Intraosseous metaplastic meningioma: A case report

Metaplastic meningioma is a rare World Health Organization Grade I meningioma subtype, accounting for 0.2%-1.6% of all meningiomas. Primary extradural meningiomas represent less than 2% of all meningiomas, with intraosseous meningioma as a subtype of primary extradural meningiomas. Herein, we report the case of a 65-year-old male presenting with headache. His computed tomography scans showed an osteolytic left parietal bone mass, and magnetic resonance imaging revealed hyperintense dots in the mass on T1-weighted images. The mass was then resected and diagnosed on histopathological examination as an intraosseous metaplastic meningioma.     

Cases from the Cleveland Clinic: cerebral venous sinus thrombosis presenting to the emergency department with worst headache of life

A 31 year old woman presented with the worst headache of her life and was diagnosed with cerebral venous sinus thrombosis (CVST) by routine unenhanced computed tomography (CT) scan, subsequently confirmed with magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Awareness of this less common cause for acute neurological presentation in the Emergency setting is important; the imaging characteristics of CVST are reviewed.     

Percutaneous gadolinium injection under MR guidance to mark target for CT-guided radiofrequency ablation

Selection of the appropriate imaging tool depends on a number of factors that reflect the patient, the procedure, and the physician. Multiple imaging techniques are often required to perform elements of a whole procedure. A patient with an allergy to iodinated contrast material and a 3.0-cm hepatic metastasis that was invisible on computed tomography (CT) was treated with CT-guided radiofrequency ablation by first injecting gadolinium under magnetic resonance guidance to mark the location of the lesion. Gadolinium's high atomic number makes it a viable contrast agent for attenuating x rays under fluoroscopic or CT guidance.     

Indications for and results of outpatient computed tomography and magnetic resonance imaging in Ontario

OBJECTIVE: Population rates of computed tomography (CT) and magnetic resonance imaging (MRI) continue to increase markedly. However, little is known about the indications for and results of these imaging tests. METHODS: A cross-sectional chart-abstraction study was used to determine the indications for and results of outpatient CT and MRI scans performed on or after January 1, 2005, at randomly selected Ontario hospitals. RESULTS: We studied 11,824 CT and 11,867 MRI scans. Cancer-related indications accounted for over 50% of CT scans of the abdomen-pelvis and chest. Headache was the most frequent indication for CT of the brain. More than one-half of MRI scans of the extremities were for knee pain or suspected meniscal tear. Back pain and radiculopathy were the most frequent indications for MRI of the spine. There was considerable variation between institutions in ordering patterns, with as much as a 70-fold difference between hospitals in the frequency of scans ordered for a specific indication. Less than 2% of CT scans of the brain for headache found abnormalities that could explain the headache, while over 90% of MRI scans of the spine for back pain were abnormal, although the clinical importance of the abnormalities was unclear. Conclusions: These data are a starting point for a discussion about appropriateness. Further information will be obtained by examining individual indications more closely, and linking these data to administrative databases to evaluate the impact of these imaging tests on clinical practice.     

Giant arachnoid granulation in a patient with benign intracranial hypertension (2009: 1b)

We report magnetic resonance (MR), computed tomography (CT) and angiographic imaging of an unusual giant arachnoid granulation 7(GAG) in the superior sagittal sinus in a man with headache and vertigo. Intrasinus pressure measurements revealed a significant pressure gradient across the lesion. MR imaging is useful to identify GAG and dural sinus thrombosis, whereas dural sinus pressure measurement in certain cases of GAGs can be used to evaluate the lesion as the cause of the patient’s symptoms.     

Syringomyelia: myelography, computed tomography, and magnetic resonance imaging

Seventeen patients with cervical spinal cord cavities were studied with myelography, postmyelographic computed tomography scanning, and magnetic resonance imaging. The three diagnostic techniques were compared for accuracy, patient comfort, and ease of procedure. Magnetic resonance imaging was the best diagnostic and most comfortable procedure. There is no need for myelography or postmyelographic computed tomography scanning for the evaluation of cervical syringomyelia.     

Fractured osteophyte demonstrated on SPECT and computed tomography

ABSTRACT We present an interesting case of a fractured osteophyte causing back pain that was demonstrated both on bone single photon emission computed tomography (SPECT) and computed tomography (CT). The magnetic resonance images, thoracic anterior spine plain radiograph, whole-body bone scan passes, and thoracic spot view were not impressive. Bone SPECT was the impetus for getting the CT scan. The CT scan not only demonstrated the osteophyte but a pseudarthrosis that was probably causing the pain. If it were not for the positive SPECT bone scan, the CT scan would not have been ordered after unimpressive magnetic resonance imaging.     

Cardiac aneurysms and diverticula: magnetic resonance and computed tomography appearances

Echocardiography is the first-line imaging modality for assessment of structural heart disease but magnetic resonance imaging and multi-detector computed tomography are being increasingly used for cardiac morphologic assessment. Aneurysms and diverticulae of the cardiac chambers and related structures represent a diverse group of conditions with varying etiologies and clinical manifestations. This article reviews the magnetic resonance imaging and multi-detector computed tomography features of these lesions with consideration of the emerging role that cross-sectional imaging has to play in their evaluation. Radiologists should be familiar with the salient imaging appearances of these conditions to facilitate optimal patient management.     

MRI and CT features in two unusual cases of xanthogranulomatous pyelonephritis

Two unusual cases of xanthogranulomatous pyelonephritis studied by both magnetic resonance imaging and computed tomography, are presented. Extension of the disease depicted by both computed tomography and magnetic resonance imaging was compatible with the findings at surgery. Computed tomography seems to be sufficient for xanthogranulomatous pyelonephritis imaging evaluation, while magnetic resonance imaging is not recommended on a routine basis, since no additional valuable information is yielded.     

Neurosarcoidosis: evaluation using computed tomography and magnetic resonance imaging

Two patients with unusual central nervous system sarcoid were investigated using computed tomography and magnetic resonance imaging, as well as other x-ray studies. A patient with intramedullary involvement of the spinal cord as well as nerve root involvement was examined. Follow-up examination after treatment with steroids showed a return to normal. The second patient had optic nerve involvement as well as two intracranial parenchymal lesions and granulomatous arachnoiditis. In this patient magnetic resonance imaging offered no advantages over computed tomography in the orbit but was significantly more accurate intracranially.     

Intracranial gumma mimicking a tuber cinereum tumor

The brain magnetic resonance (MR) and computed tomography (CT) finding in a 37-year-old patient with a history of persistent headache and secondary hypogonadism and with a strongly positive blood and cerebrospinal fluid (CSF) fluorescent treponemal antibody-absorption (FTA-ABS) test is reported. A focal enhancing mass was demonstrated involving the tuber cinereum. The mass was markedly reduced after the completion of a course of intravenous administration of penicillin G treatment. This case is interesting because of its rare incidence and unique neuroradiological findings.     

Brain MR imaging in the evaluation of chronic headache in patients without other neurologic symptoms

RATIONALE AND OBJECTIVES: The authors investigated the use of magnetic resonance (MR) imaging of the brain in adult patients with a primary complaint of chronic headache and no other neurologic symptoms or findings and determined the yield and MR predictors of major abnormalities in these patients. MATERIALS AND METHODS: The medical records and MR images of 402 adult patients with chronic headache were retrospectively reviewed. All patients had been evaluated and referred by the neurology service. The findings were categorized as either negative or positive for major abnormality. Multivariate analysis with a linear logistic regression technique was performed on the clinical data, which included patient age, patient sex, and headache type. RESULTS: Major abnormalities were found in 15 patients (3.7%), consisting of seven women (2.4%) and eight men (6.9%). Major abnormalities were found in 0.6% of those with migraine headaches, 1.4% with tension headaches, none with mixed migraine and tension headaches, 14.1% with atypical headaches, and 3.8% with other types of headaches. Multivariate analysis showed that the atypical headache type was the most significant predictor of major abnormality. CONCLUSION: The yield of major abnormalities found with brain MR imaging in patients with isolated chronic headache is low. However, those patients with atypical headaches have a higher yield of major abnormalities and may benefit from imaging.     

Evaluation of a new Spin-echo diffusion-weighted sequence on a 0.35 T open magnetic resonance imaging (MRI)-system: first experiences within 3 h after acute stroke

In acute stroke, diffusion-weighted magnetic resonance imaging helps to select patients who are eligible for thrombolysis, but is almost exclusively implemented on closed-bore scanners, which make monitoring of patients difficult. We developed and tested a cardiac gated Spin-echo diffusion-weighted sequence with prescan finetrim and motion correction on an open system with 0.35 T. Nineteen stroke patients appropriate for thrombolytic therapy by clinical criteria were enrolled in a prospective study on an intention-to-treat basis. In all but one patient, computed tomography and magnetic resonance imaging including the new diffusion-weighted sequence were performed within 3 h after symptom onset. Images were evaluated for acute cerebral ischemia and hemorrhage by two radiologists blinded to clinical information. Magnetic resonance imaging required a mean total acquisition time of 26 min. Sensitivity for early infarction was 94% in diffusion-weighted imaging and 73% in computed tomography. Six patients were excluded from thrombolysis due to an infarct size of more than 1/3 of the territory of the middle cerebral artery exclusively diagnosed with diffusion-weighted imaging. Hemorrhage was recognised by both, magnetic resonance imaging and computed tomography. We conclude that in acute stroke, diffusion-weighted imaging with an open system at 0.35 T is practicable. The implemented sequence reliably demonstrated the size of the infarction and improved the selection of patients who are eligible for thrombolysis.     

Magnetic resonance imaging of a colloid cyst of the third ventricle

A case of an isodense non-enhancing colloid cyst of the third ventricle which was not easily diagnosed by computed tomography is described. The patient underwent magnetic resonance imaging which clearly showed a colloid cyst of the third ventricle with accompanying obstructive hydrocephalus. Such lesions are potentially life-threatening if undiagnosed. It is suggested that magnetic resonance imaging has an important role to play in rapidly and clearly demonstrating the location, size and complications of such lesions when there is doubt about the aetiology of obstructive hydrocephalus of the lateral ventricles on computed tomography.     

Magnetic resonance imaging in neuronal ceroid lipofuscinosis

Neuronal ceroid lipofuscinosis is a group of neurodegenerative disorders characterized by accumulation of lipofuscin and/or ceroid within the tissues of the body. These entities are manifest by visual, intellectual, and motor deterioration as well as recurrent seizures. Computed tomography has been shown to demonstrate changes of cerebral atrophy in more severely affected patients. Seven patients with neuronal ceroid lipofuscinosis were examined with both computed tomography and magnetic resonance imaging, and the results were correlated with the clinical severity of the disorder. Two less severely affected patients had normal results on computed tomography and magnetic resonance imaging studies. Varying degrees of cerebral atrophy were seen in the remaining five patients with both computed tomography and magnetic resonance imaging. Severity of atrophy correlated with the severity of disability in these patients. Abnormal white matter was seen in the two most severely affected patients only with magnetic resonance imaging. Although the findings in patients with neuronal ceroid lipofuscinosis were nonspecific, the increased sensitivity of magnetic resonance imaging for subtle white matter abnormalities over computed tomography may prove helpful in monitoring the progression of this rare disorder.     

Pelvic hydatid disease: CT and MRI findings causing sciatica.

Pelvic masses, especially hydatid disease, rarely present with sciatica (1, 2). We present the computed tomography (CT) and the magnetic resonance imaging (MRI) findings of a 49-year-old female patient with presacral hydatid disease, who was evaluated for her sciatica. We also want to emphasize the importance of assessing the pelvis of patients with symptoms and clinical findings that are inconsistent and that cannot be satisfactorily explained by the spinal imaging findings.     

Imagen funcional de la patología pancreática

In addition to the classical morphological evaluation of pancreatic disease, the constant technological advances in imaging techniques based fundamentally on computed tomography and magnetic resonance imaging have enabled the quantitative functional and molecular evaluation of this organ. In many cases, this imaging-based information results in substantial changes to patient management and can be a fundamental tool for the development of biomarkers. The aim of this article is to review the role of emerging functional and molecular techniques based on computed tomography and magnetic resonance imaging in the evaluation of pancreatic disease.     

Ludwig's angina: An alarming radiology challenge

Ludwig''s angina is a cellulitis that affects the submandibular, sublingual, and submental regions, fast-spreading along the fascial plane. Ludwig''s angina has been classified as a fast-moving, frequently fatal gangrenous cellulitis or necrotizing fasciitis of the neck and mouth floor over the previous 2 centuries. A 60-years old male patient came with a chief complaint of swelling and pain in the neck that radiated to the chest with fever, headache, nausea, and history of toothache, poor oral hygiene, and diabetes mellitus. Ludwig''s angina with mediastinitis complication was established by a computed tomography (CT) scan, which was promptly treated and he recovered completely. Imaging is used as one of the tools to help physicians diagnose Ludwig''s angina. A trained, multidisciplinary team is required for the treatment of Ludwig''s angina because it involves surgical and antibiotic treatment and also resuscitation. A more accurate and timely diagnosis can lead to a better prognosis. In an emergency, a CT scan may be the best imaging choice, although magnetic resonance imaging is superior to a CT scan since it evaluates soft tissue and compartment involvement better.     

Atypical Hepatic Hemangioma with Fluid-Fluid Level on CT and MRI: Emphasis on Added Value of Contrast-Enhanced Ultrasound Findings

We present an atypical case of a patient with hepatic hemangiomas showing fluid-fluid levels on computed tomography (CT) and magnetic resonance imaging (MRI). None of the lesions showed contrast enhancement, mimicking complicated hepatic cysts or metastasis with hemorrhagic content. On contrast-enhanced ultrasound the lesions showed peripheral nodular enhancement with complete fill-in on late phases, suggestive of hepatic hemangioma.Teaching point: Contrast-enhanced ultrasound (CE-US) may be useful in diagnosing atypical hepatic hemangioma showing fluid-fluid levels on computed tomography (CT) or magnetic resonance imaging (MRI).     

Intracanalicular arachnoid cyst mimicking acoustic neuroma: CT and MRI.

A patient with a surgically proven intracanalicular arachnoid cyst was studied using computed tomography, magnetic resonance imaging, and air CT cisternography. The lesion had a similar radiographic appearance to acoustic neuroma and therefore, although rare, must be considered in the differential diagnosis of intracanalicular mass lesions. We report a case in which examination was performed, in evaluating the lesion, utilizing high-resolution air CT cisternography and magnetic resonance imaging (MRI).