Masses of the tongue and floor of the mouth: findings on magnetic resonance imaging

The purpose of this study was to determine the value of MR imaging for the demonstration of masses in the tongue and floor of the mouth. Nine patients were prospectively examined with MR imaging after physical examination. Imaging protocol included T2 and contrast-enhanced and non-contrast-enhanced T1-weighted turbo spin-echo sequences, and the findings were compared with surgical and histopathological results. Histopathological examination revealed four squamous cell carcinomas, one adenoid cystic carcinoma, two tongue abscesses, and one chronic inflammatory change. The other case was diagnosed as hemangioma depending on clinical and imaging findings alone. In cases with squamous cell carcinoma, staging was done on the basis of MR imaging findings, and was found to be T4 in two cases, T3 in one case, and T2 in another. The primary role of MR imaging of the tongue and oropharynx is not to make a tissue diagnosis. Multiple deep biopsies are mandatory for the differentiation of other inflammatory and neoplastic lesions. Magnetic resonance imaging produces coronal and sagittal image planes to assess the volume and spread of the lesion and helps the surgeon determine the direction in which the biopsy should be performed. Received: 4 October 1999; Revised: 31 January 2000; Accepted: 6 April 2000     

Hypoplasia of the internal carotid artery: a noninvasive diagnosis

We present the characteristic imaging findings of hypoplasia of the internal carotid artery (ICA) in two cases, one accompanied by an intracranial aneurysm. Finding of a diffuse luminal narrowing of the ICA on MR angiography or digital subtraction angiography (DSA) could wrongly evoke severe acquired diseases such as dissection or atherosclerosis. Absence of associated wall thickening and flow disturbances on color Doppler sonography (CDS) should suggest carotid hypoplasia. Confirmation of the diagnosis is obtained by CT of the skull showing a small carotid canal. Non-invasive procedures are sufficient to differentiate this rare congenital anomaly from acquired string signs. Received: 25 October 1999; Revised: 27 January 2000; Accepted: 30 March 2000     

Fibrous pseudotumor of the epididymis: imaging and pathologic correlation

We report the case of a 25-year-old man who presented a fibrous pseudotumor of the epididymis, a rare focal location of nodular and diffuse fibrous proliferation. We provide the ultrasonographic and MRI findings with pathologic correlation. Received: 8 October 1999; Revised: 25 January 2000; Accepted: 1 February 2000     

Magnetic resonance imaging in the assessment of urologic disease: an all-in-one approach

The aim of this study was to evaluate an “all-in-one” MR procedure to examine the kidneys, the renal vascular supply and renal perfusion, and the urinary tract. In 64 patients (58 with urologic disease and 6 healthy volunteers), MR was performed including: (a) T1- and T2-weighted imaging; (b) 3D contrast-enhanced MR angiography (MRA), including the renal arteries, renal veins, as well as renal perfusion; and (c) 3D contrast-enhanced MR urography (MRU) in the coronal and sagittal plane. For the latter, low- and high-resolution images were compared. Prior to gadolinium injection, 0.1 mg/kg body weight of furosemide was administered intravenously. The results were compared with correlative imaging modalities (ultrasonography, intravenous urography, CT), ureterorenoscopy and/or surgical–pathologic findings. Visualization of the renal parenchyma, the vascular supply, and the collecting system was adequate in all cases, both in nondilated and in dilated systems and irrespective of the renal function. One infiltrating urothelial cancer was missed; there was one false-positive urothelial malignancy. Different MR techniques can be combined to establish an all-in-one imaging modality in the assessment of diseases which affect the kidneys and urinary tracts. Continuous refinement of the applied MR techniques and further improvements in spatial resolution is needed to expand the actual imaging possibilities and to create new tracts and challenges in the MR evaluation of urologic disease. Received: 27 September 1999; Revised: 20 January 2000; Accepted: 22 May 2000     

Hydatid disease with unusual localization

Hydatid disease (HD) may develop in almost any part of the body. The liver is the most frequently involved organ (75 %), followed by the lung (15 %) and the remainder of the body (10 %). Hydatid cysts with unusual localizations may cause serious problems in the differential diagnosis. In this article the various imaging findings of hydatid cysts with unusual localizations are reviewed, based on our experience. Findings in brain, heart, pericard, kidney, intraperitoneum, retroperitoneum, bone, soft tissue, and breast are discussed. Hydatid disease should be considered in the differential diagnosis of all cystic masses in all anatomic locations, especially when they occur in areas where the disease is endemic. The combination of clinical history, imaging findings, and serologic test results usually help the diagnosis. Received: 22 June 1999, Revised: 25 January 2000, Accepted: 29 March 2000     

MRI of the brain in cerebrotendinous xanthomatosis (van Bogaert-Scherer-Epstein disease)

The clinical, biochemical and magnetic resonance imaging findings of two patients with cerebrotendinous xanthomatosis are reported. This is a rare hereditary disease. Early recognition of this entity is important in view of the existing treatment possibilities. Magnetic resonance imaging findings typically include a bilateral and almost symmetrical increase of the signal intensity on the T2-weighted images in the cerebellar and periventricular cerebral white matter, the basal ganglia, the dentate nuclei and the brainstem as well as cerebellar and cerebral atrophy. Received: 18 January 1999; Revised: 3 June 1999; Accepted: 7 June 1999     

Angiosarcoma: unusual cause of acute abdominal pain and hemoperitoneum

Spontaneous rupture of primary angiosarcoma of the spleen is an uncommon cause of acute abdominal pain and hemoperitoneum. Clinical findings and presentation are nonspecific and variable. CT is frequently used as a first-line imaging modality in the evaluation of acute abdominal pain; however, findings are not specific for angiosarcoma. We report a case of primary splenic angiosarcoma with spontaneous rupture, hemoperitoneum, and hepatic metastases in a patient presenting to the emergency department with acute left upper quadrant pain and fever.     

Estimation of spleen volume using MR imaging and a random marking technique

The aim of this study was to apply a random marking volumetric technique in MR images for estimation of spleen volume. The MR imaging was performed in phantoms and 16 patients with indications unrelated to splenic disease. Images were transferred to a workstation to perform volumetric measurements using the random marking technique and the conventional technique of manual planimetry. Two observers independently measured splenic volume in order to evaluate reproducibility of both volumetric techniques. Phantom experiments revealed that the accuracy of the random marking technique and manual planimetry was approximately the same. In vivo splenic volume measurements derived from both volumetric techniques were highly correlated (r = 0.99, p < 0.0001). For both observers intraobserver variation was found to be lower with the random marking technique than with manual planimetry. Interobserver coefficient of variation using the manual planimetry was 4.6 % and was reduced to 2.9 % by adopting the random marking technique. The random marking technique was almost two times faster than the manual planimetry. The combination of the random marking technique with MR imaging might provide accurate, reproducible, quick splenic volume estimations. Received: 3 March 2000, Revised: 29 May 2000, Accepted: 30 May 2000     

Gleno-humeral instabilities

The purpose of this review is to highlight the most efficient imaging exploratory techniques depicting shoulder instability, to describe its various forms and to point out the findings which can simulate instability. In anterior recurrent dislocation, surgery is indicated and the procedure essentially depends on the importance of glenoid rim lesions. In this case, a standard X-ray evaluation is usually sufficient. The CT arthrography or MRI techniques give more specific details as to the severity of the lesions, particularly soft tissues alterations; however, these data do not alter standard therapeutic protocol. In fixed posterior dislocations, CT scan represents the most pertinent technique to evaluate the size of the humeral head defect and to determine the therapeutic follow-up. In subtle forms of instability, diagnosis or instability direction are not clearly assessed clinically and standard X-ray evaluation is usually unremarkable. In this case, further exploration, such as CT arthrography, MR imaging or MR arthrography, are recommended to confirm the diagnosis of instability and to evaluate its direction. The technique of choice is undoubtedly MR arthrography. Atraumatic voluntary painless subluxations associated with hyperlaxity of the shoulder do not require any specific exploratory method because the findings are generally limited to a capacious axillary pouch. Received: 28 September 1998; Revised: 21 January 1999; Accepted: 22 March 1999     

Unusual retrovesical masses in men

Retrovesical masses in men not related to prostatic carcinoma or hyperplasia is an uncommon pathology. Rare masses or unusual manifestations of those common diseases are a diagnostic dilemma. We review our experience in three unusual retrovesical masses in men: carcinosarcoma filling a giant bladder diverticulum; cystic prostatic carcinoma; and acquired cystic dilatation of the seminal vesicle associated with a prostatic carcinoma that obstructed and invaded the vesicle. We report the imaging findings and review the literature. In our experience, the imaging findings are usually not specific for doing a precise diagnosis and biopsy procedures are necessary. Received: 18 October 1999; Revised: 13 March 2000; Accepted: 16 March 2000     

Spontaneous thrombosis of a vein of Galen aneurysmal malformation: possible effects of contrast media

A 5-year-old boy with macrocephaly and mental retardation was referred for radiologic evaluation. After cranial CT and MR imaging, the diagnosis of mural type vein of Galen aneurysmal malformation was established by angiography. Two weeks later, preembolization angiography revealed complete thrombosis of the malformation. Although it is a very rare event, vein of Galen aneurysmal malformation may spontaneously thrombose following diagnostic angiography. Possible effects of contrast media on thrombosis were discussed. Received: 27 April 1999; Revised: 29 September 1999; Accepted: 28 January 2000     

Acute spontaneous spinal epidural haematoma in a child

Spontaneous spinal epidural haematomas rarely occur. Patients tend to be in their sixties or seventies. Acute spontaneous spinal epidural haematomas in children without a predisposition for bleeding disorders, trauma, vascular malformations or anticoagulant therapy have seldom been described. We present a case of a 4-year-old girl with a spontaneous cervical epidural haematoma diagnosed with MR. Received: 20 January 2000; Revised: 18 April 2000; Accepted: 19 April 2000     

Value of fluid-attenuated inversion recovery sequences in early MRI of the brain in neonates with a perinatal hypoxic-ischemic encephalopathy

The aim of our study was to assess the usefulness of fluid-attenuated inversion recovery (FLAIR) sequences in comparison with conventional spin-echo and inversion MR imaging in neonates for evaluation of myelination and for detection of hypoxic-ischemic brain injury. We reviewed early MR scans of 18 neonates with suspected hypoxic-ischemic brain damage. Myelination could be evaluated with confidence using conventional MR imaging in all but 2 infants; however, the presence of myelin was very difficult to assess on FLAIR images. Overall, 53 lesions or groups of lesions were identified. The FLAIR technique was more sensitive in 11 of the lesions; especially (pre)cystic lesions could be identified much better and more cysts were found. Conventional MR imaging failed to identify 2 of the lesions and was more sensitive in 14 of the lesions; especially punctate hemorrhages and lesions in basal ganglia or thalami could be better determined. The FLAIR technique missed 3 of these lesions. In the remaining 28 lesions conventional MR and FLAIR images were equally diagnostic. The FLAIR technique and conventional MR imaging are complementary in detecting early sequelae of hypoxic-ischemic brain injury in neonates. The FLAIR technique is not suitable for assessing myelination of the neonatal brain; therefore, FLAIR cannot replace conventional MR imaging. Received: 11 January 2000; Revised: 10 April 2000; Accepted: 10 April 2000     

Intracranial dural arteriovenous fistula with spinal medullary venous drainage

We report on a 46-year-old patient in whom an intracranial dural arteriovenous (AV) fistula, supplied by a branch of the ascending pharyngeal artery, drained into spinal veins and produced rapidly progressive symptoms of myelopathy and brainstem dysfunction including respiratory insufficiency. Magnetic resonance imaging studies demonstrated brainstem oedema and dilated veins of the brainstem and spinal cord. Endovascular embolization of the fistula led to good neurological recovery, although the patient had been paraplegic for 24 h prior to embolization. This case demonstrates the MRI characteristics of an intracranial dural AV fistula with spinal drainage and illustrates the importance of early diagnosis and treatment. Even paraplegia may be reversible, if angiography is performed and the fistula treated before ischaemic and gliotic changes become irreversible. Received: 25 May 1999; Revised: 25 January 2000; Accepted: 15 February 2000     

Vertebral sarcoidosis: imaging findings

Sarcoidosis is a multisystemic disease of unknown aetiology characterised by noncaseating granulomatous inflammation with varying presentation and prognosis. Osseous disease reported in 1–13 % of cases commonly involves hands and feet; however, vertebral sarcoidosis is rare. This report describes the radiologic, CT, MRI and radionuclide imaging findings of vertebral involvement of a case with sarcoidosis. Received: 28 January 1999; Revised: 14 April 1999; Accepted: 25 April 1999     

MR Imaging features of pelvic mucinous carcinomas

Mucinous carcinomas in the pelvis differ from non-mucinous tumors because of the differences in clinical outcome and imaging appearance. Mucinous rectal carcinomas, for example, are known to be higher in stage at the time of the diagnosis because they are more likely to be infiltrative and show a greater tendency for recurrence. These factors may lead to a poorer prognosis in patients with the mucinous as compared with non-mucinous carcinomas. Mucinous carcinomas of all types typically show high signal intensity on T2-weighted MR images, and therefore mimic other conditions such as necrotic tumors, fluid collections, cysts, or liver hemangiomas. To familiarize readers with the MRI appearance, and to avoid pitfalls, this paper illustrates the MRI features of the mucinous adenocarcinomas in various pelvic organs. Received: 8 February 1999; Revised: 7 October 1999; Accepted: 10 January 2000     

Chronic nontraumatic spinal epidural hematoma of the lumbar spine: MRI diagnosis

An uncommon case of chronic nontraumatic spinal epidural hematoma of the lumbar spine in a 75-year-old woman is reported. The patient presented with a 7-month history of low back pain and bilateral sciatica. Magnetic resonance imaging enabled a correct preoperative diagnosis revealing a nodular, well-circumscribed epidural mass with peripheral enhancement and signal intensities consistent with chronic hematoma, which extended from L2 to L3. Laminectomy of L2–L3 was performed and the hematoma was totally resected. Histological examination of the surgical specimen demonstrated a chronic encapsulated hematoma. No evidence of vascular malformation was found. The patient recovered fully after surgical treatment. Received: 23 August 1999; Revised: 13 January 2000; Accepted: 4 February 2000     

Safety of colon contrast material in (helical) CT examination of patients with suspected diverticulitis

Purpose: Today patients with suspected diverticulitis are commonly imaged with a CT scan utilizing a variety of methods of contrast medium administration. Although CT with rectally administered colon contrast has demonstrated a high diagnostic accuracy, concerns have been raised over its safety in patients with diverticulitis. The following retrospective investigation was undertaken to answer this concern. Materials and methods: Between January, 1997, and July, 1999, 308 patients with suspected diverticulitis were examined in the Emergency Radiology Division of the Massachusetts General Hospital by means of a helical CT scan performed with rectally administered colon contrast material. The patients' CT findings were correlated with their clinical courses and/or surgical findings. Results: Of the 308 CT scans, 115 (37.3 %) were positive for diverticulitis. Of 193 patients without diverticulitis, 91 (47.1 % of patients without diverticulitis) had alternative diagnoses made by CT, such as small bowel obstruction, epiploic appendagitis, and urinary tract calculi. No complications due to colon contrast material were noted. Even in cases where there was free extraluminal air, no extravasated contrast material was seen. Rectally administered colon contrast was well tolerated by patients and provided excellent large bowel opacification. This method saved imaging time in an emergency setting, as there was no need to wait for oral contrast to reach the colon. Conclusion: Out of 308 CT scans, there were no complications from the use of rectally administered colon contrast material. No case of traumatic bowel perforation secondary to colon contrast material was observed. Rectally administered colon contrast material is safe in the CT examination of patients with suspected diverticulitis.     

Computed tomographic high-attenuation mediastinal lymph nodes after aluminum exposition

A case with increased computed tomographic densities of mediastinal lymph nodes with histologically proven aluminum storage is presented. We suggest consideration of aluminosis as differential diagnosis in patients with increased native CT densities beyond 50 HU. Received: 20 January 2000; Revised: 18 May 2000; Accepted: 22 May 2000     

Three-dimensional contrast-enhanced MRI using an intravascular contrast agent for detection of traumatic intra-abdominal hemorrhage and abdominal parenchymal injuries: an experimental study

The aim of this study was to compare the performance of 3D MRI in conjunction with an intravascular contrast agent to spiral contrast-enhanced CT, regarding the detection of abdominal parenchymal injuries as well as peritoneal hemorrhage in an animal model. Liver and kidney injuries were created surgically in six female pigs under general anesthesia. All pigs underwent contrast-enhanced spiral CT and 3D MR imaging following administration of an intravascular contrast agent (NC100150 Injection). Two readers rated their confidence independently on MR and CT data sets using a five-point scale for the presence of organ injury and hemoperitoneum. Autopsy findings served as standard of reference. Sensitivity and specificity for MR in detecting hepatic and renal injuries as well as hemoperitoneum was 100 %. Computed tomography was less accurate with sensitivity and specificity values of 90 and 94 %, respectively. Receiver operating characteristics (ROC) analysis revealed a higher confidence when interpretation was based on MR images. In an animal model 3D MR imaging in conjunction with an intravascular contrast agent proved highly accurate in detecting and localizing parenchymal injuries to the upper abdomen as well as in detecting intraperitoneal blood collections. Received: 4 November 1999, Revised: 5 May 2000, Accepted: 9 May 2000