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1.
MR imaging of supra-acetabular insufficiency fractures 总被引:3,自引:0,他引:3
Objective. Diagnosis of insufficiency fractures in the pelvis is difficult, especially in patients with prior malignancy, irradiation,
steroid therapy or osteoporosis. This report shows the MR imaging appearance of supra-acetabular insufficiency fractures and
how they can be differentiated from metastatic disease. Design and patients. Twelve patients (four men, eight women, average age 72.8 years) at risk for pelvic insufficiency fractures and who had pelvic
or hip pain were studied with MR imaging. Indications were possible recurrent tumor or previous radiation to the pelvis (7
patients); osteoporosis from steroid use in rheumatoid arthritis (two patients); to exclude osteonecrosis of the hip (two
patients); or to rule out a hip fracture (one patient). Results. A characteristic linear region of low signal intensity on both T1- and T2-weighted sequences was found in the supra-acetabular
region paralleling the superior acetabulum in a curvilinear arc in 92% (11/12) of cases, and oblique in origin in 8% (1/11).
Diffuse bands of high signal on T2-weighted images indicated surrounding edema. In two cases, MR findings obviated biopsy.
One patient underwent a biopsy prior to the imaging studies being reviewed. All patients were treated conservatively and did
well. Discussion. Attention to insufficiency fractures has previously focused on characteristic locations in the sacrum and pubic bones. Supra-acetabular
insufficiency fractures also occur and are difficult to diagnose without a high degree of suspicion. MR imaging is a useful
tool for diagnosing supra-acetabular insufficiency fractures. The characteristic MR imag-ing appearance of these fractures
can preclude additional diagnostic studies and therapy in most instances. 相似文献
2.
Subchondral insufficiency fracture of the femoral head: histopathologic correlation with MRI 总被引:5,自引:0,他引:5
Objective. To correlate the magnetic resonance imaging (MRI) features with the histopathologic findings in subchondral insufficiency
fracture (SIF) of the femoral head.
Design and patients. This study was based on a retrospective review of the MRI features and histopathologic findings in seven patients with SIF
who had had total hip replacement.
Results. In all seven cases, MRI showed a bone marrow edema pattern in the femoral head, and a focal low-intensity band beneath the
articular cartilage on some slices (not all) on the T1-weighted images. The shape of the low-intensity band varied: it was
irregular and serpentine in four cases, well-delineated, smooth, and a mirror image to the articular surface in two cases,
and parallel to the articular surface in one case. On histologic examination, the low-intensity band on MRI corresponded to
a fracture line and its associated repair tissue. In all but one case, the band was not visible on T2-weighted or fat suppression
images, and the proximal subchondral portion of the lesion had a homogeneous high signal intensity. This region of high signal
intensity corresponded histopathologically to viable bone and marrow tissue with associated callus, edema, and vascular granulation
tissue.
Conclusions. SIF of the femoral head characteristically demonstrates a low-intensity band on T1-weighted images that corresponds, histopathologically,
to a linear subchondral fracture and its associated repair tissue. In most cases, the subchondral portion of the lesion appears
on T2-weighted images as an area of homogeneously high signal intensity.
Received: 1 June 2000 Revision requested: 17 August 2000 Revision received: 11 October 2000 Accepted: 9 January 2001 相似文献
3.
K. Nakanishi Takashi Masatomi Takahiro Ochi Takeshi Ishida Shinichi Hori Junpei Ikezoe Hironobu Nakamura 《Skeletal radiology》1996,25(7):629-634
Objective. The purpose of this study was to evaluate ulnar collateral ligament (UCL) injury of the elbow in throwing athletes by MRI
and MR arthrography. Design. Ten elbows of throwing athletes were examined on both plain MRI and MR saline arthrography and the injuries subsequently surgically
proven. Spin-echo (SE) T1-weighted and fast SE T2-weighted coronal images were obtained. Results. The UCL was unclear in all ten cases on T1-weighted MRI. In five cases an avulsion fracture was also found on T1-weighted
MRI. On T2-weighted MRI, abnormal high-intensity areas were identified in or around the UCL. On T2-weighted MR arthrography
images, extracapsular high-intensity areas, which represent extracapsular leakage, were found in four of five cases with avulsion
fracture. At surgery, all these four cases showed avulsion fractures with instability; the other case had a fracture but it
was stable and adherent to the humerus. On T2-weighted MR arthrography images, an extracapsular high-intensity area was found
in one of the five cases without avulsion fracture. At surgery this patient had a complete tear of the UCL itself. Conclusion. MR arthrography provided additional information for evaluating the degree of UCL injury. 相似文献
4.
G. Hermann Michael J. Klein Ibrahim Fikry Abdelwahab Samuel Kenan 《Skeletal radiology》1997,26(11):629-632
Objective. To evaluate the signal characteristics of primary non-Hodgkin’s lymphoma of bone on MRI. Designs and patients. Ten patients with primary non-Hodgkin’s lymphoma of bone were included in the study. T1- and T2-weighted imaging was performed.
The signal intensity of the lesions was compared with that of the surrounding muscle. Results. The results of the MRI were compared with the histological findings. In the majority of cases (5/10) the lesion involved the
femur. In one case each the tibia, humerus, ileum, sacrum, and skull, respectively, were affected. A soft tissue mass was
present in four cases. In nine of ten cases on T1-weighted imaging the lesion was hypointense. On T2-weighted imaging seven
of ten lesions were hypointense compared with muscle, one isointense and, in two cases, part of the lesion showed slightly
hyperintense signal. In all ten cases the signal pattern appeared inhomogeneous. Pathological examination showed extensive
fibrosis in the majority of cases. Conclusion. According to our results there is decreased signal intensity of bone marrow on both T1- and T2-weighted imaging, unlike other
primary round cell tumors of bone. Because the diagnoses were established with small tissue biopsies, the reason for these
findings is speculative. 相似文献
5.
Theodorou SJ Theodorou DJ Schweitzer ME Kakitsubata Y Resnick D 《Clinical radiology》2006,61(2):181-190
AIM: To describe the characteristic magnetic resonance imaging (MRI) findings of para-acetabular insufficiency fractures in patients with malignancy, and compare the MRI appearance of these fractures with that of metastatic bone disease. MATERIALS AND METHODS: MRI examinations were reviewed in 16 patients with a known malignant tumour and severe hip pain that raised the possibility of local recurrence or metastatic disease. Six patients had received pelvic irradiation, and three patients were receiving steroid medication. RESULTS: The total number of fractures detected was 21: a solitary fracture was present in 11 patients and five patients had bilateral para-acetabular fractures. Two patients had associated sacral insufficiency fractures, and one of them had stress fractures involving both acetabular columns. Conventional radiography allowed the diagnosis of 14 (67%) fractures; six (28%) radiographic examinations were negative; and one (5%) examination was equivocal for fracture. Available scintigraphic and computed tomography (CT) studies revealed typical findings of fracture. Using MRI, insufficiency fractures appeared as linear regions of low signal intensity on T1- and T2-weighted images. Marked marrow oedema was evident in all cases. Fractures characteristically were parallel to the superior acetabulum in a curvilinear fashion in 18 (86%) instances, and were oblique in three (14%) instances. The fractures demonstrated considerable enhancement after intravenous gadolinium administration. No associated soft tissue masses were documented. CONCLUSION: Para-acetabular insufficiency fractures are a cause of hip pain, which may mimic skeletal metastasis in the patient with malignancy and pelvic irradiation. Recognition of the characteristic MRI findings of these fractures can preclude misdiagnosis and unnecessary bone biopsy. 相似文献
6.
Kanberoglu K Kantarci F Cebi D Yilmaz MH Kurugoglu S Bilici A Koyuncu H 《Clinical radiology》2005,60(1):105-111
AIMS: To report the magnetic resonance imaging (MRI) findings of osteomalacic insufficiency fractures of the pelvis. MATERIALS AND METHODS: In all, 12 persons presenting with chronic pelvic pain and with a definitive diagnosis of osteomalacia (OM) were enrolled in this study. Radiological work-up included direct radiographs (n = 12), computed tomography (n = 5), scintigraphy (n = 12) and MRI (n = 12). The location of the insufficiency fractures and corresponding MRI appearances were evaluated. Depending on the presence or absence of signal intensity around the fractures, the lesions were grouped into active and chronic forms. RESULTS: A total of 34 insufficiency fractures were depicted on imaging studies. MRI demonstrated 33 of the lesions. All the insufficiency fractures were seen as a hypointense lines or fissures on T1- and T2-weighted and STIR MR images. There was a high frequency of insufficiency fractures at the sacrum and iliac bone (16/34, 47%). Overall, 11 chronic-type (no abnormal signal intensity around the fissure) and 22 active-type (abnormal signal intensity around the fissure) insufficiency fractures were detected by MRI. Follow-up MR examinations of 2 subjects showed that abnormal signal intensity had disappeared after appropriate treatment. CONCLUSION: The results of this study showed that the iliac and sacral bones are frequently involved in patients with OM. MRI can determine the clinical activity of the disease, and can monitor the response to treatment of the active type of insufficiency fractures. 相似文献
7.
Role of MRI in the diagnosis of insufficiency fractures of the sacrum and acetabular roof 总被引:4,自引:0,他引:4
Objective. To review the risk factors and the radiological appearance of insufficiency fractures of the sacrum and acetabular roof. Design and patients. Twenty patients with sacral and acetabular roof insufficiency fractures were reviewed retrospectively. There were 16 women
(80%) and 4 males (age range 48–86 years, excluding an 8-year-old boy). Thirteen patients had a known tumour, and nine had
received pelvic irradiation. All patients, except one who was asymptomatic, presented with low back or hip pain. In patients
with a known tumor, metastases were suspected. Plain radiography (20), bone scintigrams (16), MR examinations (20), and bone
densitometry (14) were performed. Nine patients also each had a CT scan. Results and conclusions. In three cases the CT scan performed 10–25 days after onset of symptoms was interpreted as normal. MR examination performed
a few days after the CT scan showed in each of these three patients a fracture line with a band of edema. Scintigraphy was
very sensitive, but the H-shaped pattern of sacral uptake, specific for an insufficiency fracture, was detected in only three
of 16 cases. The earliest MR sign was medullary edema, seen as early as 18 days after the onset of symptoms. On spin echo
(SE) T1-weighted images (T1WI), the hypointense signal of edema could mask a fracture line. On SE T2WI the fracture line could
be detected within the hyperintense edema (10 of 17 patients with examinations including SE T2WI). However, in four patients
a fracture of the sacrum was not seen on T2WI, these having been obtained in the axial plane. For this reason, intravenous
gadolinium was injected, revealing a fracture line in 12 of 14 examinations, or fat suppression sequences were performed,
revealing a fracture line in five of five cases. The total number of fractures detected was 17 [15 fractures of the sacrum
(bilateral in 10 cases) and two of the acetabular roof]. At a later stage, the edema resolved and the fracture was clearly
seen. The two cases of fracture of the acetabular roof were easily recognized at MRI, particularly in the sagittal plane. 相似文献
8.
Magnetic resonance appearance of sacral insufficiency fractures 总被引:5,自引:0,他引:5
Sevil Kursunoglu Brahme M.D. Vinicio Cervilla M.D. Vinton Vint M.D. Kay Cooper M.D. Keith Kortman M.D. Donald Resnick M.D. 《Skeletal radiology》1990,19(7):489-493
Insufficiency fractures of the sacrum are a commonly recognized form of stress fracture typically occurring in elderly patients. As such patients usually present with low back pain, MR imaging is often performed initially as a means of evaluation. We present 5 patients with sacral insufficiency fractures imaged with MR. Metastatic disease was a leading clinical suspicion as all patients were elderly and three had known primary neoplasms. T1-weighted sequences demonstrated bands of decreased signal intensity, usually paralleling the sacral aspect of the sacroiliac joints and occasionally occurring as a horizontal band across the sacral body. Four of five patients underwent further evaluation with computed tomography (CT) or nuclear bone scanning, which confirmed the diagnosis of sacral insufficiency fracture. We conclude that MRI is sensitive but not specific in detecting sacral insufficiency fractures. As MR imaging is rapidly becoming the method of choice for evaluating back pain, it is important to consider this diagnosis in elderly persons. 相似文献
9.
ObjectivesThe purpose of this study is to compare the various magnetic resonance imaging (MRI) sequences when they are used to visualize and evaluate cerebral venous thrombosis.MethodsEleven patients with cerebral venous thrombosis were retrospectively analyzed using computed tomography, MRI, magnetic resonance angiography (MRA), and conventional angiography. The MR sequence included T1-weighted spin echo (SE) imaging, obtained before and after administration of contrast medium, T2-weighted turbo spin echo (TSE), fluid-attenuated inversion recovery (FLAIR), T2*-weighted conventional gradient-echo (GRE), as well as three-dimensional (3D) venous time-of-flight MRA and conventional angiography.ResultsIn all of our patients, the venous sinus thromboses were most successfully detected during the T2*-weighted GRE sequence. The thrombosis was well visualized with the T1-weighted SE sequence in three of four patients in whom it was in the subacute stage. The T2*-weighted GRE sequence was superior to the T2-weighted TSE, T1-weighted SE, and FLAIR sequences in all patients. Enhanced 3D MR venography showed the thrombosed segment of the venous sinus and well correlated with the conventional angiographic findings.ConclusionsThe T2*-weighted conventional GRE sequences may be the best method for detecting of cerebral venous thrombosis. Therefore, it would seem to be beneficial to integrate a T2*-weighted conventional GRE sequence into the MR protocol to diagnose cerebral venous thrombosis. 相似文献
10.
A comparison of pulse sequences in the detection of post-traumatic bone marrow abnormalities at low field strength MRI 总被引:1,自引:0,他引:1
Objective and patients. One hundred and forty-one patients with recent joint trauma, aged 12–71 years, were imaged on a 0.2-T dedicated MRI system
and evaluated for bone bruises. The most beneficial sequences were compared. Design. The diagnosis of post-traumatic bone marrow abnormalities was established in 20 of 141 patients on the basis of decreased
signal intensity on T1-weighted SE and GRE sequences and increased signal intensity on T2-weighted TSE and fat-suppressed
IRGE sequences. Signal changes within the bone marrow were evaluated and statistically correlated with normal bone. Results. The highest signal alteration was found on T1-weighted SE and GRE sequences, followed by IRGE, which detected smaller differences
in signal intensity. T2-weighted TSE imaging showed the least contrast. The areas with bone marrow changes were approximately
equal in size on T1-weighted SE and T2-weighted TSE sequences. The same areas depicted on IRGE and GRE sequences proved to
be significantly larger (P<0.01). Conclusion. Using a 0.2-T dedicated system T1-weighted SE, T1-weighted GRE and IRGE sequences were most effective in detecting conspicuous
bone marrow alteration, while the T2-weighted TSE sequence was inferior. GRE and IRGE imaging showed areas about 4 times larger
depicting bone marrow changes. On suspicion of bone bruise, a protocol including GRE and IRGE pulse sequences could be most
beneficial. 相似文献
11.
Objective. Previous works describe magnetic resonance (MR) imaging characteristics of stress fractures. Diagnosis of the atypical, longitudinal
type of stress fracture has been reported using computed tomography (CT). This report focuses on MR imaging of longitudinal
stress fractures of the tibia. Materials and methods. Six cases are presented in which a longitudinal linear abnormal marrow signal was detected in the middle and distal parts
of the tibial shaft. Five patients were imaged using a 1.5 Tesla MR unit. Axial, sagittal and coronal T1 and T2-weighted or
fat suppressed proton density fast spin echo images were obtained in all but one patient. One patient was imaged using a 0.5
Tesla MR unit with axial and coronal T1- and T2-weighted sequences. Initial conventional radiographs seen at clinical presentation
were interpreted as normal in all cases. Two patients underwent radionuclide bone scan, and one patient was imaged with CT
prior to MR imaging. Results. In each instance, MR imaging demonstrated linear marrow signal abnormalities orientated along the long axis of the tibial
shaft. Endosteal and periosteal callus was identified on axial images. In all cases, MR imaging clearly demonstrated a fracture
extending through one cortex with abnormal signal in both the marrow cavity as well as adjacent soft tissues indicating edema.
Conclusion. MR imaging was shown to be excellent for demonstration of fracture lines, callus, and marrow and soft tissue abnormalities
seen in association with longitudinal stress fractures. 相似文献
12.
Imaging of acute injuries of the articular surfaces (chondral, osteochondral and subchondral fractures) 总被引:7,自引:0,他引:7
Klaus Bohndorf 《Skeletal radiology》1999,28(10):545-560
Fractures involving the articulating surfaces of bone are a common cause of chronic disability after joint injury. Acute fractures
of the articular surface typically run parallel to the surface and are confined to the cartilage and/or the immediate subchondral
cancellous bone. They should be distinguished from vertical or oblique bone fractures with intra-articular extension. This
article reviews the mechanism of acute articular surface injuries, as well as their incidence, clinical presentation, radiologic
appearance and treatment. A classification is presented based on direct inspection (arthroscopy) and imaging (especially
MRI), emphasizing the distinction between lesions with intact (subchondral impaction and subchondral bone bruises) and disrupted
(chondral, osteochondral lesions) cartilage. Hyaline cartilage, subchondral bone plate and subchondral cancellous bone are
to be considered an anatomic unit. Subchondral articular surface lesions, osteochondral fractures and solely chondral fractures are different manifestations of impaction injuries that affect the articulating surface. Of the noninvasive imaging
modalities, conventional radiography and MRI provide the most relevant information. The appropriate use of short tau inversion
recovery, T1-weighted and T2-weighted (turbo) spin-echo as well as gradient-echo sequences, enables MRI to classify the various
acute articular surface lesions with great accuracy and provides therapeutic guidance.
Received: 5 April 1999 Revision requested: 6 May 1999 Revision received: 21 June 1999 Accepted: 12 July 1999 相似文献
13.
Multifocal nodular fatty infiltration of the liver mimicking metastatic disease on CT: imaging findings and diagnosis using MR imaging 总被引:1,自引:0,他引:1
Kröncke TJ Taupitz M Kivelitz D Scheer I Daberkow U Rudolph B Hamm B 《European radiology》2000,10(7):1095-1100
The aim of this study was to describe the MR appearance of multifocal nodular fatty infiltration of the liver (MNFIL) using
T1-weighted in-phase (IP) and opposed-phase (OP) gradient-echo as well as T2-weighted turbo-spin-echo sequences with fat suppression
(FSTSE) and without (HASTE). Magnetic resonance imaging examinations at 1.5 T using T1-weighted IP and OP-GRE with fast low
angle shot (FLASH) technique, and T2-weighted FSTSE, T2-weighted HASTE of 137 patients undergoing evaluation for focal liver
lesions were reviewed. Five patients were identified in whom CT indicated metastatic disease; however, no liver malignancy
was finally proven. Diagnosis was confirmed by biopsy (n = 3), additional wedge resection (n = 1) or follow-up MRI 6–12 months later (n = 5). Regarding the identified five patients, the number of focal liver lesions was 2 (n = 2) and more than 20 (n = 3). The MR imaging characteristics were as follows: OP-image: markedly hypointense (n = 5); IP image: isointense (n = 2) or slightly hyperintense (n = 3); T2-weighted FSTSE-image: isointense (n = 5); T2-weighted HASTE image isointense (n = 1); slightly hyperintense (n = 4). On OP images all lesions were sharply demarcated and of almost spherical configuration (n = 5). Further evaluation by histology or follow-up MR imaging did not give evidence of malignancy in any case. Histology
revealed fatty infiltration of the liver parenchyma in three patients. Magnetic resonance follow-up showed complete resolution
in two patients and no change in three patients. Multifocal nodular fatty infiltration can simulate metastatic disease on
both CT and MR imaging. The combination of in-phase (IP) and opposed-phase (OP) gradient-echo imaging can reliably differentiate
MNFIL from metastatic disease.
Received: 15 September 1999 Revised: 3 February 2000; Accepted: 7 February 2000 相似文献
14.
The aim of this study was to determine the efficacy of Gd-BOPTA-enhanced MRI in liver lesion detection in comparison with
unenhanced MRI and dynamic CT. The image sets of 148 of 151 patients enrolled in a multicenter German phase-III trial were
evaluated by two independent radiologists unaffiliated with the investigating centers. Patients underwent a routine MRI protocol
comprising T2- and T1-weighted spin-echo and T1-weighted gradient-echo (GE) sequences pre and 1 h post 0.1 mmol/kg Gd-BOPTA
(Bracco-Byk Gulden, Konstanz, Germany). Additionally, a serial T1-weighted GE scan was performed after administration of the
first half of the dose. All patients underwent dynamic contrast-enhanced CT. The evaluation was performed with regard to the
number and size of lesions detected per patient by each modality or sequence. Furthermore, all pre CM and pre + post CM image
sets were analyzed for number of lesions per patient. Both readers detected significantly more lesions in the contrast-enhanced
image set compared with the unenhanced image set (32 and 39 %, respectively; p < 0.0001). While contrast-enhanced CT detected a similar number of lesions to unenhanced MRI, it was clearly inferior to
contrast-enhanced MRI (reader 1: p = 0.0117; reader 2: p = 0.0225). Of the T1-weighted scans performed, the dynamic and late T1-weighted GE exams contributed most to the increased
lesion detection rate (reader 1: p = 0.0007; reader 2: p = 0.0037). The size of the smallest lesion detected by means of MRI was significantly larger in the pre-CM image sets than
in the pre + post CM image sets (reader 1: p = 0.001; reader 2: p < 0.0001). Gd-BOPTA-enhanced MRI detected significantly smaller lesions than contrast-enhanced CT (reader 1: p = 0.0117; reader 2: p = 0.0925). Gd-BOPTA-enhanced MR imaging improves liver lesion detection significantly over unenhanced MRI and dynamic CT.
Received: 18 October 1999/Revised: 19 June 2000/Accepted: 21 June 2000 相似文献
15.
Ahmed El-Assmy Mohamed E. Abou-El-Ghar Ahmed Mosbah Ahmed R. El-Nahas Huda F. Refaie Ihab A. Hekal Tarek El-Diasty El Housseiny Ibrahiem 《European radiology》2009,19(7):1575-1581
The aim of this work was to evaluate the clinical feasibility of diffusion-weighted (DW) MRI in detection and staging of urinary
bladder tumour and to compare DW MRI with the T2-weighted technique. One hundred and six patients with bladder tumour were prospectively included in our study. All patients
were evaluated with MR imaging. We started with axial T2-weighted high resolution MR of the urinary bladder, then DW MRI. Two radiologists independently interpreted the MR images,
and discrepancies were resolved by consensus. The accuracy of DW MRI in staging of bladder tumour was evaluated using the
final histopathological findings. In DW imaging (DWI) staging accuracy was 63.6% and 69.6% in differentiating superficial
from invasive tumours and organ-confined from non-organ-confined tumours, respectively. On a stage by a stage basis, DWI accuracy
was 63.6% (21/33), 75.7% (25/33), 93.7% (30/32) and 87.5% (7/8) for stages T1, T2, T3 and T4, respectively. In the T2-weighted technique, the overall staging accuracy was only 39.6% and accuracy for differentiating superficial from invasive
tumours and organ-confined from non-organ-confined tumours was 6.1% and 15.1%, respectively. DW is superior to T2-weighted MRI in staging of organ-confined tumours (≤T2) and both techniques are comparable in the evaluation of higher-stage tumours. 相似文献
16.
G. A. Hottya F. O. Häckl N. G. Iwasko E. Weber D. White L. S. Steinbach C. G. Peterfy H. K. Genant 《Emergency radiology》2000,7(6):339-348
Purpose: To examine the utility of low-field, dedicated extremity MRI for assessing acute upper extremity trauma in patients with
radiographs that are negative for fracture. Secondly, to determine which sequences are most useful when screening for fractures.
Methods: Forty-four of 46 patients with acute upper extremity trauma and initial radiographs negative for fracture were imaged with
a 0.2-T MRI system. Findings were verified with follow-up clinical assessment and plain radiography. Results: In 21 patients, dedicated extremity MRI demonstrated 26 ultimately proven occult fractures, none of which were seen on the
initial conventional radiographs. True fractures demonstrated marrow edema and a linear fracture line on low-field MRI. One
bone contusion showed edema with no fracture line and was misdiagnosed as a fracture. Low-field MRI correctly identified 23
remaining patients with no fracture. Sensitivity and specificity for fracture in the 44 patients successfully imaged were
100 % and 96 %, respectively. Additionally, 21 soft-tissue injuries were found incidentally by MRI. However, these may not
merely be incidental findings of an acute nature, but may very well be chronic, and therefore merit no specific treatment.
T1-weighted gradient-echo and short-tau inversion recovery sequences demonstrated the fracture line and marrow edema to best
advantage, and were thus the most useful sequences to assess fractures on low-field MRI. Conclusion: Extremity MRI is highly sensitive and specific for radiographically occult fractures of the upper extremity and can also
identify associated soft-tissue injuries. In our study, the management was altered in 45 % of the patients following MRI.
When adequate sequences are used this modality can direct appropriate therapy while obviating the added expense and morbidity
of unnecessary immobilization and follow-up imaging of patients without fracture. 相似文献
17.
Cecilia S. F. Wang L. S. Steinbach John B. Campbell Grant Hayashi Sangwook T. Yoon James O. Johnston 《Skeletal radiology》1999,28(7):390-395
Objective. Fibrogenesis imperfecta ossium is an extremely rare disorder that can easily be misdiagnosed. We retrospectively reviewed
the clinical and imaging data of three confirmed cases of fibrogenesis imperfecta.
Design and patients. The patients consisted of two men and one woman, ranging in age from 40 to 53 years. Radiography was performed in all the
patients. One patient had a 3-year follow-up of the thoracolumbar spine with conventional radiography and thoracolumbar magnetic
resonance (MR) imaging. Open biopsy was performed in all cases, confirming the diagnosis of fibrogenesis imperfecta ossium.
Results. All our cases demonstrated ”fishnet” trabecular pattern by conventional radiographs, and a pelvis radiograph of one patient
showed an equivocal sclerosis pattern. Multiple fractures were noted in two patients. A pseudoexostosis was present in the
ilium in one patient. Thoracolumbar MR imaging demonstrated diffuse low signal intensity within the medullary space on both
T1-weighed and T2-weighted images, except for a region of increased signal intensity in the L1 and L2 vertebral bodies on
T2-weighed images due to edema from acute collapse.
Conclusions. Although uncommon, fibrogenesis imperfecta ossium should be considered in a previously healthy patient with a combination
of progressive bone pain, unexplained fractures, a radiologic pattern of fishnet osteopenia and MR imaging of low signal intensity
bone marrow on both T1-weighted and T2-weighted images.
Received: 16 February 1999 Revision requested: 7 April 1999 Revision received: 7 May 1999 Accepted: 19 May 1999 相似文献
18.
Ozgur Oztekin Ebru Ozan Zehra Hilal Adibelli Gökhan Unal Yusuf Abali 《Skeletal radiology》2009,38(7):651-658
Objective Conventional MR sequences are sometimes not helpful in differentiating benign from pathologic fractures. Our aim was to evaluate
the usefulness of single-shot echo-planar imaging sequences (diffusion-weighted imaging (DWI)/SSH-EPI) with low b value in differentiating malignant metastatic tumor infiltration of vertebral bone marrow from benign vertebral fracture
edema.
Materials and methods A total of 47 patients, 20 with benign fractures and 27 with tumor infiltration, were included in this prospective study.
Diffusion-weighted MR images were obtained by single-shot echo-planar imaging technique with diffusion gradient (b = 300 s/mm2; TR/TE, 1,400/100), using a 1.5 T MR scanner. T1- and T2-weighted images and short inversion time inversion-recovery images
were available for all 64 lesions. The lesions on DWI/SSH-EPI were categorized as having hypo-, iso-, or hyperintense signal
intensity relative to normal vertebrae by two experienced radiologists.
Results We evaluated signal intensity patterns on DWI/SSH-EPI in 64 lesions, which showed low signal intensity on T1-weighted images
in both benign fractures and metastasis. With the exception of sclerotic metastases in two patients, malignant metastatic
tumor infiltration was hyperintense with respect to normal bone marrow on diffusion-weighted images; all but four benign vertebral
fractures were isointense with respect to normal bone marrow.
Conclusion Single-shot echo-planar imaging sequences (DWI/SSH-EPI) with low b value provided excellent distinction between metastatic tumor infiltration and benign vertebral fracture edema. Hyperintense
signal intensity on DWI/SSH-EPI was highly specific for the diagnosis of metastatic tumor infiltration of the spine. 相似文献
19.
MRI in the diagnosis of small bowel disease: use of positive and negative oral contrast media in combination with enteroclysis 总被引:12,自引:0,他引:12
Rieber A Aschoff A Nüssle K Wruk D Tomczak R Reinshagen M Adler G Brambs HJ 《European radiology》2000,10(9):1377-1382
The aim of the study was to evaluate the additional findings of MRI following small bowel enteroclysis and to compare the
efficacy of negative and positive intraluminal contrast agents. Fifty patients with inflammatory or tumorous small bowel disease
were investigated by small bowel enteroclysis and consecutive MRI using breathhold protocol (T1-weighted fast low-angle shot,
T2-weighted turbo spin echo). Patients were randomly assigned to either receiving a positive oral (Magnevist, Schering, Berlin,
Germany) or a negative oral MR contrast media (Abdoscan, Nycomed, Oslo, Norway). The pattern of contrast distribution, the
contrast effect, presence of artifacts, as well as bowel wall and extraluminal changes, were determined and compared between
the contrast type using Fischer's exact test. Sensitivity, specificity, and diagnostic accuracy for MRI and enteroclysis were
calculated. Twenty-seven patients had clinically proven Crohn's disease and two patients surgically proven small bowel tumours.
Magnetic resonance imaging had important additional findings as abscesses and fistulae in 20 patients. Surgically compared
sensitivities were 100 and 0 % for MRI and enteroclysis, for the detection of abscesses, and 83.3 and 17 % for the diagnosis
of fistulae, respectively. Bowel wall thickening was more reliably detected with use of positive oral contrast media without
intravenous enhancement (p < 0.001), whereas postcontrast negative oral contrast media allow for a superior detection (p < 0.001). T2-weighted sequences were necessary with use of negative oral contrast media, because loop abscesses may be masked.
Magnetic resonance imaging should be performed in all patients with suspicion of extraintestinal complications, because the
complications are more reliably detected by MRI. Negative oral contrast media show advantages with the use of intravenous
contrast but can mask loop abscesses using only T1-weighted imaging.
Received: 5 March 1999; Revised: 21 September 1999; Accepted: 3 February 2000 相似文献
20.
Akira Kawashima M.D. Janet E. Kuhlman M.D. Elliot K. Fishman M.D. Clare M. Tempany M.D. Donna Magid M.D. Howard M. Lederman M.D. Ph.D. Jerry A. Winkelstein M.D. Elias A. Zerhouni M.D. 《Skeletal radiology》1991,20(7):487-493
Pulmonary Aspergillus infection in patients with chronic granulomatous disease tends to involve the chest wall and consequently carries a high mortality rate. We report the findings of computed tomography (CT) and magnetic resonance imaging (MRI) in three such cases. One patient underwent both CT and MRI, one, CT only, and one, MRI only. In all three, both CT and MRI demonstrated pulmonary consolidations with direct extension to the adjacent chest wall. In both patients who were examined by CT, scans revealed permeative osteolytic changes of adjacent rib or spine compatible with osteomyelitis. In both patients who were examined by MRI, adjacent chest wall involvement was depicted on T1-weighted images and showed increased signal intensity on T2-weighted images. In one of these patients, the chest wall lesion was well defined on T2-weighted images, an appearance compatible with abscess. Epidural extension was demonstrated on MRI in the other patient, who later developed paraparesis. We suggest that CT and MRI have a complementary role in evaluating chest wall invasion by pulmonary Aspergillus infection in chronic granulomatous disease. 相似文献