Value of contrast enhanced spoiled gradient (SPGR) MR and MIP MR imaging in diagnosis of peri-anal fistula

Purpose

To assess the value of the combination of contrast enhanced T1 spoiled gradient (SPGR) MR and maximum intensity projection (MIP) MR imaging in the complete pre-operative evaluation of peri-anal fistula.

Patients and methods

This prospective study contained 28 patients with clinical diagnosis of peri-anal fistula, they were performed MRI using the following sequences in both axial and coronal planes: Pre contrast T2FSE, T1FSE and Post contrast SPGR. MIP reformated images were done using the SPGR sequence. Fistulas were classified according to Parks (6) classification, they were evaluated regarding site, type, extensions, complications and diagnostic accuracy of each sequence. Our findings were correlated with operative findings.

Results

Fourteen patients had inter-sphincteric fistulas (50%), 8 patients had trans-sphincteric fistulas (28.6%) and 6 patients had supra-sphincteric fistulas (21.4%). Simple non branching tracts were found in 22 patients, branching tracts in 6 patients, abscess cavity in 5 patients, horseshoe extension in 4 patients. Overall diagnostic accuracy of post contrast T1 SPGR was 97.3% and MIP MR imaging was 100%. Post contrast T1 SPGR accurately evaluated all patients but missed one faint horseshoe extension and other fine para anal branches. MIP imaging accurately evaluated all the extensions and ramifications but was poor in depth orientation.

Conclusion

MRI is a reliable diagnostic modality in the evaluation of peri-anal fistulas. Post contrast T1 SPGR sequence with its high resolution images and excellent anatomical orientation provides almost all the necessary details for accurate evaluation. Although MIP images lack depth orientation their high sensitivity, rotational 2D and 3D capabilities exquisitely depict all the fine ramifications and extensions. The combination of both provides complete evaluation and highest possible diagnostic accuracy aiding successful surgical interventions, aiming to reduce complications and recurrences.     

MR findings of Rosai-Dorfman disease in sellar and suprasellar region

Background

Rosai–Dorfman disease (RDD) in sellar/suprasellar region is a rare intracranial disorder. The diagnostic evaluation of this condition using magnetic resonance imaging (MRI) has seldom been described previously. The purpose of our study was to describe MRI characteristics of sellar/suprasellar region RDD.

Methods

Five patients with proved sellar/suprasellar region RDD from May 2005 to March 2010 were retrospectively reviewed. All the patients had undergone magnetic resonance scanning. The number, location, signal intensity (SI), and enhancement pattern of the lesions on MRI were retrospectively evaluated.

Results

Pathological diagnosis of RDD was achieved in all 5 cases including 4 by surgery and 1 by biopsy. The most common presenting symptoms were headache (n = 4) and blurred vision (n = 3). On MRI, isolated suprasellar lesion was found in 2 cases. Suprasellar lesion combined with intrasellar, dural, intra-axial and orbital lesions was found in 3 cases. All lesions showed homogeneous isointense SI on T1-weighted images and hypointense to isointense SI on T2-weighted images except one lesion in the midbrain with slight hyperintense SI on T2-weighted images. All lesions showed homogeneous enhancement.

Conclusion

Homogenously enhancing sellar/suprasellar masses of hypointense to isointense SI on T2-weighted images are suggestive of RDD, and central hypointensity on T2-weighted images may be a specific finding. Intra-axial and extra-axial involvements may coexist with sellar/suprasellar region RDD. Although radiological findings can provide some evidence for this rare entity, differential diagnosis is still needed.     

MRI findings in 6 cases of children by inadvertent ingestion of diphenoxylate-atropine

Purpose

Compound diphenoxylate (diphenoxylate-atropine) poisoning can cause toxic encephalopathy in children, and magnetic resonance imaging (MRI) of the brain in this condition has not been reported. This study is to analyze brain MRI findings and to investigate the relations between MRI features and possible pathophysiological changes in children.

Methods

Six children accidentally swallowed compound diphenoxylate, 4 males, 2 females, aged 20-46 months, average 33 months. Quantity of ingested diphenoxylate-atropine was from 6 to 30 tablets, each tablet contains diphenoxylate 2.5 mg and atropine 0.025 mg. These patients were referred to our hospital within 24 h after diphenoxylate-atropine ingestion, and underwent brain MRI scan within 24-72 h after emergency treatment. The characteristics of conventional MRI were analyzed.

Results

These pediatric patients had various symptoms of opioid intoxication and atropine toxicity. Brain MRI showed abnormal low signal intensity on T1-weighted images (T1WI) and abnormal high signal intensity on T2-weighted images (T2WI) and fluid-attenuated inversion recovery (FLAIR) imaging in bilateral in all cases; abnormal high signal intensity on T1WI, T2WI and FLAIR in 4 cases. Encephalomalacia was observed in 3 cases during follow-up.

Conclusion

In the early stage of compound diphenoxylate poisoning in children, multiple extensive edema-necrosis and hemorrhagic-necrosis focus were observed in basic nucleus, pallium and cerebellum, these resulted in the corresponding brain dysfunction with encephalomalacia. MRI scan in the early stage in this condition may provide evidences of brain impairment, and is beneficial for the early diagnosis, treatment and prognosis assessment.     

MRI of rectal carcinoma: Preoperative staging and planning of sphincter-sparing surgery

Background

Rectal cancer constitutes about one-third of all gastrointestinal tract tumors. Because of its high recurrence rates reaching 30%, it is vitally important to accurately stage these tumors preoperatively, so that appropriate surgical resection can be undertaken. MRI is used to assist in staging, identifying patients who may benefit from preoperative chemotherapy–radiation therapy, and in surgical planning.

Aim

To determine the accuracy of MRI in the preoperative staging and planning of surgical management of rectal carcinoma.

Subjects and methods

Twenty-five patients (14 males, 11 females) with rectal carcinoma were included in this study. MRI scans were performed prior to surgery in all patients, on a 1.5T scanner, and images were evaluated by three experienced radiologists. Inter-observer agreement between the three radiologists and the correlation between the imaging findings, histopathology and operative findings were evaluated.

Results

MRI findings were correctly predictive of T category in 21 cases (accuracy, 84%). In 19 (86.4%) of the 22 resectable cases, sphincter-sparing surgical approaches were accurately chosen on the basis of MRI findings.

Conclusion

MRI of rectal cancer is accurate for prediction of tumor stage and the feasibility of sphincter-sparing surgery, which are the main factors affecting the outcome of surgery.     

Hepatic iron deposition in patients with sickle cell disease: Role of breath-hold multiecho T2-weighted MRI sequence

Introduction

The purpose of this study is to detect the role of breath-hold multiecho T2^∗-weighted MRI, in quantification of hepatic iron deposition in patients with sickle cell disease.

Methods

Thirty-seven patients underwent 1.5-T MRI of the liver that included a multiecho T2^∗-weighted sequence. Hepatic T2^∗ iron grading was done for each patient by placing regions of interest in the hepatic parenchyma. Hepatic T2^∗ values were correlated with histopathological iron grade. Liver biopsy was done for all patients. Written consent was obtained from all patients prior to MRI studies.

Results

Thirty-two patients (86.5 %) had evidence of hepatic iron deposition on histopathological examination, including eight (25%) with grade 3, eleven (34%) with grade 2 and thirteen patients (41%) with grade 1.Patients with negative iron deposition histologically, had T2^∗ values ranging from 28–32 ms. For the patients with positive hepatic iron deposition, hepatic T2^∗ decreased with increasing iron grade.Statistical analysis showed that for differentiation of hepatic iron deposition grade 3 from grades 1 and 2, hepatic T2^∗ less than 13 ms had a sensitivity and specificity of 100 % and 98%, respectively.

Conclusion

Breath-hold multiecho T2^∗-weighted MRI sequence offers an accurate estimation of hepatic iron deposition.     

Characterization of carotid atherosclerosis with black-blood carotid plaque imaging using variable flip-angle 3D turbo spin-echo: comparison with 2D turbo spin-echo sequences

Purpose

To compare the diagnostic performance of three-dimensional variable-flip-angle turbo spin-echo and two-dimensional turbo spin-echo sequences in carotid plaque imaging, with histological analysis as the standard of reference.

Materials and methods

Twenty-two patients scheduled for carotid endarterectomy underwent carotid plaque imaging including axial T1-weighted and T2-weighted two-dimensional turbo spin-echo, and coronal T1-weighted and T2-weighted three-dimensional variable-flip-angle turbo spin-echo sequences. The quality of images was visually graded using a three-point scale. The signal ratio of the arterial lumen to the plaque component, and that of the carotid plaque to the ipsilateral submandibular gland was calculated in each sequence. These ratios between two-dimensional and three-dimensional sequences were compared for each plaque component according to the histological category of the plaque.

Results

No significant difference was observed among the overall imaging quality scores of the two-dimensional and three-dimensional sequences, although three-dimensional sequences allowed visualization in arbitrary orientations, as well as depiction of small plaque components such as ulcerations and calcifications. The signal ratio of the plaque to the submandibular gland on T1-weighted three-dimensional sequence was significantly higher than that on two-dimensional sequence (p < 0.01), whereas no significant difference was found between two T2-weighted sequences.The signal ratios of the plaque to the submandibular gland of histology-defined soft plaque components were significantly higher on T1-weighted three-dimensional sequence than on two-dimensional sequence (p < 0.01), whereas no significant differences were observed between two T1-weighted sequences for hard components.

Conclusions

Three-dimensional variable-flip-angle turbo spin-echo is a promising tool for the diagnosis of carotid plaques.     

Detecting lesions in multiple sclerosis at 4.7 tesla using phase susceptibility‐weighting and T2‐weighting

Purpose

To demonstrate 4.7 Tesla (T) imaging methods for visualizing lesions in multiple sclerosis in the human brain using phase susceptibility‐weighting and T2 weighting.

Materials and Methods

Seven patients with relapsing‐remitting multiple sclerosis were imaged at 4.7T using three‐dimensional (3D) susceptibility‐weighted imaging (SWI) with 0.90 mm³ voxel volumes, and with 2D T2‐weighted fast spin echo (T2WFSE) with 0.34 mm³ voxels and 1.84 mm³ voxels. The visibility of MS lesions at 4.7T with phase SWI and T2WFSE was assessed by independent lesion counts made by an experienced neuroradiologist, and by quantitative measures.

Results

High resolution T2WFSE at 4.7T provided excellent depiction of hyperintense lesions. When combined with phase SWI, 124 total lesions were identified of which 18% were only visible on phase SWI and not on T2WFSE. The phase lesions had a mean phase shift relative to local background of ?11.15 ± 5.97 parts per billion.

Conclusion

Imaging at 4.7T can provide both high quality, high resolution T2WFSE and SWI for visualization of lesions in multiple sclerosis. Phase susceptibility‐weighting can identify additional lesions that are not visible with high resolution T2WFSE. J. Magn. Reson. Imaging 2009;30:737–742. © 2009 Wiley‐Liss, Inc.

     

MRI of persistent cloaca: Can it substitute conventional imaging?

Purpose

To define the role of MRI in the preoperative assessment of patients with persistent cloaca and whether it can substitute other imaging modalities.

Methods

We prospectively examined eleven patients with persistent cloaca between July 2007 and March 2012. Non contrast MRI examinations were performed on 1.5 T magnet using head coil. Multiple pulse sequences (T1WI, T2WI, fat suppression) were obtained in axial, sagittal and coronal planes of the pelvis, abdomen, and spine. The scans were reviewed for the following: the level and type of rectal termination, the developmental state of striated muscle complex (SMC), associated genitourinary and spinal anomalies. MRI findings were compared to conventional fluoroscopic imaging, operative and endoscopic findings. We applied novel MRI parameters (urethral length, relative hiatal distance and vaginal volume). The relation between different parameters was tested statistically using Pearson correlation test.

Results

MRI could accurately demonstrate the level of bowel termination in patients with persistent cloaca, in addition to its high sensitivity for detection of mullerian anomalies which were present in 73% of patients. Furthermore, MRI could disclose associating renal and spinal anomalies, and assess the developmental state of SMC.The shorter the urethra (higher urogenital confluence), the narrower the pelvic hiatus, and the more was the obstruction (vaginal distension).

Conclusion

MRI is a valuable tool in exploring the different internal anatomical features of the cloacal anomaly; and when combined with endoscopy, MRI can make other preoperative conventional imaging unnecessary.     

T1rho MRI of menisci and cartilage in patients with osteoarthritis at 3T

Objective

To assess and compare subregional and whole T1rho values (median ± interquartile range) of femorotibial cartilage and menisci in patients with doubtful (Kellgren–Lawrence (KL) grade 1) to severe (KL4) osteoarthritis (OA) at 3T.

Materials and methods

30 subjects with varying degrees of OA (KL1–4, 13 females, 17 males, mean age ± SD = 63.9 ± 13.1 years) were evaluated on a 3T MR scanner using a spin-lock-based 3D GRE sequence for T1rho mapping. Clinical proton density (PD)-weighted fast spin echo (FSE) images in sagittal (without fat saturation), axial, and coronal (fat-saturated) planes were acquired for cartilage and meniscus Whole-organ MR imaging score (WORMS) grading. Wilcoxon rank sum test was performed to determine whether there were any statistically significant differences between subregional and whole T1rho values of femorotibial cartilage and menisci in subjects with doubtful to severe OA.

Results

Lateral (72 ± 10 ms, median ± interquartile range) and medial (65 ± 10 ms) femoral anterior cartilage subregions in moderate–severe OA subjects had significantly higher T1rho values (P < 0.05) than cartilage subregions and whole femorotibial cartilage in doubtful–minimal OA subjects. There were statistically significant differences in meniscus T1rho values of the medial posterior subregion of subjects with moderate–severe OA and T1rho values of all subregions and the whole meniscus in subjects with doubtful–minimal OA. When evaluated based on WORMS, statistically significant differences were identified in T1rho values between the lateral femoral anterior cartilage subregion in patients with WORMS5–6 (advanced degeneration) and whole femorotibial cartilage and all cartilage subregions in patients with WORMS0–1 (normal).

Conclusion

T1rho values are higher in specific meniscus and femorotibial cartilage subregions. These findings suggest that regional damage of both femorotibial hyaline cartilage and menisci may be associated with osteoarthritis.     

MRI T2 mapping of the asymptomatic supraspinatus tendon by age and imaging plane using clinically relevant subregions

Purpose

Diagnosis of partial rotator cuff tears and tendonopathy using conventional MRI has proven variable. Quantitative T2 mapping may have application for assessing rotator cuff health. In order to evaluate the usefulness of T2 mapping for the rotator cuff, methods must be refined for mapping the supraspinatus tendon, and normative T2 values must first be acquired.

Materials and methods

This study was IRB approved. Thirty asymptomatic volunteers (age: 18–62) were evaluated with sagittal and coronal T2 mapping sequences. Manual segmentation of tendon and muscle as a unit and tendon alone was performed twice by two independent raters. Segmentations were divided into medial, middle and lateral subregions and mean T2 values calculated.

Results

Anatomic comparison of mean T2 values illustrated highest values in the medial region, lowest values in the lateral region, and intermediate values for the middle region upon coronal segmentation (p < 0.001). In sagittal segmentations, there were higher values in the medial region and no significant differences between the lateral and middle subregions. No significant differences were found with comparison across age groups. Inter and intra-rater segmentation repeatability was excellent, with coefficients ranging from 0.85 to 0.99.

Conclusion

T2 mapping illustrated anatomic variation along the supraspinatus muscle-tendon unit with low standard deviations and excellent repeatability, suggesting that changes in structure due to degeneration or changes associated with healing after repair may be detectable.     

H proton MR spectroscopy and diffusion-weighted imaging in discrimination between pyogenic brain abscesses and necrotic brain tumors

Background

Differentiation between cerebral abscesses and necrotic brain tumors showing ring enhancement can be confusing at times by conventional MRI. The introduction of advanced imaging techniques, such as MR spectroscopy and diffusion WI, have contributed to the differentiation.The purpose of this study is to test the hypothesis that MR spectroscopy and diffusion weighted can be used to differentiate between necrotizing or cystic brain tumor and brain abscesses.

Methods

The study was conducted on 45 patients (necrotic or cystic tumor (30 cases); brain abscess (15 cases) showing ring-shaped contrast enhancement on conventional MRI. 1.5-T ¹H-MR Spectroscopy and diffusion WI were performed and the results were ensured by stereotactic biopsy or aspiration procedures in surgically indicated cases and/or follow up.

Results

14 patients (out of 15) with pyogenic abscess had lactate, amino acids, and acetate peaks; Succinate peak is seen as extra peak in three of these patients, and lipid peaks are also seen as extra peaks in 3 patients. One patient with brain stem abscess after 20 days treatment by antibiotics shows only lactate and lipid peaks. 2 of them show mild increase in choline with decrease in NAA (brain tissue contamination).17 out of 30 patients with cystic or necrotic tumor showed only lactate peak in MRS. While 13 patients show lactate and lipid peaks, four of them show additional high choline peak with low NAA and creatine peak (contamination with brain tissue).The results were confirmed by Sterotactic biopsy in 27 cases and aspiration in 13 cases and follow up for all cases.The sensitivity, specificity, PPV, NPV and overall accuracy of diffusion and MRS were 88%, 100%, 100%, 93.3% and 95.5% respectively.

Conclusion

¹H-MRS and diffusion WI are fast, easy to perform, noninvasive, and provide additional information that can accurately differentiate between necrotic/cystic tumors and cerebral abscesses.     

Treatment of hepatocellular carcinoma adjacent to large blood vessels using 1.5T MRI-guided percutaneous radiofrequency ablation combined with iodine-125 radioactive seed implantation

Objective

The objective is to study the technology associated with and feasibility of the treatment of hepatocellular carcinoma (HCC) adjacent to large blood vessels using 1.5T MRI-guided radiofrequency ablation combined with iodine-125 (I-125) radioactive seed implantation.

Methods

Sixteen patients with a total of 24 HCC lesions (average maximum diameter: 2.35 ± 1.03 cm) were pathologically confirmed by biopsy or clinically diagnosed received 1.5T MRI-guided percutaneous radiofrequency ablation (RFA) treatment. Each patient had one lesion adjacent to large blood vessels (≥3 mm); after the ablation, I-125 radioactive seeds were implanted in the portions of the lesions that were adjacent to the blood vessels.

Results

All the ablations and I-125 radioactive seed implantations were successful; a total of 118 seeds were implanted. The ablated lesions exhibited hypointense signals on the T2WI sequence with a thin rim of hyperintense signals; they also exhibited significant hyperintense signals on the T1WI sequence with clear boundaries. The average follow-up period was 11.1 ± 6.2 months. There were 23 complete responses and one partial response in the 24 lesions. The alpha-fetoprotein (AFP) levels of the patients significantly decreased.

Conclusion

The 1.5T MRI-guided RFA combined with I-125 radioactive seed implantation for the treatment of HCC adjacent to large blood vessels is an effective technology.     

MRI as complementary tool added to ultrasound in the diagnosis of fetal renal abnormalities – any added value?

Purpose

To assess the potential role of magnetic resonance imaging (MRI) as a complementary diagnostic tool to ultrasonography (US) in the diagnosis of fetal renal anomalies in pregnant women with oligohydramnios in the absence of amniotic membrane rupture.

Methods

Ninety pregnant women, with oligohydramnios were prospectively evaluated using both US and MRI. Prenatal findings were correlated with the babies’ outcome.

Results

MRI studies of diagnostic quality were obtained in all fetuses. The US and MRI findings were concordant in 79 (87.8%) of the fetuses. MRI modified and changed the diagnosis in 11 fetuses (12.2%), these were five fetuses in which US diagnosis was inconclusive, five cases in which the diagnosis changed from bilateral renal agenesis to unilateral agenesis with the other kidney multicystic dysplastic kidney (MCDK), and in the remaining fetuses the modification was from bilateral renal agenesis to unilateral agenesis with the other kidney structurally normal.Concordant findings for the prenatal US and MRI scans were seen in 100% of the autosomal recessive polycystic kidney disease (APCKD), 96% of MCDK, and 92.9% of bilateral normal kidneys.

Conclusion

MRI is of value in cases of oligohydramnios in limited circumstance when US findings were inconclusive.     

Dynamic magnetic resonance angiography for localization of hyperfunctioning parathyroid glands in the reoperative neck

Objectives

To evaluate the use of dynamic magnetic resonance angiography for localization of hyperfunctioning parathyroid glands in the reoperative neck.

Methods

We retrospectively evaluated the head-neck MRIs of 30 patients with a history of hyperparathyroidism, prior head-neck surgery, and intraoperative proven adenomas. The protocol included conventional imaging with T2-weighted STIR sequences, T1w axial and coronal prior to and after contrast media administration, and dynamic magnetic resonance angiography. We compared the results from MRI, dynamic magnetic resonance angiography with 99m-Tc-Sestamibi with intraoperative findings as the gold standard.

Results

In conventional MRI 19/30 true positives were detected with a sensitivity and specificity of 63.3% and 100%, respectively. However, by adding dynamic magnetic resonance angiography the detection rate increased to 28/30 true positives. Based on intraoperative findings, the sensitivity and specificity of dynamic magnetic resonance angiography were 93.3% and 100%, respectively. 99m-Tc-Sestamibi detected 24/30 true positives, sensitivity was 80%.

Conclusion

The diagnostic value of MRI including dynamic magnetic resonance angiography is superior to MRI alone and superior to that of 99m-Tc-Sestamibi in the diagnostic workup of hyperfunctioning parathyroid glands when compared against intraoperative findings.     

Role of dynamic contrast-enhanced and diffusion weighted MRI in evaluation of necrosis of hepatocellular carcinoma after chemoembolization

Purpose

The purpose of this study is to evaluate the role of dynamic contrast enhanced and diffusion weighted MRI in the assessment of response and necrosis in the treatment of hepatocelluar carcinoma after transcatheter arterial chemoembolization (TACE).

Subjects and methods

Precontrast T1, T2, STIR, Dynamic contrast enhanced and respiratory triggered diffusion weighted MR images (b factor, 500, 1000 s/mm² obtained in 50 patients with hepatocellular carcinoma who underwent transarterial hepatic chemoembolization). Diffusion-weighted MR images, gadolinium-enhanced MR images after TACE were assigned confidence levels for postoperative HCC recurrence. The sensitivity, specificity, PPV, NPV and overall agreement were calculated for both the dynamic and the DWI images. Apparent diffusion coefficients (ADCs) were calculated searching for a cut off value using the ROC curve.

Results

Dynamic MRI had a sensitivity of 90.5%, a specificity of 96.6%, a positive predictive value of 95%, a negative predictive value of 93.3% and an overall agreement of 94% compared to 100%, 65.5%, 67.7%, 100% and 80% respectively of diffusion weighted imaging.The difference between the malignant and benign groups’ ADC variables was statistically significant P value 0.006.The ROC curve showed that the area under the curve is C = 0.728 with SE = 0.075 and 95% CI from 0.582 to 0.874.

Conclusion

Diffusion weighted MR imaging has lower specificity compared to dynamic MRI with increased false positives. We suggest that increase is due to intralesional hemorrhage or liquefactive necrosis causing diffusion restriction. Diffusion weighted imaging may act as a supplementary sequence to compensate the dynamic MRI in patients who could not hold their breath adequately.     

Magnetic resonance imaging evaluation of perianal fistula

Aim of work

To clarify the role of MRI in diagnosis and classification of perianal fistula and to evaluate the additional clinical value of preoperative MR imaging and its benefit to surgeon.

Methods

This prospective study contained 25 patients (21 males and 4 females; age range 10–60 years; mean age 34.8 years) selected from 40 patients referred to the Radiodiagnosis department with perianal sepsis, the study was conducted between October 2009 and September 2011, MRIs were performed and the results were ensured by surgical results, sensitivity, specificity and predictive values of MRIs were determined.

Results

25 patients with perianal sepsis were included in this study, 3 cases grade 1 (simple linear intersphincteric fistula), 2 cases grade 2 (intersphincteric fistula with abscess or secondary track), 9 cases grade 3 (trans-sphincteric fistula), 9 cases grade 4 (trans-sphincteric fistula with abscess (5 cases), secondary track within the ischiorectal fossa (3 cases) and both (1 case)) and 2 cases grade 5 (supralevator and translevator disease one case for each).

Conclusion

MRI is a useful procedure for successful management of peri-anal fistula by correct assessment of the extent of disease and relationship to sphincter complex. Also it helps in identification of secondary extensions, particularly horseshoe tracts and abscesses resulting in complete evaluation and highest possible diagnostic accuracy aiding successful surgical interventions, aiming to reduce complications and recurrences.     

T2 mapping in patellar chondromalacia

Objective

To study the correlation between the T2 relaxation times of the patellar cartilage and morphological MRI findings of chondromalacia.

Methods

This prospective study comprises 50 patients, 27 men and 23 women suffering of anterior knee pain (mean age: 29.7, SD 8.3 years; range: 16–45 years).MRI of 97 knees were performed in these patients at 1.5 T magnet including sagittal T1, coronal intermediate, axial intermediate fat sat and T2 mapping. Chondromalacia was assessed using a modified version of Noyes classification. The relaxation time, T2, was studied segmenting the full thickness of the patellar cartilage in 12 areas: 4 proximal (external facet–proximal–lateral (EPL), external facet–proximal–central (EPC), internal facet–proximal–central (IPC), internal facet–proximal–medial (IPM), 4 in the middle section (external facet–middle–lateral (EML), external facet–middle–central (EMC), internal facet–middle–central (IMC), internal facet–middle–medial (IMM) and 4 distal (external facet–distal–lateral (EDL), external facet–distal–central (EDC), internal facet–distal–central (IDC), internal facet–distal–medial (IDM).

Results

T2 values showed a significant increase in mild chondromalacia regarding normal cartilage in most of the cartilage areas (p < 0.05), except in the internal distal facet (IDC and IDM), EPC, EDL, and IMM. Severe chondromalacia was characterized by a fall of T2 relaxation times with loss of statistical significant differences in comparison with normal cartilage, except in EMC and IMC, where similar values as mild chondromalacia were maintained (p < 0.05).

Conclusions

Steepest increase in T2 values of patellar cartilage occurs in early stages of patellar cartilage degeneration. Progression of morphologic changes of chondromalacia to more severe degrees is associated to a new drop of T2 relaxation times approaching basal values in most of the areas of the patellar cartilage, except in the central area of the middle section, where T2 values remain increased.     

Assessment of cartilage repair after chondrocyte transplantation with a fibrin-hyaluronan matrix--correlation of morphological MRI, biochemical T2 mapping and clinical outcome

Objective

To evaluate change over time of clinical scores, morphological MRI of cartilage appearance and quantitative T2 values after implantation with BioCart™II, a second generation matrix-assisted implantation system.

Methods

Thirty-one patients were recruited 6–49 months post surgery for cartilage defect in the femoral condyle. Subjects underwent MRI (morphological and T2-mapping sequences) and completed the International Knee Documentation Committee (IKDC) questionnaire. MRI scans were scored using the MR Observation of Cartilage Repair Tissue (MOCART) system and cartilage T2-mapping values were registered.Analysis included correlation of IKDC scores, MOCART and T2 evaluation with each other, with implant age and with previous surgical intervention history.

Results

IKDC score significantly correlated with MOCART score (r = −0.39, p = 0.031), inversely correlated with previous interventions (r = −0.39, p = 0.034) and was significantly higher in patients with longer follow-up time (p = 0.0028).MOCART score was slight, but not significantly higher in patients with longer term implants (p = 0.199).T2 values were significantly lower in patients with longer duration implants (p < 0.001). This trend was repeated in patients with previous interventions, although to a lesser extent.

Conclusions

Significant improvement with time from BioCart™II implantation can be expected by IKDC scoring and MRI T2-mapping values. Patients with previous knee operations can also benefit from this procedure.     

The role of MRI in the evaluation of muscle diseases

The aim of the work

To assess the role of MRI in the early detection and evaluation of some muscle diseases and its prognostic value for the follow up.

Patients and methods

The study is carried out on 40 patients (20 males and 20 females) suffering from different muscle diseases and 8 control group patients (4 males and 4 females); 27.5% are below 20 years of age, 35% are between 21 and 40 years and 37.5% are above 40. A conventional MRI study is performed on all patients; to study the value of qualitative, semi-quantitative and quantitative analyses for the estimation of full disease extent and the follow up. The Spearman correlation coefficient model is used to correlate the semi-quantitative MR imaging grade and clinical assessments. Proton MRS is also performed to quantify the key intra-myocellular metabolites.

Results

Calf muscles (gastrocnemius and soleus) and gluteus maximus muscle had the highest T2 values. The mean T2 values and semiquantitative MR imaging grade of fatty infiltration and edema show a significant correlation with the clinical grading of muscle power.

Conclusion

MRI is a useful tool for assessing muscle diseases particularly with the implementation of the up to date analytic methods.     

The role of MRI in the diagnosis of endometriosis

Aim

The aim of this study is to evaluate the accuracy of the magnetic resonance imaging in diagnosis of endometriosis especially in non-apparent types as tubal and cul de sac endometriosis.

Patients and methods

MRI obtained between January 2007 and June 2009 for 34 premenopausal women complaining of dysmenorrhea, menorrhagia and infertility and the diagnosis of endometriosis were included in the differential diagnosis. T1 weighted fat saturated and T2 weighted images were done for every patient, we evaluated the MR images for the presence of T1 bright signal suggesting endometriosis. Transvaginal US was performed in two perpendicular planes for the detection of focal areas with ill defined borders or abnormal echo texture. Suspicious cases which become negative by laparoscopy were excluded from the study.

Results

MRI diagnosed endometriosis in the uterus in 18 patients, ovarian endometriosis in 13 patients, tubal in two patients, and cul de sac in one patient.

Conclusion

It is concluded that MRI is superior in the diagnosis of endometriosis than transvaginal ultrasound.