Bilateral retinal detachment in a patient with Vogt–Koyanagi–Harada syndrome

We present a 38-year-old woman with bilateral serous retinal detachments and bilateral panuveitis on fundoscopic exam. CT of the orbits and MRI scans revealed bilateral ocular choroidal thickening and bilateral retinal detachments; however, no other CNS or meningeal lesion was detected. This patient met the clinical criteria for Vogt–Koyanagi–Harada (VKH) Syndrome. Review of VKH syndrome as well as the radiographic findings will be discussed.     

Paired inspiratory–expiratory thin-section CT findings in patients with small airway disease

The objective of this study was to evaluate minimal small airway disease (SAD) as reflected on paired inspiratory–expiratory CT findings. Seventy-two subjects, 34 with SAD, 11 with normal lung function, and 27 with chronic obstructive pulmonary diseases (COPD), underwent thin-section CT during deep inspiration and expiration at upper, middle, and lower lung levels. Evaluation of CT measurement was performed between inspiratory and expiratory CT attenuation of lung parenchyma, in non-dependent and dependent lung at each of the three levels. Visual assessment of mosaic patterns and attenuation differences was also performed using the inspiratory and expiratory images. Patients with SAD were differentiated from those with COPD, by visual assessment and from the CT measurements. Visual assessment failed to differentiate between the SAD and normal groups. However, one measurement, an inspiratory–expiratory attenuation difference in the dependent lower lung, was different between SAD and normal group. Early small airway disease may be indicated by an inspiratory–expiratory attenuation difference in the dependent lower lung using the simple method of a paired inspiratory–expiratory CT. Received: 10 April 2000 Revised: 7 June 2000 Accepted: 8 June 2000     

Sonographic findings in patients with adenomyosis: can sonography assist in predicting extent of disease?

OBJECTIVE: We assessed whether specific sonographic characteristics are indicative of the extent of adenomyosis and whether fibroids alter this assessment. MATERIALS AND METHODS: Patients' records were evaluated for the diagnosis of adenomyosis determined by hysterectomy and for sonography performed within 2 months of surgery. Seventy-three sonograms were evaluated by sonologists without knowledge of the extent of adenomyosis. Sonographic categories included visualization of the endometrium, presence of a diffuse uterine process, presence of fibroids, and normal findings. Pathologic results included mild, focal, and severe adenomyosis. Histologic and sonographic categories were correlated using the chi-square and Fisher's exact tests. RESULTS: Forty-six specimens contained mild adenomyosis, 18 contained severe disease, and nine contained focal disease. Forty-one specimens contained fibroids. The endometrium was visualized in 10 cases of severe adenomyosis, seven cases of adenomyoma, and 35 cases of mild disease. Visualization of the endometrium did not relate to the severity of disease (p = 0.6). Of 18 cases of severe disease, 13 sonograms showed a diffuse process. Of nine cases of adenomyomas, no sonograms showed a diffuse process; and of 46 cases of mild disease, nine sonograms showed a diffuse process. A diffuse process was related to the severity of adenomyosis (p < 0.001). When fibroids were present, a diffuse process did not relate to the extent of adenomyosis (p = 0.01). CONCLUSION: In the absence of focal fibroids, a diffuse uterine process seen on sonography relates to the severity of adenomyosis. Fibroids limit the ability to diagnose the severity of adenomyosis. The visualization of the endometrium does not relate to the severity of adenomyosis.     

Substantia innominata: MR findings in Parkinson’s disease

To elucidate MR imaging changes of the substantia innominata in Parkinsons disease (PD), using a 1.5-T superconductive MR unit, the thickness of the substantia innominata was measured on coronal thin-section images in 44 PD patients and 20 age-matched control subjects. We also evaluated the correlation between the thickness of the substantia innominata and mental status in PD patients. Mean thickness of the substantia innominata was 2.3 mm in PD patients, and 2.5 mm in control subjects. Thinning of the substantia innominata was statistically significant in PD patients compared with control subjects, although there were large overlaps. Among the PD patients, thinning was remarkable in cases with dementia. A positive correlation between thickness of substantia innominata and score of Mini-Mental-Status-Examination was also observed in PD patients. Atrophy of the substantia innominata was demonstrated, especially in PD patients with cognitive impairment, on coronal MR images, and this is compatible with the previous pathological reports.     

Proton MR Spectroscopy of the brain in children with neuronopathic Gaucher’s disease

Objective

To assess the clinical usefulness of proton magnetic resonance spectroscopy (¹H-MRS) in children with neuronopathic Gaucher’s disease (NGD).

Methods

A prospective study was conducted upon 21 consecutive children with acute (n?=?7) and chronic (n?=?14) forms of NGD (13 boys, 8 girls; mean age 37 months) and for a control group (n?=?15). All patients and controls underwent ¹H-MRS of frontal white matter. The choline/creatine (Ch/Cr) and N-acetyl aspartate (NAA)/Cr ratios were calculated. A modified severity scoring tool (m-SST) of NGD was calculated and genotyping was performed for all patients. Metabolic ratios were correlated with clinical types, m-SST and genotyping.

Results

There was a significant difference in Ch/Cr (P?=?0.001) between patients with NGD and the control group. Lipid peak was detected in 15 patients with NGD. Patients with acute NGD revealed higher m-SST (P?=?0.001) and Ch/Cr (P?=?0.001) compared with the chronic form. Patients with homozygous gene mutation (L444P/L444P) had significantly higher m-SST (P?=?0.001) and Ch/Cr (P?=?0.013) than those with the heterozygous gene mutation (L444P/other). The Ch/Cr was negatively correlated with m-SST (r?=??0.682; P?=?0.001)

Conclusion

¹H-MRS can be used to detect brain abnormalities in children with NGD and Ch/Cr is well correlated with m-SST and genotyping.

Key Points

? Proton magnetic resonance spectroscopy offers important information in some paediatric neurological conditions. ? Significantly different choline/creatine ratios were found between neuronopathic Gaucher’s disease and controls. ? Lipid peak helps with the diagnosis of neuronopathic Gaucher’s disease. ? Ch/Cr correlated with the modified severity scoring tool of Gaucher’s disease.     

The role of nasoenteric intubation in the MR study of patients with Crohn??s disease: our experience and literature review

Purpose

The aim of this study was to compare magnetic resonance (MR) enteroclysis with MR enterography to verify whether nasoenteric intubation in patients affected by Crohn??s disease can provide supplementary information to that afforded by MR study of the small bowel.

Materials and methods

In a 12-month period, 40 patients (28 women and 12 men, mean age 35 years) affected by Crohn??s disease underwent MR imaging. Distension of the small-bowel loops was obtained by administering polyethylene glycol: 15 patients were given the mixture by mouth (MR enterography), whereas the remaining 25 received it via nasoenteric intubation (MR enteroclysis). Our study protocol included morphological sequences taken before and after intravenous injection of contrast medium and real-time functional sequences. Accuracy criteria for the execution of the examinations were designed according to 11 bands.

Results

Complete distension of the small-bowel loops was obtained in the 25 patients who underwent MR enteroclysis, with the additional advantage of a suitable assessment of those segments involved in the pathological process. This was not the case for the 15 patients who underwent MR enterography, because both the jejunum and the small-bowel loops appeared partially collapsed.

Conclusions

MR enteroclysis is the most effective technique for studying the small bowel in Crohn??s disease, as it not only provides a suitable morphological assessment but also supplies functional information.     

Combined arterial and venous whole-body MR angiography with cardiac MR imaging in patients with thromboembolic disease—initial experience

The objective was to assess the feasibility of a combined arterial and venous whole-body three-dimensional magnetic resonance (MR) angiography, together with a cardiac MR examination, in patients with arterial thromboembolism. Ten patients with arterial thromboembolism underwent a contrast-enhanced whole-body MR examination of the arterial and venous vessels, followed by a cardiac MR examination on a separate occasion within 24 h. All examinations were performed on a 1.5-T MR scanner. For both arterial and venous MR angiography only one injection of contrast agent was necessary. The cardiac imaging protocol included dark-blood-prepared half-Fourier acquisition single-shot turbo-spin-echo sequences, fast steady-state free precession cine sequences, T2-weighted turbo-spin-echo sequences and inversion recovery gradient-echo fast low-angle-shot sequences after injection of contrast agent. MR imaging revealed additional clinically unknown arterial thromboembolisms in four patients. The thoracic aorta was depicted as embolic source in four patients, while deep vein thrombosis (DVT) was found in one patient as the underlying disease. Unsuspected infarction of parenchymal organs was detected by MRI in two patients. An unknown additional DVT was found in one patient. Four patients were considered to have arterial emboli of cardiac origin. In conclusion, acquisition of arterial and venous MR angiograms of the entire vascular system combined with cardiac MR imaging is a most comprehensive and valuable strategy in patients with arterial thromboembolism.     

PET and PET–CT imaging findings of peritoneal and omental involvement in patients with lymphoma

A retrospective institutional-review-board-approved study was performed evaluating positron emission tomography (PET)–computed tomography (CT) imaging findings of peritoneal and omental involvement of lymphoma. Twelve patients were identified with a wide spectrum of imaging findings on PET–CT including but not limited to peritoneal thickening, ascites, and serosal involvement. Lymphoma is among the rare causes of malignant peritoneal or omental involvement. The most common manifestations of peritoneal lymphomatosis are peritoneal 2-[fluorine 18] fluoro-2-deoxy-d-glucose uptake with corresponding peritoneal thickening and nonobstructive serosal masses on CT.     

MR imaging findings of vertebral involvement in Gorham–Stout disease,generalized lymphatic anomaly,and kaposiform lymphangiomatosis

Purpose

To assess the MR imaging findings of vertebral involvement in Gorham–Stout disease (GSD), generalized lymphatic anomaly (GLA), and kaposiform lymphangiomatosis (KLA).

Methods

Nine patients (three patients with GSD, three with GLA, and three with KLA) who underwent whole-spine MR examinations were included. MR findings of fatty marrow replacement and prolonged T1 and T2 lesions of the vertebrae were retrospectively assessed. Prolonged T1 and T2 lesions were defined as well-defined and round-, oval-, or geographic-shaped areas.

Results

Six patients [one (33%) patient with GSD, two (67%) with GLA, and three (100%) with KLA] showed both fatty marrow replacement and prolonged T1 and T2 lesions. Fatty marrow replacement was seen in the cervical spine of two (33%) patients, thoracic spine of six (100%), lumbar spine of six (100%), and sacral spine of two (33%). Prolonged T1 and T2 lesions were seen in the cervical spine of three (50%) patients, thoracic spine of three (50%), lumbar spine of six (100%), and sacral spine of three (50%).

Conclusion

Both fatty marrow replacement and prolonged T1 and T2 lesions of the vertebrae could be observed in GSD, GLA, and KLA. The most commonly affected site was the lumbar spine, followed by the thoracic spine.

     

Arthropathy in Behçet disease: MR imaging findings in two cases

Arthropathy is part of the protean manifestations of Beh?et disease. Imaging findings reported thus far have been based on those of conventional radiography. Magnetic resonance imaging in two cases of Beh?et disease with arthropathy demonstrated synovial thickening and effusion, as well as myositis manifested by high signal intensity on T2-weighted images.     

Clinical and imaging findings of lymphoma in patients with Sjögren syndrome

OBJECTIVE: To describe and correlate the clinical and imaging findings of lymphomas in patients with Sj?gren syndrome. METHODS: The authors reviewed the medical and imaging records of 27 cases of lymphoma from among a total of 463 patients with Sj?gren syndrome. The estimated prevalence of lymphoma in patients with Sj?gren syndrome was 5.8%. There were 22 women and 5 men. Histopathologically, 26 of the 27 neoplasms were non-Hodgkin lymphoma, including 6 mucosa-associated lymphoid tissue lymphomas, and the other neoplasm was Hodgkin lymphoma. The clinical and imaging findings of lymphomas were analyzed. RESULTS: No obvious correlations were present between the duration or severity of Sj?gren syndrome and the lymphoma development. At the initial diagnosis, extranodal involvement was observed in 14 (52%) of the 27 patients, including the salivary gland (n = 9), lacrimal gland (n = 2), lung (n = 2), and thyroid gland (n = 1), mostly in the neck organs. On the other hand, nodal involvement was observed in 21 (78%) of the 27 patients. Of these 21 patients, 19 had at least cervical lymph node involvement. CONCLUSION: Patients with Sj?gren syndrome are at increased risk of lymphoma development. Because most lymphomas initially involve the neck organs, including the lymph nodes, meticulous imaging studies mainly focused on the cervical regions are recommended in the follow-up of patients with Sj?gren syndrome.     

MR enterography versus capsule endoscopy in paediatric patients with suspected Crohn��s disease

Objective

The aim of this prospective study was to compare the diagnostic yield of MR enterography (MRE) with small-bowel capsule endoscopy (SBCE) in paediatric patients with suspected Crohn??s disease (CD).

Methods

Paediatric patients with suspected CD were considered eligible to be enrolled in the study. All patients underwent diagnostic work-up including 1.5-T MRE, ileo-colonoscopy and oesophagogastroduodenoscopy. SBCE was not performed if MRE showed SB stricture or extra-intestinal findings consistent with symptoms.

Results

Sixty consecutive paediatric patients (36 male; average age 14) were enrolled into the study. A positive diagnosis for CD was made in 19 patients, 29 had a negative result and 12 were affected by other gastro-intestinal conditions. SBCE was performed in 37 patients (61.7%); 23 patients were excluded (strictures in five, extra-intestinal findings in 11 and parents?? refusal in seven cases). The accuracy, sensitivity, and specificity of MRE and SBCE were 98.3%, 100%, 97.6%, and 91.9%, 90.9%, 92.3%, respectively.

Conclusion

Both MRE and SBCE are accurate methods for patients with suspected CD. MRE can be used as a primary imaging technique in suspected CD, in that it allows access to the ileal stricture, which forms a contra-indication for SBCE and provides extra-intestinal information.     

CT and MR in non-neonatal hypoxic–ischemic encephalopathy: radiological findings with pathophysiological correlations

Non-neonatal hypoxic–ischemic encephalopathy is a clinical condition often related to cardiopulmonary arrest that demands critical management and treatment decisions. Management depends mainly on the degree of neurological impairment and prognostic considerations. Computed tomography (CT) is often used to exclude associated or mimicking pathology. If any, only nonspecific signs such as cerebral edema, sulci effacement, and decreased gray matter (GM)/white matter (WM) differentiation are evident. Pseudosubarachnoid hemorrhage, a GM/WM attenuation ratio <1.18, and inverted GM attenuation are associated with a poor prognosis. Magnetic resonance (MR) imaging is more sensitive than CT in assessing brain damage in hypoxic–ischemic encephalopathy. Some MR findings have similarities to those seen pathologically, based on spatial distribution and time scale, such as lesions distributed in watershed regions and selective injury to GM structures. In the acute phase, lesions are better depicted using diffusion-weighted imaging (DWI) because of the presence of cytotoxic edema, which, on T2-weighted images, only become apparent later in the early subacute phase. In the late subacute phase, postanoxic leukoencephalopathy and contrast enhancement could be observed. In the chronic phase, atrophic changes predominate over tissue signal changes. MR can be useful for estimating prognosis when other tests are inconclusive. Some findings, such as the extent of lesions on DWI and presence of a lactate peak and depleted N-acetyl aspartate peak on MR spectroscopy, seem to have prognostic value.