Tongue abscesses: MR imaging findings

BACKGROUND AND PURPOSE: A lingual abscess is difficult to diagnose in the absence of physical signs. MR imaging may provide an excellent and invaluable adjunct to clinical examination, but the literature is incomplete in defining the various MR imaging findings of abscess. The objective of this study was to determine the MR imaging features of tongue abscesses. METHODS: Seven surgically proved tongue abscesses were evaluated with MR imaging. Four patients underwent MR imaging because of suspected tumor, and 3 patients, to show the extent and precise anatomic location of the lesion. Lesions were assessed with regard to the location, size, signal-intensity characteristics, and pattern of contrast enhancement. RESULTS: Five lesions were located in the anterior tongue and 2, in the posterior tongue. The central parts of 4 anterior tongue abscesses were hypointense, surrounded by a hyperintense wall on T1-weighted precontrast images. On postcontrast images, marked wall enhancement was detected. On T2-weighted images, a markedly hyperintense central part surrounded by a hypointense rim was seen. In 2 of these patients, there was a hypointense halo surrounding the wall (target sign). In 3 patients, a perilesional hyperintense area that enhanced diffusely after contrast administration was detected on T2-weighted images. The smallest lesion located in the anterior tongue was hypointense on T1-weighted images and enhanced diffusely on postcontrast images. On T2-weighted images, a markedly hyperintense central part surrounded by a mildly hyperintense peripheral part was depicted. Posterior tongue lesions appeared as polypoid ill-defined masses and were hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images. On postcontrast images, the lesion in 1 patient showed diffuse and heterogeneous contrast enhancement, whereas the lesion in another patient enhanced peripherally. The lesions were totally excised in 4 patients and drained with surgical incisions in 3 patients. No recurrence was detected on follow-up. CONCLUSION: An abscess typically presents as a cystic lesion surrounded by an enhancing capsule formation, but lesions may also present as solid masses that enhance diffusely or peripherally.     

Sacroiliitis: MR imaging findings

Magnetic resonance (MR) imaging was performed in seven asymptomatic volunteers and 17 patients with clinical and radiologic evidence of sacroiliitis. MR imaging findings were compared with those at computed tomography (CT) to determine the MR imaging appearance of the sacroiliac joint when normal and in sacroiliitis. The normal articulation was well depicted with MR imaging. Findings of sacroiliitis were identified in 20 sacroiliac joints (12 patients). MR imaging findings characteristic of sacroiliitis included abnormal cartilage signal intensity (95% of joints) and erosions (75% of joints) on T1-weighted images. Areas of increased intensity in the articulation (80% of joints) or in erosions (60% of joints) were seen on T2-weighted images. MR imaging was superior to CT for evaluation of cartilage and detection of erosions. Four sacroiliac joints (20%) and two patients (17%) with MR imaging findings of sacroiliitis were negative at CT. The authors conclude that MR imaging is a valuable method for detecting sacroiliitis, particularly when results of other imaging techniques are inconclusive.     

Paget disease: MR imaging findings

Magnetic resonance (MR) images of 13 patients with Paget disease were reviewed, and findings were correlated with those from computed tomographic (CT) scans, radiographs, and, in two patients, surgical biopsy. MR imaging findings correlated with CT and radiographic findings of cortical thickening, increased size of bone, and coarse thickened trabeculae. Focal or diffuse decreased signal intensity, representing dense bone, was seen on images obtained with short and long repetition times (TRs) and echo times (TEs); high-signal foci, representing fat collections, were seen on short TR/TE images; and high-signal foci, representing fibrovascular marrow in active Paget disease, were seen on long TR/TE images. Complications of Paget disease-including basilar invagination, spinal stenosis, and sarcoma--were well identified on MR images. Although MR imaging is not generally used in diagnosis of Paget disease, the disease will be encountered more frequently as more MR imaging examinations are performed. An awareness of the range of findings in Paget disease is useful in evaluating MR images of the musculoskeletal and other systems.     

Sneddon's syndrome: MR imaging findings

Sneddon's syndrome is a systemic disease characterized by generalized livedo racemosa and cerebrovascular disease. We present a case of Sneddon's syndrome which has typical dermatological lesions and occipital infarct demonstrated by both CT and MRI.     

Fibrolipomatous hamartoma: MR imaging findings

 Objective. To analyze the MR imaging features of fibrolipomatous hamartoma (FLH) of nerves. Design and patients. MR imaging studies from six patients (three men and three women) were retrospectively reviewed by three musculoskeletal radiologists. In four patients, a biopsy of the nerve lesion was performed. In two patients, biopsy data were unavailable and the diagnosis was based on the clinical history combined with the MR imaging findings. Results and conclusion. MR imaging demonstrated fusiform nerve enlargement that was caused by fatty proliferation and thickening of nerve bundles. Nerve bundles appeared as serpentine tubular structures, hypointense on both T1- and T2-weighted images. The degree of fatty proliferation varied among patients. In addition, significant variation in the distribution of fat along the course of the nerves was noted. In three patients, FLH followed the branching pattern of the nerves, a characteristic pathologic finding. In two patients, intramuscular fat deposition (biceps and tibialis posterior muscles) was present. MR imaging findings of FLH are typical, allowing a confident diagnosis. The variation of fatty proliferation among patients and involved nerves as well as the tendency of the abnormalities to follow the branching pattern of the nerves is well demonstrated with MR imaging. FLH may present as an isolated nerve lesion, may be associated with intramuscular fat deposition, or may occur as a feature of macrodystrophia lipomatosa (MDL).     

Craniocervical artery dissection: MR imaging and MR angiographic findings

Dissection of the carotid and vertebral arteries is a not so uncommon cause of stroke and has to be considered as a differential diagnosis especially in younger patients. Therapeutic and prognostic implications are different from those in extracranial atherosclerotic disease. Dissection results from hemorrhage into the vessel wall usually between the layers of the media. Digital subtraction angiography (DSA) depicts the resulting luminal compromise that may reveal some typical, but not specific, findings. The same is true for non-invasive angiographic techniques such as time-of-flight magnetic resonance angiography (MRA) and computed tomography angiography (CTA), which have shown accurate results compared with DSA. The main advantage of these techniques is the direct visualization of the vessel wall confirming the intramural hematoma. This is achieved best with MR imaging due to the high signal of blood degradation products on T1- and T2-weighted images. Therefore, MRI in combination with MRA is presently the method of choice for initial diagnosis and follow-up of craniocervical artery dissection (CCAD). In some questionable cases, CTA is a non-invasive alternative that is independent of flow phenomena. Received: 4 May 1998; Revision received: 8 September 1998; Accepted: 10 November 1998     

Pantothenate kinase-associated neurodegeneration: MR imaging,proton MR spectroscopy,and diffusion MR imaging findings

We herein report the case of a 15-year-old male patient with pantothenate kinase-associated neurodegeneration. The classic "eye-of-the-tiger" appearance was initially present on the globus pallidi on T2-weighted MR images and had disappeared by the time of the 10-month follow-up examination. Fluid-attenuated inversion recovery images revealed marked hypointensity in the globus pallidi and dentate nuclei and high signal intensity changes in the deep cerebral white matter. Proton MR spectroscopy revealed markedly decreased N-acetylaspartate in the globus pallidi, associated with decreased N-acetylaspartate and increased myoinositol in the deep cerebral white matter. Diffusion MR images (b=1000 s/mm(2)) were negative (normal appearing) for deep cerebral white matter lesions, whereas apparent diffusion coefficient values were slightly increased (1.08-1.12 x 10(-3) mm(2)/s), compared with the apparent diffusion coefficient values from the normal white matter regions. Apparent diffusion coefficient values in the globus pallidi were lower than those in the unaffected thalamus.     

Kimura disease: CT and MR imaging findings

BACKGROUND AND PURPOSE:KD is a rare chronic inflammatory disorder of unknown etiology. The purpose of this study was to evaluate the CT and MR imaging findings of KD in the head and neck.MATERIALS AND METHODS:We retrospectively reviewed the CT (n = 21) and MR (n = 9) images obtained in 28 patients (24 males and 4 females; mean age, 32 years; age range, 10–62 years) with histologically proved KD in the head and neck.RESULTS:In these 28 patients, CT and MR images demonstrated a total of 52 non-nodal lesions, 1–8 cm in greatest diameter, in the head and neck. The lesions were unilateral in 11 patients and bilateral in 17 patients. Eleven patients had a solitary lesion, and 17 patients had 2–4 lesions. The parotid and/or periparotid area was the most frequent location, with 36 lesions in 23 patients. The margin of the lesions was well-defined in 1 and ill-defined in 51 cases. Compared with the adjacent muscle, the MR signal intensity of all lesions was iso- to slightly hyperintense on T1-weighted images and hyperintense on T2-weighted images. Most of the lesions demonstrated mild or moderate enhancement on postcontrast CT scans and moderate or marked enhancement on postcontrast MR images. MR images also showed tubular signal-intensity voids in 7 of 13 lesions. Associated lymphadenopathy was demonstrated in 23 patients, usually bilaterally.CONCLUSIONS:Multiple ill-defined enhancing masses within and around the parotid gland with associated regional lymphadenopathy are characteristic CT and MR imaging findings of KD in the head and neck.

KD is a rare chronic inflammatory disorder of unknown etiology, characterized by angiolymphoid proliferation with peripheral eosinophilia and elevated serum IgE. The disease has a predilection for the head and neck and typically occurs in young Asian males.^1,2 Although it was first described in the Chinese literature in 1937 under the designation of “eosinophilic hyperplastic lymphogranuloma,” it was not until 1948 that the disease to become widely known as KD when Kimura and Ishikawa³ reported it in the Japanese literature.⁴ KD often produces subcutaneous tumorlike nodules with frequently associated involvement of the major salivary gland and regional lymph nodes.⁵Although the clinical and histopathologic findings of KD have been well described in the literature, only a few reports have dealt with its radiologic findings, and generally as case reports or small case series.^6–15 The purpose of this study was to describe the CT and MR imaging findings of histologically proved KD involving the head and neck in 28 patients. To our knowledge, this is the largest imaging study of patients with KD of the head and neck.     

Elastofibroma dorsi: CT and MR imaging findings

Elastofibroma dorsi is a benign fibroelastic tumor of unknown etiology that arises bilaterally or unilaterally at the lower subscapular level. It can be easily diagnosed on computed tomography or magnetic resonance images and should not be mistaken for a malignant tumor.     

Tongue cancer: correlation of MR imaging and sonography with pathology

Ten patients with tongue cancer underwent both MR imaging and sonography. In seven of these patients, pathologic findings from glossectomies were correlated with MR and sonographic results. MR images of resected specimens also were obtained in two patients, and relaxation time was calculated in one of these patients. MR images (5- to 7-mm thick slices) were obtained by using a 0.1-T resistive magnet with a 128 x 256 acquisition matrix. MR and sonography had almost the same sensitivity for detecting primary-site tongue cancer. However, in the three patients with extraorgan spread of tumor, MR was superior, showing three of three cases, compared with sonography, which showed extraorgan spread in only one of the three cases. Although MR failed in one patient to differentiate postradiation scar tissue from tumor, because of similar relaxation time of both, this imaging technique proved to be an important adjunct to the physical examination in the staging of tongue cancer.     

Painful heel: MR imaging findings.

Heel pain is a common and frequently disabling clinical complaint that may be caused by a broad spectrum of osseous or soft-tissue disorders. These disorders are classified on the basis of anatomic origin and predominant location of heel pain to foster a better understanding of this complaint. The disorders include plantar fascial lesions (fasciitis, rupture, fibromatosis, xanthoma), tendinous lesions (tendinitis, tenosynovitis), osseous lesions (fractures, bone bruises, osteomyelitis, tumors), bursal lesions (retrocalcaneal bursitis, retroachilleal bursitis), tarsal tunnel syndrome, and heel plantar fat pad abnormalities. With its superior soft-tissue contrast resolution and multiplanar capability, magnetic resonance (MR) imaging can help determine the cause of heel pain and help assess the extent and severity of the disease in ambiguous or clinically equivocal cases. Careful analysis of MR imaging findings and correlation of these findings with patient history and findings at physical examination can suggest a specific diagnosis in most cases. The majority of patients with heel pain can be successfully treated conservatively, but in cases requiring surgery (eg, plantar fascia rupture in competitive athletes, deeply infiltrating plantar fibromatosis, masses causing tarsal tunnel syndrome), MR imaging is especially useful in planning surgical treatment by showing the exact location and extent of the lesion.     

Penile epithelioid sarcoma: MR imaging findings

Magnetic resonance imaging findings of a 38-year-old man with epithelioid sarcoma of the penis is presented. It started as a firm, painless and slowly growing nodule at the base of his penis 6 months previously which caused pain radiating to the testis during coitus. It has been well known that sarcomas may well mimic reactive processes. Initial presentation of epithelioid sarcoma may provoke considerable diagnostic difficulty, and its differentiation from benign lesions, such as Peyronie's disease and chronic inflammation, may be a clinical problem. In our present report the MR findings are compared with those of the epithelioid sarcomas of various locations reported in the literature and differential diagnosis of the entity is discussed. To our knowledge, this is the first report regarding the MR findings of the epithelioid sarcoma of penis. Received: 15 September 1998; Revision received: 22 December 1998; Accepted: 20 January 1999     

Methanol intoxication: Diffusion MR imaging findings

We present diffusion MR imaging findings and ADC values in acute methanol intoxication in a 32-year-old man. T2-weighted and FLAIR images showed bilateral increased signal in the caudate nuclei, putamen, cerebral peduncle, and centrum semiovale. Diffusion MR showed hyperintensity in same localization, and splenium of corpus callosum. ADC values of these areas were markedly reduced consistent with restricted diffusion.     

Metachromatic leukodystrophy: diffusion MR imaging findings

Herein the case of a 10-month-old boy with metachromatic leukodystrophy is reported. Diffusion MR imaging performed with an echo-planar trace sequence revealed a cytotoxic edema-like pattern (high signal intensity on b = 1000 s/mm(2) images and low apparent diffusion coefficient values) in the affected white matter in the absence of an ischemic condition. This finding was unchanged at a 6-month follow-up, as revealed by diffusion MR imaging. A gradient-echo diffusion sequence, reverse fast imaging in steady-state precession, revealed hyperintense changes at the corresponding regions. It is likely that the cytotoxic edematous pattern (restricted diffusion pattern) reflected restriction of mobility of the water molecules within abnormal portions of the myelin sheath, because impaired myelin breakdown and reutilization are known features of metachromatic leukodystrophy.     

Schistosomal myelitis: findings at MR imaging

Schistosomal spinal cord involvement is a rare complication of infection by Schistosoma mansoni. This work reports the MR imaging findings in a patient with schistosomal myelitis involving the lower spinal cord and conus medullaris. MR imaging showed a focal mass with a slightly nodular surface and which had peripheral enhancement after contrast administration. The MR appearance of this complication of schistosomal infection is important to recognize so that early medical therapy can be started in an attempt to maximize neurologic recovery.     

Muscular sarcoidosis: findings at MR imaging

Twelve patients with muscular sarcoidosis were evaluated with magnetic resonance (MR) imaging: Nine patients had the nodular type and three had the myopathic type of muscular sarcoidosis. The nodular type showed a characteristic appearance on MR images. In each patient with the nodular type, both T1- and T2-weighted axial spin-echo images showed an oval nodule consisting of a star-shaped area of low signal intensity surrounded by an area of high signal intensity. Histopathologic correlation in patients with the nodular type revealed that the central portion of the nodule was fibrotic tissue surrounded by inflammatory granulomatous tissue. In each patient with the myopathic type of muscular sarcoidosis, MR images failed to show any abnormality; the authors hypothesize that this failure correlated with the sparse distribution of epithelioid cell granulomas. Identification of the star-shaped area of low signal intensity may help in the diagnosis of muscular sarcoidosis and the differentiation of lesions associated with sarcoidosis from other soft-tissue masses.     

Subcutaneous granuloma annulare: MR imaging findings

We present a case of subcutaneous granuloma annulare evaluated with MR imaging. The mass was poorly defined and showed thickened interconnecting strands with low signal intensity on T1- and T2-weighted MR images. When a poorly defined subcutaneous mass with low signal intensity on both T1- and T2-weighted MR images is observed in an otherwise healthy child, subcutaneous granuloma annulare should receive serious consideration. Subcutaneous granuloma annulare should be added to the list of tumors with short T2.