing misinterpretation and unnecessary treatment. A review of the MR imaging appearances, prevalence, and clinical features of the more common accessory muscles around the ankle is presented. Emphasis is placed on their distinguishing MR imaging features.     

MR imaging of the adrenal glands

MR imaging is used commonly for imaging the adrenal glands. Its high-contrast resolution and multiplanar imaging capability enables the detection and characterization of many adrenal masses. The advent of chemical-shift imaging revolutionized the role of MR imaging in characterizing adrenal masses. In this article, the authors discuss the range of MR appearances of common and uncommon adrenal masses, focusing on the nonfunctioning incidentally discovered mass and its characterization methods. MR imaging is continuously improving. The increasing use of higher strength magnets and the introduction of newer coils, sequences, and techniques will help detect and characterize very small adrenal masses, quantify their fat content, and provide exquisite morphologic images of the gland and its vascular supply.     

Advanced MR imaging of the cruciate ligaments

The anterior and posterior cruciate ligaments are crucial stabilizers of the knee. These ligaments are named by the location of their tibial attachments. Each ligament is composed of separate functional bundles that differ in size but are equally important in function. MR imaging is accurate and sensitive, making it the imaging technique of choice for evaluating these ligaments. Acute and chronic injuries involving the cruciate ligaments have typical appearances and associated findings. MR imaging interpretation must take into account atypical injuries and imaging pitfalls. Knowledge of normal ligament reconstruction techniques allows differentiation of the normal postoperative appearance from reconstruction failure and complications. Ligament reconstruction techniques, complications, and appearances are reviewed in this article.     

颅脑孤立性浆细胞瘤的MR影像学表现

目的：总结颅脑孤立性浆细胞瘤的ＭＲ表现，提高对该病的认识。方法：搜集了４例经我院病理证实的颅脑孤立性浆细胞瘤，全部病人均在我院行ＭＲ检查。ＭＲ扫描重点观察了肿瘤的发生部位，信号特点，侵润范围，骨质破坏情况，和增强扫描特征。根据病人病历资料，我们对病人的ＣＴ和Ｘ线平片表现也进行了总结，并与ＭＲ表现进行了对照。结果：４例颅脑孤立性浆细胞瘤中，两例肿瘤发生于额式顶骨，并造成相应的骨质破坏。另两例肿瘤与颅骨无任何联系，一例位于左额镰旁，一例位于右三角区。肿瘤多表现为均匀的等或稍低Ｔ１信号，等或稍高Ｔ２信号，注药后均匀强化。肿瘤边界清楚，无骨硬化及增生。本组３例行尿本周蛋白检查病人，全部表现阴性。结论：颅脑浆细胞瘤的ＭＲ表现与肿瘤起源部位和侵润范围有着密切关系。肿瘤的ＭＲ表现与某些常见中枢神经系统肿瘤十分相似，不易鉴别。ＭＲ能够清楚地显示肿瘤及其与周围组织的关系，是显示浆细胞瘤及其侵润范围的最佳影像学检查方法。     

结节性筋膜炎的MRI表现与病理分型对照

目的 探讨结节性筋膜炎(NF)的组织病理学分型及其相应的MRI特征。方法 回顾性分析19例经手术病理证实的软组织NF患者的MRI资料,分析其MRI表现特点,并与组织病理学分型进行对照分析。结果 19例患者中,黏液型8例,细胞型4例,纤维型7例。黏液型NF含有较多黏液基质,其中6例病灶中央区细胞排列疏松并见液化区;8例患者T1WI均呈稍高信号,6例T2WI呈"反靶征"表现。细胞型NF细胞成分较多,毛细血管分布均匀,4例病灶的MRI信号及内部强化均相对较均匀。7例纤维型NF病灶中5例中央富含胶原成分,T2WI于相应区域可见"中央纤维瘢痕征"。结论 各型NF的MRI表现具有一定特征性,可反映其组织病理学改变。     

Magnetic resonance imaging of the liver

Hepatic MRI has become a useful imaging modality in recent years. As with all diagnostic imaging, the scanning techniques available for hepatic MRI are manifold and complex. The article discusses these techniques and their practical applications. Contrast agents and the MR appearances of various pathologic hepatic entities are also reviewed.     

Magnetic resonance imaging of inflammatory arthropathies of peripheral joints

As the treatment of inflammatory arthropathies has advanced with new therapies that can slow or even halt the development of disabling disease, early and accurate diagnosis has become imperative. Magnetic resonance (MR) imaging has proved to be very sensitive in the detection of erosions, but more importantly, it can demonstrate pre-erosive changes. Detection of synovitis and edema-like bone marrow lesions for initial diagnosis and as an indicator of disease progression can provide crucial information leading to therapeutic interventions before permanent joint damage occurs. Understanding the characteristic intra-articular and extra-articular MR imaging findings of the inflammatory arthritides allows the radiologist to provide appropriate consultations in the care of these patients. The MR appearances of both intra-articular and extra-articular findings of inflammatory arthritis are presented. Despite the advances in imaging, however, many of the MR findings remain nonspecific, and radiologists must avoid overdiagnosis by synthesizing all of the clinical information available into their interpretations.     

MR imaging of bone tumors of the cervical spine

MR Imaging has altered radically the detection, characterization, and the staging of bone tumors. This article reviews MR imaging techniques and appearances of benign and malignant bone tumors that are encountered in the cervical spine.     

Dynamic contrast-enhanced brain perfusion imaging: Technique and clinical applications

Magnetic resonance (MR) and computed tomographic (CT) perfusion imaging are evolving noninvasive imaging techniques that, unlike conventional MR and CT angiographic methods, can be used to evaluate capillary level tissue perfusion. These techniques can provide early, highly accurate delineation of ischemic tissue, allowing the underlying hemodynamic disturbances of disorders such as stroke and vasospasm to be further analyzed, as well as defining abnormal regions of blood pool in brain tumors. Because MR perfusion (MRP) and CT perfusion (CTP) imaging can assess physiologic parameters such as cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT), they offer additional data that can be useful in the detection and characterization of entities such as tumor, infection, inflammation, and infarction, which all can have similar appearances on both contrast and noncontrast enhanced conventional CT and MR images. They can also facilitate the further evaluation of processes such as early dementia, psychiatric illnesses, and migraine headaches, which may appear normal on routine CT and MR imaging. MRP and CTP might also be of value in distinguishing residual or recurrent tumor from treatment effects such as radiation-induced necrosis. This article reviews the background principles, scanning techniques, and clinical applications of noninvasive cerebral perfusion imaging.     

Deep pelvic endometriosis: don’t forget round ligaments. Review of anatomy,clinical characteristics,and MR imaging features

Deep infiltrating endometriosis is an important gynecologic disease that may develop during the reproductive years and is responsible for severe pelvic pain. Deep pelvic endometriosis can affect the retrocervical region, uterosacral ligament, rectum, rectovaginal septum, vagina, urinary tract, and other extraperitoneal pelvic sites. Surgery remains the best therapeutic treatment for affected patients and an accurate preoperative evaluation of the extension of endometriotic lesions is essential for a successful outcome. However, many atypical locations for deep pelvic endometriosis exist although still lesser known to both gynecologists and radiologists such as endometriosis of the round ligaments of the uterus (RLUs). In this article, we review embryology and anatomy of the RLUs as well clinical characteristics associated with these endometriotic locations. In addition, we describe magnetic resonance (MR) imaging protocol, normal MR imaging appearances of the RLUs and the most common abnormal findings of endometriotic involvement of these ligaments at MR imaging. Radiologists should always keep in mind the RLUs as a possible site of deep pelvic endometriosis localization and should not forget to carefully look for them on MR images.     

肝脏局灶性结节增生影像表现（附6例报告）

目的：通过回顾性总结7例临床病理确诊的肝脏局灶性结节增生的影像学表现,以期提高影像诊断的准确性,避免临床不必要的手术和有创的病理活检。材料与方法：收集我院手术或者病理活检临床确诊的7例共8个肝脏局灶性结节增生病灶的CT平扫,增强动脉期、门静脉期及平衡期图像以及MRI平扫、增强早期及增强晚期的图像。其中5例行CT及磁共振平扫及增强扫描,1例仅行磁共振平扫,对其影像学表现进行分析总结。结果：6例7个病灶,其中左叶2个病灶,右叶5个病灶。CT平扫病灶显示不清,增强动脉期表现为边界清晰车轮状明显强化结节,中心星芒状瘢痕强化不明显,门静脉期或延迟后病变逐渐为与邻近肝实质等密度结节,中心星芒状瘢痕延迟后明显强化,周边可见增粗迂曲的回流静脉血管影;MRIT1WI呈边界清晰的等信号或略低信号结节,中心星芒状瘢痕呈低信号;T2WI病灶为边界清晰的略高信号结节,中心条形或星芒状明显高信号影。增强T1WI脂肪抑制像表现和CT增强表现一致,早期轮辐状强化,延迟后呈等信号灶,中心瘢痕延迟后强化明显。结论：肝脏局灶性结节增生的CT和MRI表现具有一定的特征性,据此可以进行临床准确诊断,减少误诊。     

Celiac disease: MR enterography and contrast enhanced MRI

Magnetic resonance imaging of the gastrointestinal tract is gaining increasing clinical acceptance and is being increasingly used for the evaluation of patients with celiac disease. The purpose of this article is to describe the MR features of celiac disease and its complications. The MR signal appearances of the intraluminal, mural, and mesenteric abnormalities in celiac disease can help in the evaluation of patients. Radiologists, therefore, should be familiar with the MR findings of patients with celiac disease.     

MR imaging of the placenta: what a radiologist should know

Imaging of the placenta can have a profound impact on patient management, owing to the morbidity and mortality associated with various placental conditions. Placental conditions affecting the mother and fetus include molar pregnancies, placental hematoma, abruption, previa, accreta, vasa previa, chorioangioma, and retained products of conception. Although uncommon, abnormalities of the placenta are important to recognize owing to the potential for maternal and fetal morbidity and mortality. Sonography remains the first imaging modality for evaluation of the placenta. Magnetic resonance (MR) imaging has many unique properties that make it well-suited for imaging of the placenta: the multi-planar capabilities, the improved tissue contrast that can be obtained using a variety of pulse sequences and parameters and the lack of ionizing radiation; MR imaging can be of added diagnostic value when further characterization is required. In this article, we review the appearances and the role of MRI in diagnosis and management of these conditions. We present our clinical perspective on diagnosing these challenging problems with MRI and review the imaging findings that can lead to a correct diagnosis.