Postnatal cranial ultrasonographic findings in feto-fetal transfusion syndrome

Our objective was a retrospective evaluation of cranial US in survivors of twin pregnancy with feto-fetal transfusion syndrome (FFTS), with knowledge of prenatal treatment and neonatal/postnatal clinical data. In 18 pregnancies with FFTS (January 1996 to May 2000), pregnancy management and outcome, and neonatal clinical/neurological data and follow-up (age of 3–7 months) were documented when available. Postnatal cranial US abnormalities were differentiated in prenatal and peri/postnatal lesions, respectively, in "donor" and "recipient." The statistical analysis used was Mann Whitney U test and Fisher's exact test. Overall pregnancy survival rate was 19 of 36 (53%); mors in utero occurred in five twin members. Gestational age at birth was significantly lower in FFTS after laser coagulation (13 of 18; p<0.05). Initial (≤4 days of age) postnatal cranial US was abnormal in 13 of 27 cases: antenatal brain lesion in 9 of 13 patients (7 of 13 donors, 2 of 14 recipients); after treatment: antenatal hemorrhage (n=6), hydrocephaly (n=1), subependymal germinolysis (n=1), lenticulostriatal vasculopathy (n=1), evidence for brain atrophy (n=2), cystic periventricular leukomalacia in<3 days (n=1); peri/postnatal brain lesions in 4 of 13 patients (hemorrhage (n=3), and periventricular leukomalacia (n=1). Finally, an abnormal brain US was found in 18 patients. Twin pregnancies complicated with FFTS are high-risk pregnancies with antenatal and postnatal mortality and morbidity. In utero cranial hemorrhage dominated the antenatal brain insults; however, pregnancy survivors remain at risk for severe peripartal and/or postnatal brain insults. Electronic Publication     

Choroid plexus carcinomas in children: MRI features and patient outcomes

Choroid plexus carcinomas (CPC) are rare malignant intracranial neoplasms usually occurring in young children. The objectives of this study were to characterize the preoperative MRI features of CPC, determine the frequency of disseminated disease in the CNS at diagnosis, and assess patient outcomes. The preoperative cranial MR images of 11 patients with CPC were retrospectively reviewed for lesion location, lesion size, un-enhanced and enhanced MRI signal characteristics, and presence of disseminated intracranial tumor. Postoperative cranial and spinal MRI images were reviewed for residual, recurrent, and/or disseminated tumor. The study group included six male and five female patients ranging in age from 5 months to 5.3 years (median=1.8 years). CPC were located in the lateral (n=8), fourth (n=1), and third (n=1) ventricles, and foramen of Luschka (n=1). Mean tumor size was 5.2cm×4.9cm×5.0 cm. On short-TR images, CPC had heterogeneous, predominantly intermediate signal with foci of high signal in 45% of lesions from areas of hemorrhage. On long-TR/long-TE images, solid portions of CPC typically had heterogeneous, intermediate-to-slightly-high signal. Small zones of low signal on long-TR/long-TE images were seen in 55% of the lesions secondary to areas of hemorrhage and/or calcifications. Tubular flow voids representing blood vessels were seen in 55% of the lesions. Zones of high signal comparable to CSF were seen in 64% of CPC secondary to cystic/necrotic zones. All CPC showed prominent contrast enhancement. Irregular enhancing margins suggesting subependymal invasion were seen in 73% of the lesions. Findings consistent with edema in the brain adjacent to the enhancing lesions were seen in 73% of CPC. CPC caused hydrocephalus in 82% of patients at diagnosis. Two patients died from hemorrhagic complications from surgical biopsies. Disseminated tumor in the leptomeninges was present in 45% of patients at diagnosis and was associated with a poor prognosis. The 1-year and 5-year survival probabilities were 55% and 45%, respectively. In conclusion, MRI features commonly associated with CPC include large intraventricular lesions with irregular enhancing margins; heterogeneous signal on long TR/long TE images and short-TR images; edema in adjacent brain; hydrocephalus; and presence of disseminated tumor. MRI evidence of disseminated tumor at diagnosis is associated with a poor prognosis.     

Magnetic resonance imaging in the evaluation of placental adhesive disorders: correlation with color Doppler ultrasound

The purpose of this study was to compare the value of pelvic ultrasound with color Doppler and magnetic resonance imaging (MRI) in: (1) the diagnosis of placental adhesive disorders (PADs), (2) the definition of the degree of placenta invasiveness, (3) determining the topographic correlation between the diagnostic images and the surgical results. Fifty patients in the third trimester of pregnancy with a diagnosis of placenta previa and at least one previous caesarean section underwent color Doppler ultrasound (US) and MRI. The sonographic and MRI diagnoses were compared with the final pathologic or operative findings. Outcomes at delivery were as follows: normal placenta (n = 38) and PAD (n = 12). MR and US Doppler showed no statistically difference in identiyfing patients with PAD (P = 0.74), while MRI was statistically better than US Doppler in evaluating the depth of placenta infiltration (P < 0.001). MRI accurately characterized the topography of invasion in 12/12 (100%) of the cases, while US accurately characterized the topography of invasion in 9/12 (75%) of the cases. In conclusion, we confirmed that pelvic US is highly reliable to diagnose or exclude the presence of PAD and found MRI to be an excellent tool for the staging and topographic evaluation of PAD.     

Posttraumatic pseudolipoma: MRI appearances

The goal of this study was to describe the MRI characteristics of posttraumatic pseudolipomas. Ten patients with previous history of blunt trauma or local surgery were investigated with MRI at the level of their deformity. The etiology was blunt trauma in eight patients and postoperative trauma in two. For all patients medical documentation, in the form of clinical history and physical examination, confirmed that a visible hematoma was present acutely at the same location following the injury and that the contour deformity subsequently appeared. All patients underwent liposuction. Preoperative bilateral MRI examinations were performed on all patients. The mean clinical follow-up was 17.8 months. MRI examinations were interpreted in consensus by two experienced musculoskeletal radiologists with attention to fatty extension (subcutaneous fatty thickness and anatomical extension), asymmetry compared with the asymptomatic side, the presence or absence of fibrous septae or nonfatty components, and patterns of contrast enhancement. Ten posttraumatic pseudolipomas were identified. Clinically, they showed as subcutaneous masses with the consistency of normal adipose tissue. Their locations were the abdomen (n=1), hip (n=1), the upper thigh (n=6), the knee (n=1), and the ankle (n=1). On MRI examinations, using the contralateral side as a control, pseudolipomas appeared as focal fatty masses without a capsule or contrast enhancement. Posttraumatic pseudolipomas may develop at a site of blunt trauma or surgical procedures often antedated by a soft tissue hematoma. Characteristic MRI findings are unencapsulated subcutaneous fatty masses without contrast enhancement.     

Preoperative evaluation of malignant liver tumors: comparison of unenhanced and SPIO (Resovist)-enhanced MR imaging with biphasic CTAP and intraoperative US

The purpose of this study was to evaluate the diagnostic efficacy of iron-oxide-enhanced MRI vs CT during arterial portography (CTAP) and intraoperative ultrasound (IOUS) in detection of liver neoplasms. Seventeen patients with malignant focal liver lesions (liver metastases, n=7), hepatocellular carcinomas (HCC, n=9), and cholangiocellular carcinoma (CCC, n=1) underwent presurgical Resovist-enhanced MRI and CTAP. Two independent observers (A and B) assessed the blinded images of unenhanced and iron-oxide-enhanced MRI vs CTAP for the presence, number, and location of the liver lesions. These results were compared lesion by lesion and segment by segment with the results of intraoperative ultrasound (n=17) serving as the reference standard. Eighty lesions were detected by intraoperative ultrasound in 17 patients. In comparison with IOUS (lesion-by-lesion analysis) the sensitivity was 86.8% for CTAP, 65% for combined unenhanced MR imaging, and 86.8% for combined Resovist-enhanced MRI as well as 86.8% for the combination of unenhanced and Resovist-enhanced MRI. Compared with the sensitivity of combined unenhanced MRI the sensitivity of CTAP as well as the sensitivity of combined Resovist-enhanced MRI was significantly higher (p<0.05). False-positive results were much higher in CTAP as compared with combined unenhanced and SPIO-enhanced MRI. Using the segment-by-segment analysis the specificity of combined unenhanced MRI with 100% (96.7–100%) as well as combined Resovist-enhanced MRI with 100% (96.7–100%) was significantly higher (p<0.05) in comparison with the specificity of CTAP with 91.1% (83.2–96.1%). The accuracy of combined unenhanced MRI was 100% (93.2–100%), combined Resovist-enhanced MRI 100% (93.6–100%) and of CTAP 85.2% (72.9–93.4%). In the detection of focal liver lesions iron-oxide-enhanced MR imaging is superior to unenhanced MRI and similar to CTAP. Electronic Publication     

Preface

Intracranial lipomas are rare congenital malformations. They are usually pericallosal asymptomatic midline lesions. Other brain malformations are often seen in association with intracranial lipomas. We describe the findings of imaging studies, including computed tomography (CT), magnetic resonance (MR) imaging, and MR angiography, along with a brief review of the literature. The frequency and the spectrum of the associated brain malformations are also discussed. We retrospectively reviewed CT and MR findings of 24 patients (14 female, 10 male, mean age 38.6 years) diagnosed with intracranial lipoma between December 2000 and June 2004 in two different radiology departments. Seventeen of the patients were diagnosed using cranial MR and seven with cranial CT. The CT density of all lesions was measured. Imaging characteristics of lipomas, morphological findings and associated malformations were described. The intracranial locations of the lipomas were left-sided quadrigeminal cistern (n=3), right-sided quadrigeminal cistern (n=4), interpeduncular cistern (n=1), sylvian fissure (n=3), interhemispheric fissure (n=3), choroid plexus (n=2), intercerebellar fissure (n=3), corpus fornicis (n=1) and the periphery of the corpus callosum (n=4). Eighteen of the intracranial lipomas were tubulonodular; six were curvilinear. Associated anomalies were observed in six patients. All of the patients with sylvian fissure lipoma had seizures. The two preferential sites of intracranial lipomas were pericallosal and dorsal mesencephalic. Most intracranial lipomas are found incidentally during neuroradiological investigations. CT and MR examination usually lead to the diagnosis, because of the very low attenuation values of lipomas on CT and the short T1 and T2 on MR. Midline anomalies and other malformations such as aneurysms are frequently associated with intracranial lipomas. Careful radiologic evaluation is therefore necessary to evaluate associated pathologies. Sylvian fissure lipomas should be considered in the differential diagnosis of patients with epilepsy.     

Unsuspected lower extremity deep venous thrombosis simulating musculoskeletal pathology

Objective The purpose of this study was to highlight the critical role that MRI may play in diagnosing unsuspected lower extremity deep venous thrombosis and to stress the importance of scrutinizing MRI studies of the lower extremity showing apparently non-specific muscle edema for any evidence of intramuscular venous thrombosis.Design and patients The imaging studies of four patients in whom deep venous thrombosis was unsuspected on clinical grounds, and first diagnosed on the basis of MRI findings, were reviewed by two musculoskeletal radiologists in consensus. In all four patients the initial clinical suspicion was within the scope of musculoskeletal injuries (gastrocnemius strain, n=3; ruptured Baker cyst, n=1), explaining the choice of MRI over ultrasound as the first diagnostic modality.Results All patients showed marked reactive edema in the surrounding soft tissues or muscles. Three patients showed MR evidence of branching rim-enhancing structures within intramuscular plexuses characteristic of venous thrombosis (gastrocnemius, n=1; sural, n=2); one patient showed a distended popliteal vein. Ultrasound was able to duplicate the MRI findings in three patients: one patient showed above-the-knee extension on ultrasound; neither of the two patients with intramuscular thrombosis demonstrated on ultrasound showed extension to the deep venous trunks.Conclusion Intramuscular venous thrombosis can present as marked edema-like muscle changes on MRI, simulating primary musculoskeletal conditions. In the absence of clinical suspicion for deep venous thrombosis, only the identification of rim-enhancing branching intramuscular tubular structures will allow the correct diagnosis to be made.     

Acromioclavicular joint cyst: nine cases of a pseudotumor of the shoulder

Objective (1) To analyse the imaging appearances of nine patients with acromioclavicular joint cysts presenting as shoulder masses for tumor staging with operative, histopathological and joint aspiration findings.Design and patients Retrospective review of imaging and correlation with clinical, operative and surgical notes. Images were reviewed by two musculoskeletal radiologists by consensus. Nine patients who presented clinically with a shoulder mass were evaluated by radiographs (n=9), ultrasound (n=1), conventional arthrography (n=3), MRI (n=6; with direct MR arthrography n=2, indirect MR arthrography n=4).Results All patients had a focal mass superior to the AC joint, with a size ranging from 1.5 cm to 6 cm and a mean of 3.27 cm. Correlation was available with surgery (n=7), histopathology (n=2) and cyst aspiration (n=2). Two patients were managed conservatively. Geyser sign was positive in all three arthrograms. All MRIs revealed extensive rotator cuff tears with a column of fluid extending from the glenohumeral joint through the rotator cuff tear into the acromioclavicular joint and acromioclavicular cyst. Chondrocalcinosis was seen in the acromioclavicular joint cyst (n=2) and in the glenohumeral joint (n=1). Aspirate in two patients contained calcium pyrophosphate dihydrate crystals.Conclusion Acromioclavicular joint cysts may present as a tumor mass. They are associated with extensive rotator cuff tears and there is usually communication of the cyst with the joint space. This feature excludes a diagnosis of tumor. AC joint cysts may be associated with calcium pyrophosphate dihydrate deposition disease.     

Chondroblastoma of the hands and feet

Objective To review the imaging findings, age and gender distribution of chondroblastoma of the hands and feet.Design and patients Twenty-five cases of pathologically proven chondroblastoma of the hands and feet were reviewed. Available imaging modalities included radiographs (n=24), CT (n=3), MRI (n=5), and radionuclide bone scintigraphy (n=1). The following imaging features for each case were tabulated: location, presence of sclerotic margin, calcification, expansion, presence of fluid/fluid levels on cross-sectional imaging and surrounding edema on MRI. The images were evaluated for skeletal maturity using closure of the physeal plate in the region as a standard.Results The average age at time of diagnosis was 23 years (range 7–57 years). Eighty-four percent (n=21) of the patients were skeletally mature. Males (20 of 25) outnumbered females by a ratio of 5:1. The bones of the foot accounted for 22 cases: calcaneus (n=8), talus (n=8), metatarsals (n=3), and the cuboid (n=3). The bones of the hand accounted for three cases: phalanx (n=1), triquetrum (n=1), and a metacarpal (n=1). Radiographically all lesions were osteolytic with identifiable calcification in 54% (13 of 24). Fluid/fluid levels were seen in four of five cases on MRI. Edema on MR images was seen in 40% (2 of 5). The size of the lesions ranged from 2 to 41 cm².Conclusion Chondroblastomas of the hands and feet share many of the radiographic characteristics seen in the long bones, but manifest in skeletally mature patients with a higher male to female ratio than in long bone chondroblastoma. Talar and calcaneal lesions were encountered only in males. Chondroblastoma of the wrist and hand appears to be exceptionally rare.Presented at the special scientific session of the International Skeletal Society held in San Francisco, California, USA, September 2003     

Experimental and clinical evaluation of acromioclavicular joint structures with new scan orientations in MRI

The objective of the study was to evaluate MRI for visualization of acromioclavicular (ac) joint structures in cadaveric shoulders, asymptomatic volunteers and symptomatic patients with trauma of the ac-joint. Three cadaveric shoulders were examined to find adequate planes and sequences for MRI. Afterwards, MR images were correlated to corresponding anatomical sections. Six asymptomatic volunteers and 13 patients were scanned in a 1.5 T Magnetom Vision with three sequences in the following planes: (1) parallel to the clavicle; (2) orthogonal to the ac joint, each time a fat-suppressed proton density-weighted + T2-sequence (TR/TE 4,000/15 ms) was performed; (3) parallel to the clavicle, T1-SE (TR/TE 817/20 ms). The parameters were: slice thickness 3 mm, field-of-view 180 mm, matrix 210×256 pixels. Standard of reference in the patients was clinical examination and conventional X-rays. Classification was by Rockwood grades I–VI. MRI allowed excellent visualization and diagnoses of ac-joint structures in volunteers and patients (n=6 normal, n=1 Rockwood I, n=5 Rockwood II, n=3 Rockwood III, n=4 Rockwood V). On MRI, in one lesion type II and III each, a lower lesion type was suspected clinically and by X-ray. In one patient additional information by MRI led to surgery. MRI allows excellent anatomical display of ac-joint structures and can give clinically relevant information on type and extension of ac-joint trauma, which may influence therapy.     

MR determination of neonatal spinal canal depth

Objectives

Lumbar punctures (LPs) are frequently performed in neonates and often result in traumatic haemorrhagic taps. Knowledge of the distance from the skin to the middle of the spinal canal (mid-spinal canal depth – MSCD) may reduce the incidence of traumatic taps, but there is little data in extremely premature or low birth weight neonates. Here, we determined the spinal canal depth at post-mortem in perinatal deaths using magnetic resonance imaging (MRI).

Patients and methods

Spinal canal depth was measured in 78 post-mortem foetuses and perinatal cases (mean gestation 26 weeks; mean weight 1.04 kg) at the L3/L4 inter-vertebral space at post-mortem MRI. Both anterior (ASCD) and posterior (PSCD) spinal canal depth were measured; MSCD was calculated and modelled against weight and gestational age.

Results

ASCD and PSCD (mm) correlated significantly with weight and gestational age (all r > 0.8). A simple linear model MSCD (mm) = 3 × Weight (kg) + 5 was the best fit, identifying an SCD value within the correct range for 87.2% (68/78) (95% CI (78.0, 92.9%)) cases. Gestational age did not add significantly to the predictive value of the model.

Conclusion

There is a significant correlation between MSCD and body weight at post-mortem MRI in foetuses and perinatal deaths. If this association holds in preterm neonates, use of the formula MSCD (mm) = 3 × Weight (kg) + 5 could result in fewer traumatic LPs in this population.     

Sensitivity of T2-weighted FSE sequences towards physiological iron depositions in normal brains at 1.5 and 3.0 T

To evaluate the sensitivity of T2-weighted fast spin-echo (FSE) sequences to physiological iron depositions in normal brains at MR imaging field strengths of 1.5 and 3.0 T. T2-weighted FSE sequences acquired at 1.5 and 3.0 T clinical imaging systems (Gyroscan Intera, Philips Medical Systems, Best, The Netherlands) were compared by means of MRI in phantoms (n=6) and healthy volunteers (n=10). Contrast-to-noise ratios (CNRs) of tubes doped with iron oxides at different concentrations and of brain areas with physiological iron depositions (nucleus ruber, substantia nigra, globus pallidus) were calculated for either field strength. Apparent susceptibility effects of iron-containing brain structures were qualitatively analyzed by comparing the degree of visible hypointensity by a score system at either field strength. The mean CNR of iron oxide tubes and iron-containing brain areas was significantly decreased at 3.0 T. Qualitative analysis confirmed these measurements. Detection and diagnosis of brain disorders with altered iron content such as neurodegenerative parkinsonian disorders (NPD) or intracerebral hemorrhage should benefit from the increased sensitivity of T2-weighted FSE sequences to susceptibility effects at 3.0 T.     

急性阴囊闭合性损伤的磁共振成像与彩色多普勒超声诊断

目的探讨磁共振成像（magnetic resonance imaging,MRI）与彩色多普勒超声在急性阴囊闭合性损伤中的诊断价值。方法收集急性阴囊闭合性损伤患者8例,所有病例全部经MRI及彩色多普勒超声检查,回顾性分析及比较MRI及彩色多普勒超声图像。结果8例急性阴囊闭合性损伤患者中,MRI示睾丸损伤出血8例（其中自膜下少量积血2例）,睾丸增大、阴囊肿大皮肤增厚、鞘膜积液8例,白膜毛糙3例,附睾增大5例（其中附睾损伤出血3例）,腹股沟区淋巴结肿大4例。彩色多普勒超声示睾丸损伤出血6例,睾丸增大6例,阴囊肿大、皮肤增厚8例,鞘膜积液6例,白膜异常未见,附睾增大2例,腹股沟区淋巴结肿大未见。结论MRI能清楚显示急性阴囊闭合性损伤,是目前诊断急性阴囊闭合性损伤的精确影像检查方法。     

Magnetic resonance imaging versus Ultrasound examination in detection of prenatal fetal brain anomalies

Purpose

Evaluation of the role of MR Imaging in detection of fetal brain anomalies versus 2D and 4D Ultrasound examination.

Study design

This study included 23 pregnant females who were suspected to have fetus with congenital brain anomalies over a period of one year using ultrasound. MRI was done within one week following 2D and 4D US examination. The maternal age ranged from 18 to 39 years. The gestational age ranged from 16 to 36 weeks (mean age = 26 weeks). Antenatal Ultrasound and magnetic resonance findings were compared with postnatal MRI findings.

Results

We reported different types of congenital brain anomalies including eight cases of isolated central nervous system anomalies. MRI and ultrasound showed concordant findings in six cases. MRI changed the diagnosis in 14 cases and provided additional information in two cases. Ultrasound was superior to magnetic resonance imaging in one case at second trimester due to fetal motion.

Conclusion

Our results showed that fetal MR imaging is useful in detection of fetal central nervous system anomalies as well as a complementary modality to 2D/4D Ultrasound in diagnosis of fetal central nervous system anomalies.     

Ultrasound and MRI findings in appendicular and truncal fat necrosis

Objective The objective was to evaluate ultrasound and MRI in clinical appendicular and truncal fat necrosis. Materials and methods Thirty-three patients (14 men, 19 women, median age 55, range 29–95) were retrospectively evaluated. Histologically, three groups were seen: Group 1 (n = 18) consisted of patients with subcutaneous masses with septal and extrinsic oedema; in Group 2 (n = 11) necrosis occurred within lipomatous tumours and little oedema; and in Group 3 (n = 4) there were large complex masses consistent with Morel-Lavallée lesions. Two experienced radiologists reviewed MR (n = 30) and ultrasound (n = 32) images with consensus agreement. MRI was performed on a 1.5T system with T1-weighted, T2-weighted fat-suppressed and T1-weighted fat-suppressed post-intravenous gadolinium sequences obtained in two orthogonal planes. Ultrasound (linear 5- to 13.5-MHz probe) was performed in the longitudinal and short axis. Anatomical position, size, shape (oval, linear, ill-defined), internal architecture (lobules, septi or stranding), intrinsic signal characteristics, presence of surrounding pseudocapsule, extrinsic linear stranding and vascularity (gadolinium enhancement or power Doppler) were recorded. Results Anatomical locations were buttock/thigh (n = 17), leg (n = 6), upper limb (n = 5) and thoracic/abdominal wall (n = 5) with the majority of lesions (30 out of 33) oval/linear in shape. On ultrasound and MRI most lesions showed internal fat lobules, intervening septi and a surrounding pseudocapsule. Conclusion Fat necrosis can usually be identified as containing multiple fat lobules on ultrasound and MRI despite a varying degree of inflammatory change surrounding and within the mass.     

Pulse sequence and timing of contrast‐enhanced MRI for assessing blood–brain barrier disruption after transcranial focused ultrasound in the presence of hemorrhage

Purpose:

To optimize the timing of contrast‐enhanced magnetic resonance imaging (MRI) that best indicates blood–brain barrier (BBB) disruption induced by focused ultrasound (FUS) along with an ultrasound contrast agent (UCA) and to verify that the contrast‐enhanced spin‐echo MRI sequence can indicate the degree and location of BBB disruption in the presence of hemorrhage better than a gradient‐echo sequence.

Materials and Methods:

Sonication was applied to 12 rat brains with four different doses of UCA to cause variable degrees of hemorrhage. Two imaging sequences were performed to acquire T1‐weighted (T1W) images at two time‐points after the administration of a T1‐shortening contrast agent. The contrast enhancement at the sonicated regions was quantified and correlated against Evans blue (EB) staining.

Results:

The spin‐echo T1W images at 10 minutes post–contrast enhancement showed the best correlation with EB staining in both quantity of EB extravasation (r = 0.812; P < 0.01) and spatial distribution (r = 0.528, P < 0.01). This capability was more robust than the gradient‐echo sequence.

Conclusion:

Our results suggest that contrast‐enhanced T1W spin‐echo sequence acquired in the early phase post–contrast enhancement should be considered to monitor the degree and location of BBB disruption under the possibility of hemorrhage induced by FUS. J. Magn. Reson. Imaging 2010;31:1323–1330. © 2010 Wiley‐Liss, Inc.     

MRI of the brachial plexus and its region: anatomy and pathology

Magnetic resonance imaging (MRI) of the brachial plexus and its region has become the imaging modality of choice, due to its multiplanar capabilities and inherent contrast differences between the brachial plexus, related vessels, and surrounding fat. A total of 41 patients with clinically suspected brachial plexus pathology or tumors in its region were studied. A normal anatomy was found in 12 patients. Pathologic entities included: traumatic nerve-root avulsion (n=2), hematoma (n=1), postoperative changes after scalenotomy (n=2), primary tumor of the brachial plexus (n=2), primary (n=8) and metastatic (n=1) tumors in the superior sulcus, primary (n=5) and metastatic (n=4) tumors in the axillary, supra- or infraclavicular region, and changes after nodal dissection and radiation therapy for breast carcinoma (n=5; 1 patient also had had a prior scalenotomy). There was a positive correlation with surgery in 11 patients, and a negative correlation in 1 patient. Correspondence to: H. W. van Es     

Budd-Chiari syndrome: value of duplex sonography and colour Doppler imaging for diagnosis and follow-up

This retrospective study was designed to evaluate duplex sonography in the diagnosis and follow-up of patients with Budd-Chiari syndrome. Thirteen patients with clotting disease and histologically proven Budd-Chiari syndrome (3 acute and 10 chronic cases) were examined, using conventional duplex sonography (n=5) or colour-coded duplex sonography (n=8). Results were compared with CT in 6 cases, MRI in 11, coeliac and mesentric angiography in 5, and hepatic wedge venography and cavography in 6. Of 39 hepatic veins examined, 33 had an abnormal appearance on ultrasound studies: endoluminal thrombus, stenosis, dilatation, thick wall echoes. Doppler findings included total obstruction of 8 hepatic veins, reversed flow in 22 hepatic veins and intrahepatic collaterals with continous non-phasic flow in all cases. Duplex sonography showed portal thrombosis (n=1), evidence of portal hypertension (n=8) and inferior vena cava thrombosis (n=2). Nine patients were treated surgically. Patency of portocaval shunts was correctly assessed with colour coded duplex sonography in 8 of 9 patients. We believe that colour Doppler imaging is the procedure of choice for initial diagnosis of Budd-Chiari syndrome. Correspondence to: M. F. Bellin     

Developmental venous anomaly in the newborn brain

Introduction

Cerebral developmental venous anomaly (DVA) is considered a benign anatomical variant of parenchymal venous drainage; it is the most common vascular malformation seen in the adult brain. Despite its assumed congenital origin, little is known about DVA in the neonatal brain. We report here the first cohort study of 14 neonates with DVA.

Methods

Fourteen infants (seven preterm) with DVA diagnosed neonatally using cranial ultrasound (cUS) and magnetic resonance imaging (MRI) from three tertiary neonatal units over 14 years are reviewed.

Results

DVA was first detected on cUS in 6 and on MRI in 8 of the 14 infants. The cUS appearances of DVA showed a focal fairly uniform area of increased echogenicity, often (86 %) adjacent to the lateral ventricle and located in the frontal lobe (58 %). Blood flow in the dilated collector vein detected by Doppler ultrasound (US) varied between cases (venous flow pattern in ten and arterialized in four). The appearance on conventional MRI was similar to findings in adults. Serial imaging showed a fairly constant appearance to the DVAs in some cases while others varied considerably regarding anatomical extent and flow velocity.

Conclusions

This case series underlines that a neonatal diagnosis of DVA is possible with carefully performed cUS and MRI and that DVA tends to be an incidental finding with a diverse spectrum of imaging appearances. Serial imaging suggests that some DVAs undergo dynamic changes during the neonatal period and early infancy; this may contribute to why diagnosis is rare at this age.