Ganglia of the tarsal sinus: MR imaging features and clinical findings

Purpose

To analyze MR imaging and clinical findings associated with ganglia of the tarsal sinus.

Materials and methods

In a record search, ganglia of the tarsal sinus were retrospectively identified in 26 patients (mean age 48 ± 16 years), who underwent MR imaging for chronic ankle pain. Images were reviewed by two radiologists in consensus for size and location of ganglia, lesions of ligaments of the ankle and the tarsal sinus, tendon abnormalities, osteoarthritis, osseous erosions and bone marrow abnormalities. Medical records were reviewed for patient history and clinical findings.

Results

Ganglia were associated with the interosseus ligament in 81%, the cervical ligament in 31% and the retinacula in 46% of cases. Signal alterations suggesting degeneration were found in 85%, 50% and 63% in case of the interosseus ligament, the cervical ligament and the retinacula, respectively. Scarring of the anterior talofibular ligament and the fibulocalcaneal ligament was found in 68% and 72% of the patients, respectively, while only 27% of the patients recalled ankle sprains. Ganglia at the retinacula were highly associated with synovitis and tendinosis of the posterior tibial tendon (p < 0.05).

Conclusion

All patients with ganglia in the tarsal sinus presented with another pathology at the ankle, suggesting that degeneration of the tarsal sinus may be a secondary phenomenon, due to pathologic biomechanics at another site of the hind foot. Thus, in patients with degenerative changes of the tarsal sinus, one should be alerted and search for underlying pathology, which may be injury of the lateral collateral ligaments in up to 70%.     

侧脑室脑膜瘤的磁共振表现

目的：通过分析侧脑室脑膜瘤的磁共振特征,以提高诊断准确性。方法分析手术病理证实的27例侧脑室脑膜瘤的磁共振资料,总结其磁共振影像特点。结果25例位于侧脑室后角及三角区（其中19例位于左侧、6例位于右侧）、1例位于侧脑室体部、1例为多发。所有肿瘤M RI均表现为边界清楚的肿块影。22例肿瘤形态呈圆形（81．5％）,5例浅分叶（18．5％）,1例深分叶。信号均与脑灰质对比,T1 WI呈等高或稍低信号,T2 W/FLAIR呈等或稍高信号,与脑室外脑膜瘤信号基本一致。T1 WI增强扫描多数为明显强化,并显示肿块边缘与脉络丛相连。肿瘤病理类型：19例为纤维型、8例为上皮型。测ADC平均值分别为纤维型（0．89±0．12）×10-3mm2/s ,上皮型（0．95±0．18）×10-3mm2/s。结论侧脑室脑膜瘤具有一定的M RI征象,可以提高术前诊断的准确性。     

局限性硬皮病:MR表现与临床特征

目的描述局限性硬皮病骨骼肌肉系统的MR表现,并探讨MR表现与临床亚型的关系,临床怀疑存在骨骼肌肉系统改变的病人的MR表现。材料与方法本研究获得大学伦理审查委员会的批准。2005年11月—2010年6月局     

Parsonage-Turner syndrome: MR imaging findings and clinical information of 27 patients

PURPOSE: To review retrospectively the magnetic resonance (MR) imaging findings and clinical information of patients with Parsonage-Turner syndrome (PTS). MATERIALS AND METHODS: The institutional review board did not require its formal approval or informed patient consent at the time of the study. However, the study was HIPAA compliant. The information in a computerized database of 2875 consecutive shoulder MR examinations was retrospectively reviewed. With use of key terms, the database software identified 81 examinations potentially associated with PTS. Both authors together reviewed the 81 imaging reports and the corresponding patients' medical records. In consensus, they made the diagnosis of PTS in 21 patients (two with bilateral involvement) on the basis of MR findings, electromyographic results, and clinical data. They also examined the data of an additional six patients (one with bilateral involvement) obtained from outside facilities. Ultimately, 30 shoulders of 27 patients (18 male, nine female; age range, 12-81 years; mean age, 41 years) were evaluated. The MR findings and clinical information (ie, regarding atrophy, pain, weakness, electromyographic results, neck and spine history, trauma, excessive overhead activity, recent surgery, vaccination, and illness) of all patients with PTS were reviewed. MR findings of diffuse high T2 signal intensity abnormality and fatty atrophy of muscles were evaluated to assess the pattern of nerve involvement. Structural causes (eg, ganglion cyst or other mass) of neurogenic high T2 signal intensity abnormality were excluded at MR imaging. RESULTS: Twenty-nine (97%) of 30 shoulders had suprascapular nerve involvement; in 15 (50%) shoulders, the involvement was limited to this nerve. Fifteen (50%) shoulders had axillary nerve involvement; in only one (3%) shoulder, the involvement was limited to this nerve. One shoulder (3%) had subscapular nerve involvement. Nine (30%) shoulders demonstrated focal muscular atrophy. Eleven (41%) of 27 patients also underwent electromyography; all of these patients demonstrated neuropathies that matched the patterns of neurogenic high T2 signal intensity abnormality seen at MR imaging. CONCLUSION: The suprascapular nerve was almost invariably involved (in 97% of shoulders) in patients with PTS. Axillary nerve involvement also was commonly observed (in 50% of shoulders). Subscapular nerve involvement was uncommon (in 3% of shoulders).     

Liver adenomatosis: clinical, histopathologic, and imaging findings in 15 patients

PURPOSE: To report and correlate the clinical, histopathologic, and imaging findings in 15 patients with liver adenomatosis. MATERIALS AND METHODS: Fifteen adult patients had more than 10 hepatic adenomas each and no history of glycogen storage disease or anabolic steroid use. Ten of them underwent bolus-enhanced dynamic computed tomography (CT) with or without magnetic resonance (MR) imaging, ultrasonography, and/or angiography. RESULTS: Clinical abnormalities included abdominal pain in 11 (73%) and hepatomegaly in 10 (67%) patients, and abnormal liver function in 10 (91%) of 11 patients. The number of adenomas in each patient was 10-50 at imaging, but many more lesions were found in the resected specimens. Hemorrhage was commonly found within adenomas at histopathologic analysis, but only four patients had clinical and imaging evidence of substantial hemorrhage. In all patients, the adenomas increased over time, and two patients developed hepatocellular carcinoma. CT and MR features of the adenomas included evidence of hypervascularity (63%), intratumoral fat (50% of patients at CT, 80% at MR), and decreased conspicuity at portal venous and delayed-phase imaging. Fifty percent of patients had congenital or acquired hepatic vascular abnormalities. CONCLUSION: The imaging and histopathologic features of individual adenomatous lesions are similar to those reported in young women who are taking oral contraceptives. However, the lesions in liver adenomatosis are not steroid dependent but rather multiple, progressive, and symptomatic, and they are more likely to lead to impaired liver function, hemorrhage, and perhaps malignant degeneration.     

应激性心肌病的临床特征及影像诊断

目的分析和总结应激性心肌病的临床和影像特征，旨在提高对该病的认识。方法71岁女性患者，入院前1d生气后突发胸闷、胸痛伴胸骨后烧灼。先后行心电图、超声心动图、冠状动脉和左室造影、核素心肌灌注（代谢）显像和MR扫描。结果急诊心电图示V1～V4导联sT段抬高和T波倒置，1周后出现病理性Q波，1个月后Q波消失：代之为巨大倒置的T波。心肌酶正常或仅轻度升高。急诊左室造影示左室巨大室壁瘤形成，约占左室容积3／4，左室射血分数（LVEF）约30％，但选择性冠状动脉造影未发现与之对应的冠状动脉病变；1个月后复查造影，示左室室壁瘤明显缩小，左室功能基本恢复，LVEF63．6％。发病1周内心肌核素检查示相应区域灌注和代谢不匹配，提示心肌存活。MRI示左室心尖部巨大室壁瘤形成，但受累节段既无灌注缺损又未见明显延迟强化，提示无坏死心肌。结论极度心理打击发生的短暂性左室心尖球状扩张可称为应激性心肌病。核素心肌灌注（代谢）显像以及MRI心肌灌注延迟显像能够提示病变区存活心肌，可指导临床治疗。     

Infratemporal fossa meningioma: CT and MR findings

We report an unusual case of an extracranial meningioma presenting as a large facial mass. The CT and magnetic resonance findings and a brief review of extracranial meningiomas are presented.     

MR imaging features of clear-cell meningioma with diffuse leptomeningeal seeding

Clear-cell meningioma is a rare disease entity showing a more aggressive nature, clinically, than those of other subtypes of meningioma. It occurs in younger persons and commonly in the spinal canal. The recurrence rate has been reported to be as high as 60%. We present a case of clear-cell meningioma in a 17-year-old man in whom initial MR imaging showed localized leptomeningeal enhancement that had progressed into the entire subarachnoid space after surgical resection of the primary tumor.     

Salivary duct carcinomas: clinical and CT and MR imaging features in 20 patients

Introduction

Salivary duct carcinoma (SDC) is an uncommon high grade adenocarcinoma of the salivary gland with a grave prognosis. The aim of this study was to investigate the clinical and CT and MR imaging features of SDC.

Methods

We retrospectively evaluated the clinical and CT and MR imaging findings in 20 patients (14 men and six women; mean age, 59?years) with histologically proved SDC. We also tried to correlate clinicoradiological tumor staging with pathologic tumor staging in 17 patients who underwent surgery.

Results

The tumor originated in the parotid gland (n?=?11; 55%), the submandibular gland (n?=?7; 35%) and the buccal space along the distal Stensen's duct (n?=?2; 10%). Locoregional recurrence occurred in 41% and distant metastasis in 47%. Fifty-eight percent died of the disease with a mean survival period of 32?months after diagnosis. On CT and MR images, SDC was mostly seen as an ill-defined (85%) and infiltrative (60%) mass with frequent calcification (50%) and necrosis (80%). Although various signal intensities were seen on MR images, six of nine tumors contained the areas of marked hypointensity on T2-weighted images. Clinicoradiological tumor staging correlated well with pathologic tumor staging in 82% of the patients.

Conclusion

Ill-defined, infiltrative mass with calcification on CT scans and the areas of marked hypointensity on T2-weighted MR images may be useful radiologic features to suggest the diagnosis of SDC. CT and MR imaging are useful for staging of SDC.     

Intrasellar meningioma: characteristic imaging findings

Intrasellar meningioma is rare. We present a case in which both angiography and dynamic contrast-enhanced MRI suggests the diagnosis.     

Diencephalic syndrome: clinical features and imaging findings.

PURPOSETo emphasize the importance of imaging in children with diencephalic syndrome due to hypothalamic/chiasmatic astrocytomas.METHODSFindings in nine patients (mean age, 26 months) with diencephalic syndrome and hypothalamic/chiasmatic astrocytomas were analyzed retrospectively, including reviewing clinical records, imaging examinations, and follow-up studies.RESULTSSymptoms and signs included failure to thrive (n = 9), nystagmus (n = 3), visual field defects (n = 1), optic pallor (n = 1), emesis (n = 2), and headache (n = 1). All patients had hypothalamic/chiasmatic masses. Five patients underwent biopsy, and, in all cases, specimens showed low-grade astrocytoma. Imaging studies were available in eight patients. All tumors were large (median maximum diameter, 3.5 cm), involved the chiasm and hypothalamus, and showed homogeneous enhancement. Three patients had hydrocephalus and two had metastases. At follow-up, five patients had recurrent disease and two had died.CONCLUSIONDiencephalic syndrome is a rare cause of failure to thrive in childhood, and diagnosis of a hypothalamic/ chiasmatic astrocytoma might therefore be delayed. The astrocytomas associated with this syndrome are larger, occur at a younger age, and are often more aggressive than other astrocytomas arising in this region.     

Radiation myelopathy in over-irradiated patients: MR imaging findings

The objective of this work is to report the MRI findings in patients with radiation myelopathy due to accidental local over-irradiation syndrome. Eight patients (seven males and one female) were suffering from over-irradiation syndrome as a result of treatments from a malfunctioning linear electron accelerator. The mean accidental estimated dose was 136 Gy delivered to the “open-neck” (seven cases) and to the thoracic wall (one case), during a mean of 5.4 sessions (range 1–9 sessions). Paresthesia and weakness in the upper extremities were the earliest symptoms (87.5 %), with evolution to paralysis in all patients. No patient is alive (mean survival time 64 days). In all cases MRI was negative for neurologic lesions in the acute phase ( < 90 days from irradiation; Radiation Therapy Oncology Group scoring system). Late signs of radiation myelitis manifested as high-intensity signals on T2-weighted images in three patients, and as Gd-DTPA enhancement of T1-weighted images in one case. Autopsies performed on four patients who died in acute phase showed morphologic alterations in white matter: edema in 75 %, and necrosis and glial reaction as well as obliterative vasculitis in all cases. In cases of over-irradiation, MRI may be normal in acute phase even if the patients have severe neurologic deficit, as positive MRI findings appear only in delayed radiation myelitis. Received 25 March 1996; Revision received 3 July 1996; Accepted 4 September 1996     

Tolosa-Hunt syndrome: MR imaging features in 15 patients with 20 episodes of painful ophthalmoplegia

Purpose

(a) To assess MR features in patients with Tolosa-Hunt syndrome (THS) and to (b) correlate MR findings with criteria derived from previously reported pathologic observations.

Methods

Fifteen patients with twenty episodes of painful ophthalmoplegia prospectively selected according to International Headache Society (IHS) standards underwent MR examinations focused on the cavernous sinus. Initial examinations in 20 and follow-up MR images in 17 episodes were retrospectively reviewed by 3 independent observers.

Results

The primary criteria: an enhancing soft tissue lesion within the cavernous sinus, increase in size and lateral bulging of the anterior cavernous sinus contour were consistently present in 15 initial episodes and in 5 recurrences (20/20). Agreement among observers was 100%. The secondary criteria: internal carotid artery narrowing in 7 patients, extension towards the superior orbital fissure in 13 and orbital apex involvement in 8 patients were unanimously agreed upon in 87.5%, 86.6% and 80%. Complete resolution of findings was observed on follow-up studies.

Conclusion

In patients with THS the MR features conform to previously reported pathologic findings. MR features are evocative of THS when an increase in size and bulging of the dural contour of the anterior CS supplemented by carotid artery involvement and extension towards the orbit are present. Resolution of findings within 6 months is required to support the diagnosis.     

Spinal abnormalities in pediatric patients: MR imaging findings compared with clinical, myelographic, and surgical findings

Eighty-one pediatric patients with a variety of spinal disorders, including suspected dysrhaphism, scoliosis, neoplasia, and neurofibromatosis, underwent magnetic resonance (MR) imaging. The results were retrospectively compared with those of myelography followed by computed tomography (CT) and surgery. In patients with dysrhaphism, most abnormalities, including hydromyelia, inclusion tumors, and sites of cord tether, were demonstrated with MR imaging. Diastematomyelia and small hydromyelic cavities were indistinguishable on routine coronal and sagittal T1-weighted images; axial images with T2 weighting were optimal for this differentiation. MR imaging did not enable direct visualization of a thickened filum or evaluation of tethering with a thin, dorsally positioned neural placode. Congenital or severe scoliosis required lengthy studies with multiple planes of imaging or myelography and CT. Milder curvatures were readily evaluated with MR imaging, and neoplastic lesions, with the exception of intrathecal tumor seeding, were adequately defined.     

Epithelioid sarcoma: clinical,MR imaging and pathologic findings

OBJECTIVE: To report and describe the MR imaging features of eight new cases of this rare soft tissue sarcoma and correlate them with the clinical and histologic findings.DESIGN AND PATIENTS. Retrospective analysis was carried out for the MR imaging characteristics and histologic findings of eight patients with pathologically proven epithelioid sarcoma and the literature was reviewed. Findings were correlated in each case with the patient's clinical presentation and eventual outcome.RESULTS: The patients, whose primary tumors ranged from 2.5 cm to 19 cm in maximum dimension, were 1 to 90 years of age. Tumors involved the extremities ( n=5), the scalp ( n=2) and the paraspinal muscles ( n=1). Five tumors presented as well-defined, frequently painful, deeply situated masses and three as subcutaneous nodules or cutaneous ulcers with no palpable mass. Four patients had associated regional lymphadenopathy and one had distant metastases at diagnosis. MR imaging showed tumor infiltration of adjacent tissues in seven patients. Signal characteristics reflected varying degrees of cellularity, and the presence of necrosis, hemorrhage, fibrosis, hyalinization and inflammation. Bone marrow involvement was demonstrated in one patient. Clinical outcomes were generally poor.CONCLUSIONS: Epithelioid sarcoma is an aggressive soft tissue sarcoma with a varied clinical presentation, growth pattern, MR signal characteristics and histologic picture. The tumor favors the distal extremities and is commonly infiltrative and accompanied by enlarged regional lymph nodes. This neoplasm may present as an intramuscular mass but should also be suspected in patients with ulcerating cutaneous nodules with or without regional lymphadenopathy.