Creutzfeldt-Jakob disease: magnetic resonance imaging findings

Rapidly progressive dementia in an adult with findings of bilateral, symmetric high signal intensity on T2-weighted sequences and normal findings on T1-weighted sequences predominantly in the deep grey matter is suggestive of Creutzfeldt-Jakob disease (CJD). The peripheral cortex may be involved, as it was in the present case. The absence of subcortical periventricular white matter high signal intensity suggests that symmetric high signal intensities within the basal ganglia and cortical grey matter are more likely to be due to a degenerative process rather than due to ischaemia, infection or tumour.     

Hoyeraal-Hreidarsson syndrome: magnetic resonance imaging findings

Hoyeraal-Hreidarsson syndrome (HH) has been defined as a severe variant of dyskeratosis congenita (DKC). We report here a case of a 6-year-old girl with HH who presented with bone marrow hypoplasia, skin pigmentation, nail dystrophy, growth retardation, and bilateral retinal hemorrhage. Brain MRI revealed cerebellar hypoplasia, hypoplasia of the corpus callosum, a small pituitary gland, a small brain stem, and focal long T2 lesions in the thalamus and brain stem. A brain computed tomography scan revealed intracranial calcification as well. To the best of our knowledge, a small pituitary gland and focal long T2 lesions in the thalamus and brain stem have never been reported as a feature of HH.     

Sturge-Weber syndrome: diffusion magnetic resonance imaging and proton magnetic resonance spectroscopy findings

We report on the diffusion magnetic resonance imaging (MRI) and proton MR spectroscopy findings of a 26-year-old female patient with Sturge-Weber syndrome. Echo-planar trace diffusion MRI revealed mildly high signal intensity changes at parieto-occipital lobes on b = 1000 s/mm² images, suggesting restricted diffusion. On corresponding apparent diffusion coefficient maps, those areas had moderately high signal intensity and high apparent diffusion coefficient values (around 0.9×10(-3) mm²/s) compared with the contralateral symmetrical normal side of the brain (0.776×10(-3) mm²/s). This finding was consistent with increased motion of water molecules (disintegration of the neural tissue) in these regions. Proton MR spectroscopy revealed decreased N-acetyl aspartate and increased choline peaks, indicating disintegration of neural tissue associated with neuronal loss as well.     

Cat scratch disease: magnetic resonance imaging findings

Cat scratch disease is an infectious lymphadenitis frequently occurring in children and adolescents. We present the magnetic resonance imaging findings of two patients with this disease. In both cases, lymphadenopathy was characterized by extensive stranding of the surrounding soft tissues, consistent with the inflammatory nature of this condition. Magnetic resonance imaging can be diagnostic and may obviate the need for invasive means of evaluation in patients suspected of having cat scratch disease.     

Nonketotic hyperglycinemia: diffusion magnetic resonance imaging findings

We report about a boy with nonketotic hyperglycinemia who was studied at 15 days of life with a follow-up examination at age 6 months. Magnetic resonance (MR) imaging revealed progressive atrophy, callosal thinning, and delayed myelination. Glycine peaks were shown by proton MR spectroscopy at 3.56 ppm with a long echo time (TE, 135 milliseconds; TR, 1500 milliseconds). Echo-planar diffusion MR imaging (TR, 5700 milliseconds; TE, 139 milliseconds) at 15 days of life revealed high-signal lesions in the pyramidal tracts, middle cerebellar pedicles, and dentate nuclei on b = 1000 s/mm2 images associated with low apparent diffusion coefficient (ADC) values. By age 6 months, the lesions became more prominent on b = 1000 s/mm2 images with lower ADC values. Diffusion MR imaging findings likely reflected the histopathologic changes of the disease which consisted of spongiosis of the myelinated brain tissue due to myelin vacuolation.     

Canavan disease: diffusion magnetic resonance imaging findings

A 15-month-old boy with Canavan disease is reported in whom a restricted diffusion pattern on diffusion magnetic resonance imaging (MRI) (high signal on b = 1,000 mm2/s images and low apparent diffusion coefficient [ADC] values) was evident in the affected regions of the brain, including the peripheral white matter, globi pallidi, thalami, brainstem, dorsal pons, and dentate nuclei. The ADC values at these regions ranged from 0.42 to 0.56 x 10(-3) mm2/s compared with the normal ADC values from the uninvolved deep frontal white matter (0.68-0.92 x 10(-3) mm2/s). The known histopathologic features in Canavan disease include edematous and gelatinous brain tissue associated with diffuse vacuolization. Considering these and the diffusion MRI findings in this patient, it is likely that existence of a gel (gelatinous) state rather than the usual sol state of water molecules in the affected brain regions accounted for the restricted diffusion pattern in Canavan disease.     

Large paravaginal angiomyofibroblastoma: magnetic resonance imaging findings

Angiomyofibroblastoma (AMFB) is a rare, benign, mesenchymal tumor that occurs mainly in the female lower genital tract. We report on a large posterior paravaginal AMFB that presented as a buttock mass, describing the magnetic resonance imaging (MRI) features of the disease. The tumor displays heterogeneous signal intensity on T2-weighted MRI and fast and persistent inhomogeneous enhancement on dynamic gadolinium-enhanced MRI.     

Rhabdomyolysis: magnetic resonance imaging and computed tomography findings

OBJECTIVE: Our purpose was to describe the magnetic resonance (MR) imaging and computed tomography (CT) findings in patients with rhabdomyolysis. METHODS: The medical records and imaging studies of 10 patients (5 males, 5 females; age range, 14-60 years; mean age, 28.3 years) with rhabdomyolysis were retrospectively reviewed. Magnetic resonance imaging was available in 9 patients and CT in 2 patients. RESULTS: Two distinct imaging types of rhabdomyolysis were observed. For type 1 rhabdomyolysis (n = 2), the affected muscles revealed homogeneously isointense to hyperintense on T1-weighted, homogeneously hyperintense on T2-weighted and short-tau inversion recovery (STIR) images, and homogeneously enhanced on contrast-enhanced MR images. For type 2 rhabdomyolysis (n = 8), the affected muscles revealed homogeneously or heterogeneously isointense to hyperintense on T1-weighted images, heterogeneously hyperintense on T2-weighted and STIR images, heterogeneously hypodense on CT images, and rim enhanced on contrast-enhanced MR and CT images with the presence of a specific presentation, named as the "stipple sign." CONCLUSIONS: Rhabdomyolysis is a clinical and biochemical syndrome comprising 2 distinct imaging types. Homogeneous signal changes and enhancement in the affected muscles advocate type 1 rhabdomyolysis. The stipple sign is helpful in demonstrating the areas of myonecrosis in type 2 rhabdomyolysis and, together with clinical and laboratory presentations, in reaching the correct diagnosis.     

Retropharyngeal tendinitis: radiographic and magnetic resonance imaging findings

Purpose: To describe the magnetic resonance imaging (MRI) findings in retropharyngeal tendinitis.

Material and methods: Within 1 year, four patients presenting with symptoms of retropharyngeal tendinitis were examined by radiography and MRI.

Results: On MRI and radiographs, all patients had characteristic soft-tissue swellings and calcifications related to the tendon of the longus colli muscle situated inferior to the anterior arc of C1. MRI showed well-defined edema, with high signal in the retropharyngeal tissue anterior to C1-C5 on short T1 inversion recovery (STIR) sequences, low signal on T1-weighted sequences, and low signal in the calcification on both sequences. In addition, three patients had high signal intensity changes on STIR sequences in the atlantoaxial joint situated posterior to the anterior arc of C1.

Conclusion: MRI is a sensitive and accurate method in the diagnosis of retropharyngeal tendinitis. A new finding in this condition is an effusion or synovitis in the anterior atlantoaxial joint. MRI is a valuable tool in differentiating retropharyngeal tendinitis from other diagnoses such as retropharyngeal abscess, pyogenic spondylitis, and spondyloarthropathy.     

Double-chambered right ventricle: magnetic resonance imaging findings

Primary double-chambered right ventricle is an uncommon congenital anomaly that presents with right ventricular outflow tract obstruction in childhood or adolescence. A search of the literature revealed only a few documented case reports with MRI findings. We present a case with mixed lesions, and with anomalous muscle bundles located both in the middle portion of the right ventricular sinus and at the subinfundibular level.     

Subungual keratoacanthoma: ultrasound and magnetic resonance imaging findings

Subungual keratoacanthoma is a rare, squamoproliferative neoplasm arising at the nail bed. It may cause erosion of the underlying bone. We report a case of subungual keratoacanthoma of the right thumb in a 63-year-old man. Radiographs showed cortical erosion of the distal phalanx of the right thumb. Ultrasonography showed a mixed echoic tumor. On magnetic resonance imaging (MRI), the tumor showed intermediate signal intensity on T1-weighted images and mixed intermediate and high signal intensity on T2-weighted images with peripheral thin rim enhancement.     

Comparison of magnetic resonance angiography,magnetic resonance imaging and conventional angiography in cerebral arteriovenous malformation

Summary 10 patients with an AVM of the brain were examined by magnetic resonance angiography (MRA), magnetic resonance imaging (MRI) and conventional cerebral angiography (CCA). From MRA in 7/10 patients important information about vascular supply could be provided; in 3 patients, all with small AVM's it could be only suspected. CCA revealed the vascularisation of the AVM's in all patients and showed additional hemodynamic aspects better than MRA. With MRI in all cases the AVM could be diagnosed, but only the involvement of the main cerebral vessels could be demonstrated; however, MRI is superior to MRA and CCA in showing the nidus and the involved brain structures.     

Hypogenetic lung syndrome: Functional and anatomic evaluation with magnetic resonance imaging and magnetic resonance angiography

A case of hypogenetic lung syndrome is described in which anatomic and functional information was obtained with use of ECG-triggered turbo (fast) spin-echo, cine, velocity-encoded cine, and contrast-enhanced magnetic resonance angiography (MRA) sequences. To the best of our knowledge, a complete functional and anatomic study of hypogenetic lung syndrome with MRI has not been previously reported.     

Giant fibroma in the left ventricle of an infant: imaging findings in magnetic resonance imaging,echocardiography and angiography

The diagnosis of a rare case of giant intraventricular fibroma in an infant by MRI in comparison with other imaging modalities, such as echocardiography and angiography, is discussed. For preoperative planning only MRI showed the myocardial infiltration. The myocardial blood supply of the tumor could be evaluated qualitatively by contrast-enhanced MRI, but the direct visualization of the distally located branches could only be assessed by coronary angiography. Magnetic resonance coronary angiography using the navigator technique failed to depict the distal part of the coronaries. The obstruction of the left ventricle outflow tract could be assessed and quantified by all imaging modalities.     

Giant fibroma in the left ventricle of an infant: imaging findings in magnetic resonance imaging,echocardiography and angiography

European Radiology - The diagnosis of a rare case of giant intraventricular fibroma in an infant by MRI in comparison with other imaging modalities, such as echocardiography and angiography, is...     

L-2 hydroxyglutaric aciduria: proton magnetic resonance spectroscopy and diffusion magnetic resonance imaging findings

A 10-month-old boy was reported with the diagnosis of L-2 hydroxyglutaric aciduria. Amino acid chromatographic analysis revealed an 80-fold increase of hydroxyglutaric acid in the urine. Proton magnetic resonance (MR) spectroscopy of the brain obtained with the hybrid chemical shift imaging sequence (repetition time = 1,500 milliseconds, echo time = 40 milliseconds) revealed prominent peaks resonating at 2.50 ppm, which were attributable to L-2 hydroxyglutaric acid. Diffusion MR imaging was obtained using the echo-planar trace sequence (repetition time = 5,700 milliseconds, echo time = 139 milliseconds). Two different diffusion patterns were evident: a restricted diffusion pattern in the globi pallidi and an increased diffusion pattern in the white matter.     

Polyorchidism: color Doppler ultrasonography and magnetic resonance imaging findings

Polyorchidism, the presence of more than two testes, is a very rare anomaly. We report the color Doppler ultrasonography and magnetic resonance imaging findings of the case of a 20-year-old man with polyorchidism, presenting with an asymptomatic scrotal mass. Ultrasonography showed double testes with double separate epididymides sharing a common vas deferens in the left side of the scrotum. The double testes demonstrated similar echo texture and vascular flow as the normal testis, but smaller in size. Magnetic resonance imaging showed three testes very clearly and confirmed the diagnoses. After 2 years of follow-up, he was managed with surgical intervention. Pathology report revealed polyorchidism.     

Wilson's disease: computed tomography and magnetic resonance imaging findings

The condition of a patient with Wilson's disease was evaluated by magnetic resonance imaging (MRI) on initial presentation of the illness. The examination revealed mild atrophy of the superior vermis. Symmetric areas of increased signal intensity on T2-weighted images were detected in the anterior thalami, mesencephalic tectum and tegmentum. Marked symmetric hypointensities appeared in the head of caudate, pallida, substantia nigra and red nuclei. The histopathology of Wilson's disease suggests that these hypointensities may be secondary to the presence of protein-bound copper.