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1.
Karchevsky M Schweitzer ME Morrison WB Parellada JA 《AJR. American journal of roentgenology》2004,182(1):119-122
OBJECTIVE: The purpose of this study was to describe the soft-tissue, synovial, and osseous MRI findings of septic arthritis. MATERIALS AND METHODS: At 1.5 T (T1-weighted, T2-weighted or STIR, and contrast-enhanced images), 50 consecutive cases of septic arthritis were evaluated by two observers for synovial enhancement, perisynovial edema, joint effusion, fluid outpouching, fluid enhancement, and synovial thickening. The marrow was assessed for abnormal signal on T1- and T2-weighted images or after contrast enhancement. We noted whether the marrow signal was diffuse or abnormal in bare areas. MRI findings were compared with microbiologic, clinical, and surgical data and diagnoses. RESULTS: The frequency of MRI findings in septic joints was as follows: synovial enhancement (98%), perisynovial edema (84%), joint effusions (70%), fluid outpouching (53%), fluid enhancement (30%), and synovial thickening (22%). The marrow showed bare area changes (86%), abnormal T2 signal (84%), abnormal gadolinium enhancement (81%), and abnormal T1 signal (66%). Associated osteomyelitis more often showed T1 signal abnormalities and was diffuse. CONCLUSION: Synovial enhancement, perisynovial edema, and joint effusion had the highest correlation with the clinical diagnosis of a septic joint. However, almost a third of patients with septic arthritis lacked an effusion. Abnormal marrow signal-particularly if it was diffuse and seen on T1-weighted images-had the highest association with concomitant osteomyelitis. 相似文献
2.
Objective. To differentiate the MR features of septic versus nonseptic inflamed joints.
Design and patients. Thirty patients were referred for MRI with inflamed joints (19 were subsequently found to be septic and 11 nonseptic). At
1.5 T enhanced MRI five groups of signs related to joint space, synovium, cartilage, bone and peri-articular soft tissue respectively
were assessed and compared between the septic and nonseptic groups.
Results. The prevalence of MRI findings in septic versus nonseptic joints (respectively) was as follows: effusion (79% vs 82%), fluid
outpouching (79% vs 73%), fluid heterogeneity (21% vs 27%), synovial thickening (68% vs 55%), synovial periedema (63% vs 55%),
synovial enhancement (94% vs 88%), cartilage loss (53% vs 30%), bone erosions (79% vs 38%), bone erosions enhancement (77%
vs 43%), bone marrow edema (74% vs 38%), bone marrow enhancement (67% vs 50%), soft tissue edema (63% vs 78%), soft tissue
enhancement (67% vs 71%), periosteal edema (11% vs. 10%). The presence of bone erosions appeared to be an indicator for an
infected joint (P=0.072); coexistence of bone marrow edema slightly improves the significance (0.068). A similar trend was obtained when combining
bone erosions with either synovial thickening, synovial periedema, bone marrow enhancement or soft tissue edema (P=0.075).
Conclusions. The combination of bone erosions with marrow edema is highly suggestive for a septic articulation; the additional coexistence
of synovial thickening, synovial edema, soft tissue edema or bone marrow enhancement increases the above level of confidence.
Similar to conventional radiography, the single sign that appeared to show a significant trend was the presence of bone erosions.
However, no single sign or combination could either be considered pathognomonic or exclude the presence of a joint infection.
Received: 18 February 1999 Revision requested: 6 April 1999 Revision received: 26 July 1999 Accepted: 26 July 1999 相似文献
3.
C. C. A. Nolte-Ernsting Gerhard Adam Markus Bühne Andreas Prescher Rolf W. Günther 《Skeletal radiology》1996,25(5):413-420
Objective. The objective of this study was to determine the value of MRI in the detection of degenerative bone marrow abnormalities in
an animal osteoarthritis model. Design. In 10 dogs with experimentally induced unilateral osteoarthritis of the knee, MRI was performed using two-dimensional spin-echo
(2D-SE) and three-dimensional gradient-echo (3D-GE) imaging. Contrast enhanced T1-weighted 2D-SE sequences were also obtained
after injection of gadolinium-DTPA. The results were compared with the gross and histopathologic findings and with radiography.
Results. Histopathologic specimens revealed 21 osteosclerotic lesions and 5 intraosseous cysts. On 2D-SE images, 24 of 26 lesions were
detected, while 21 of 26 lesions were identified on 2D-GE sequences. Radiography, including conventional tomography, demonstrated
9 of 26 lesions. Regardless of the sequence weighting, all osteosclerotic lesions appeared hypointense on MRI. Signal loss
in bone sclerosis resulted primarily from the reduction of intact fat marrow, the increased bone density being of secondary
importance. Quantitative signal analysis allowed approximate estimation of the grade of sclerosis. On postcontrast images,
sclerotic bone remained hypointense, although significant but non-specific enhancement relative to the normal fat marrow was
observed. The extent of contrast enhancement did not correlate with the grade of osteosclerosis. All five cysts were readily
diagnosed by MRI. Cysts displayed either central or marginal contrast enhancement within their cavities. Conclusions. MRI provides a sensitive method for the diagnosis of osteoarthritic bone abnormalities, allowing their differentiation from
most non-degenerative subarticular lesions. 相似文献
4.
Objective The aim of this study was to describe the magnetic resonance imaging (MRI) features of juvenile psoriatic arthritis (JpsA)
in children in order to facilitate early diagnosis and proper management.
Materials and methods Two pediatric radiologists retrospectively reviewed in consensus a total of 37 abnormal MRI examinations from 31 pediatric
patients (nine boys, 22 girls; age range 1–17 years; mean age 9.4 years) who had a definite diagnosis of JpsA and underwent
MRI. Each MRI was evaluated for synovium abnormality (thickening and enhancement), joint effusion (small, moderate, and large),
bone marrow abnormality (edema, enhancement, and location of abnormality), soft tissue abnormality (edema, enhancement, atrophy,
and fatty infiltration), tendon abnormality (thickening, edema, tendon sheath fluid, and enhancement), and articular abnormality
(joint space narrowing and erosion). The distribution of abnormal MRI findings among the six categories for the 37 MRI examinations
was evaluated. The number of abnormal MRI findings for each MRI examination was assessed. Age at MRI examination and all six
categories of abnormal MRI findings according to gender were evaluated.
Results There were a total 96 abnormal MRI findings noted on 37 abnormal MRI examinations from 31 pediatric patients. The 37 abnormal
MRI examinations included MRI of the hand (n = 8), knee (n = 8), ankle (n = 5), pelvis (n = 5), temporomandibular joint (n = 4), wrist (n = 3), foot (n = 2), elbow (n = 1), and shoulder (n = 1). Twenty-eight diffuse synovial thickening and/or enhancement were the most common MRI abnormality (29.2%). Joint effusion
comprised 22 abnormal MRI findings (22.9%). There were 16 abnormal MRI bone marrow edema and/or enhancement findings (16.7%),
and in seven (7.3%) the edema involved non-articular sites. Soft tissue abnormality manifested as edema and/or enhancement
constituted 14 abnormal MRI findings (14.5%). There were ten MRI abnormalities (10.4%) involving tendons. Articular abnormality
seen as joint space narrowing and/or bone erosion comprised six abnormal MRI findings (6.2%). Most MRI examinations had more
than one abnormal finding (84%). Age at which MRI examinations were performed was not significantly different between boys
and girls. All six categories of abnormal MRI findings were not significantly different between boys and girls.
Conclusion Children with JpsA typically present with more than one abnormal finding on their MRI studies. While synovial abnormality
is the most common MR finding in children with JpsA, multi-focal bone marrow edema and enhancement at both articular and non-articular
sites are also notable findings in children with JpsA. The rate of articular abnormality is much lower in children with JpsA
in comparison to adults with psoriatic arthritis. Our findings suggest that MRI can play a useful role in the diagnosis and
ongoing assessment of this uncommon, though important, pediatric rheumatologic disorder. 相似文献
5.
Rheumatoid knee: role of gadopentetate-enhanced MR imaging 总被引:8,自引:0,他引:8
S Kursunoglu-Brahme T Riccio M H Weisman D Resnick N Zvaifler M E Sanders C Fix 《Radiology》1990,176(3):831-835
Physical examination is often insufficient in distinguishing between joint effusion and inflamed synovium in the knee joints of patients with rheumatoid arthritis. The authors prospectively evaluated the role of intravenously administered gadopentetate dimeglumine in distinguishing between these two conditions. Fourteen patients with classic rheumatoid arthritis were examined first by a rheumatologist and then by means of magnetic resonance (MR) imaging with T1- and T2-weighted sequences. T1-weighted images were also obtained following the intravenous administration of gadopentetate dimeglumine. T1-weighted images obtained prior to contrast material administration demonstrated an identical low-intensity signal from both effusion and inflamed synovium, and T2-weighted images demonstrated increased signal intensity in both cases. Intravenous administration of gadopentetate dimeglumine allowed distinction between effusion and abnormal synovium, with the effusion remaining of low signal intensity and the synovium demonstrating enhancement and increased signal intensity. The authors conclude that the use of gadopentetate allows distinction between synovial thickening and joint effusion in the knee, which may affect treatment decisions. 相似文献
6.
A total of 17 patients with hemophilic arthropathy of the knee joint were studied with static and dynamic MRI before and after an IV bolus injection of Gadolinium-DTPA (Gd-DTPA; 0.1 mmol/kg body weight). The T1-weighted spin-echo (SE) and gradient-echo (fast-field echo [FFE]) sequences were applied. The FFE sequences of eight consecutive scans carried out over a time interval of 160 s were used in order to determine the time to signal intensity (SI) curves of the synovial proliferations surrounding soft tissue, bone marrow, and joint effusion. After the administration of a contrast agent, synovial proliferations exhibited an increase on FFE and SE images of 47.7 % (SD ± 14.3 %) and 37.4 % (SD ± 11.2 %), respectively, whereas muscle and fatty tissue, tendons, bone marrow, and joint effusion revealed only a minor increase in SI. The gradient of SI (ratio SI/time) of pannus was 39.6 %/min (SD ± 7.7 %/min) and differed significantly (P < 0.001) from that of bone marrow, fatty tissue, muscle tissue, tendons, and joint effusion (P < 0.05). In contrast to synovial proliferations in rheumatoid arthritis, no differentiation between various pannus vascularities based on the degree of enhancement was possible. The Gd-DTPA-enhanced MRI studies delineate and quantify the synovial proliferations in hemophilic arthropathy. Dynamic studies in hemophilic arthropathy do not provide qualitative assessment of the inflammatory process.
Correspondence to: M. Nägele 相似文献
7.
Rheumatoid arthritis of the knee: value of gadopentetate dimeglumine-enhanced MR imaging 总被引:3,自引:0,他引:3
G Adam M Dammer K Bohndorf R Christoph F Fenke R W Günther 《AJR. American journal of roentgenology》1991,156(1):125-129
In an attempt to differentiate among joint effusion, synovitis, pannus, and subchondral sclerosis in patients with clinically proved chronic rheumatoid arthritis, we used gadopentetate dimeglumine-enhanced MR imaging to examine 23 patients with acute knee symptoms. All patients had had rheumatoid arthritis for more than 6 months and satisfied four or more of the criteria of the American Rheumatism Association for rheumatoid arthritis. MR imaging was performed on a 1.5-T machine by using unenhanced T1-weighted spin-echo imaging, unenhanced T2*-weighted gradient-echo imaging, and unenhanced and enhanced T1-weighted gradient-echo imaging. Signal intensities of the synovium and bone marrow were measured with the region-of-interest technique on unenhanced and enhanced T1-weighted gradient-echo scans. Conventional radiographs were available for each patient. Joint effusion, synovitis, intraarticular pannus, subchondral sclerosis, and subchondral pannus had the same signal intensities on unenhanced T1-weighted spin-echo, unenhanced T1-weighted gradient-echo, and unenhanced T2*-weighted gradient-echo MR images, and could not be differentiated from one another. On enhanced T1-weighted gradient-echo sequences, pannus and synovitis showed marked enhancement in 15 patients, whereas joint effusion and sclerosis did not. Synovitis was diagnosed if the synovial membrane showed high enhancement; pannus was diagnosed if enhancing masses were seen within the joint space or in the subchondral area. In eight of the 23 joints, there was no enhancement of the synovium or intraarticular or subchondral tissue. We conclude that gadopentetate dimeglumine-enhanced MR imaging allows differentiation between synovitis and joint effusion and between subchondral pannus and subchondral sclerosis. Enhancement of the synovium and pannus indicates acute inflammation of the joint. 相似文献
8.
目的:研究滑膜软骨瘤病的MRI表现及其与病理变化之间的联系。方法:回顾性分析经手术病理证实的12例滑膜软骨瘤病的MRI表现和病理变化。结果:①MRI表现:所有12例关节滑膜均增厚,其中3例增强扫描者滑膜明显强化;滑膜软骨瘤病结节呈现五种信号表现:1型.与骨骼肌相比呈均匀的长T1长T2信号;2型.在所有脉冲序列呈均匀低信号;3型.低信号的结节中心为高信号;4型.与3类似,但在高信号区内散在点状低信号;5型.黄骨髓信号。X线不能显示1型结节,增强扫描者滑膜软骨瘤病结节无强化。3例病变邻近骨质出现外压性侵蚀;②病理变化:大体病理可见增厚的滑膜表面有多发的结节状突起;显微镜下可见滑膜软骨瘤病结节主要有以下特点:可见结节状的透明软骨,结节部分区域被覆纤维组织层;软骨结节中见软骨细胞,软骨结节部分区域钙化和骨化。结论:MRI能准确的反映滑膜软骨瘤病的病理变化,对该病有很高的诊断价值。 相似文献
9.
Robert Hemke Taco W. Kuijpers J. Merlijn van den Berg Mira van Veenendaal Koert M. Dolman Marion A. J. van Rossum Mario Maas 《European radiology》2013,23(7):1998-2004
Objectives
To assess the diagnostic accuracy and reliability of MRI without contrast enhancement in the evaluation of JIA knee joint abnormalities.Methods
JIA patients with clinically active knee involvement were prospectively studied using an 1-T open-bore magnet. MRI features were independently evaluated by two readers using the JAMRIS system. The first reading included unenhanced images, whereas complete image sets were available for the second reading.Results
Imaging findings from 73 patients were analysed. Agreement between Gd-enhanced (+Gd) and Gd-unenhanced (?Gd) MRI scores of bone marrow changes, cartilage lesions and bone erosions was good concerning sensitivity, specificity, negative predictive value and positive predictive value. Inter-observer agreement was good for both ?Gd and +Gd scores (ICC?=?0.91–1.00, 0.93–1.00, respectively). Regarding the assessment of synovial hypertrophy, specificity of ?Gd was high (0.97), but the sensitivity of unenhanced MRI was only 0.62. Inter-reader agreement for +Gd MRI was ICC?=?0.94; however, omitting post-Gd acquisitions increased inter-reader variation (ICC?=?0.86).Conclusions
If Gd-enhanced MRI is the reference standard, omitting Gd contrast medium is irrelevant for the assessment of bone marrow changes, cartilage lesions and bone erosions as joint abnormalities in JIA. Omitting intravenous Gd in the MRI assessment of joints in JIA is inadvisable, because it decreases the reliability of detecting synovial disease.Key Points
? Magnetic resonance imaging is increasingly used to assess juvenile idiopathic arthritis. ? Synovial hypertrophy, a marker of JIA activity, is well shown by MRI. ? Omitting intravenous contrast medium decreases the reliability of synovial hypertrophy scores. ? Bone marrow, cartilage and erosions can be reliably evaluated without contrast enhancement. ? In the evaluation of JIA disease activity, unenhanced MRI is inadvisable. 相似文献10.
Darshana A. Sanghvi Veena R. Iyer Tejaswini Deshmukh Sumedh S. Hoskote 《Skeletal radiology》2009,38(3):267-273
Objective The objective of this study was to describe the magnetic resonance imaging (MRI) features of tuberculosis (TB) of the knee
joint.
Materials and methods The MRI features in 15 patients with TB of the knee, as confirmed by histology of the biopsied joint synovium, were reviewed
retrospectively. The images were assessed for intra-articular and peri-articular abnormalities.
Results All patients had florid synovial proliferation. The proliferating synovium showed intermediate to low T2 signal intensity.
In the patients who were administered intravenous contrast, the hypertrophic synovium was intensely enhancing. Marrow edema
(n = 9), osteomyelitis (n = 4), cortical erosions (n = 5), myositis (n = 6), cellulitis (n = 2), abscesses (n = 3), and skin ulceration/sinus formation (n = 2) were seen in the adjacent bone and soft tissue.
Conclusion Synovial proliferation associated with tuberculous arthritis is typically hypointense on T2-weighted images. This appearance,
in conjunction with other peri-articular MRI features described, can help in distinguishing TB arthritis from other proliferating
synovial arthropathies. 相似文献
11.
MRI gadolinium enhancement of bone marrow: age-related changes in normals and in diffuse neoplastic infiltration 总被引:5,自引:0,他引:5
Objective: To quantify gadolinium-related enhancement in the bone marrow of the spine in normals and in patients with homogeneous diffuse
malignant bone marrow infiltration. Design and patients: The patients consisted of two groups: group 1 comprised 94 healthy adults (18–86 years) without bone marrow disease and group
2 comprised 30 patients with homogeneous diffuse malignant bone marrow infiltration due to myeloma (n=20) or breast carcinoma (n=10). All patients received intravenous gadopentetate dimeglumine (Gd-DTPA), 0.1 mmol/kg body weight. Pre- and postcontrast
signal intensity (SI) on T1-weighted spin-echo (SE) images (TR/TE: 572 ms/15 ms) was measured over a region of interest (ROI)
and the percentage SI increase was calculated. The results were confirmed by bone marrow biopsy (n=20) and clinical parameters (n=10). Dynamic contrast-enhanced studies using a spoiled gradient-recalled-echo (GRE) sequence (TR/TE/α: 68 ms/6 ms 75°) were
performed in 10 controls with normal bone marrow.
Results and conclusion: Contrast material enhancement in healthy persons can vary greatly (range 3–59%, mean 21%, SD 11%). With increasing age there
is a significant decrease in contrast enhancement (Pearson’s correlation, P<0.01). The percentage SI increase in patients with intermediate-grade (biopsy 20–50 vol%) and high-grade (biopsy >50 vol%)
diffuse malignant bone marrow infiltration was significantly higher than in normals (mean 67%, SD 34%, P<0.001). Low-grade (biopsy <20 vol%) diffuse malignant bone marrow infiltration can not be assessed by non-enhanced T1-weighted
SE images or Gd-DTPA application. In conclusion, contrast material enhancement in healthy persons can vary greatly and is
dependent on age, while intermediate-grade and high-grade diffuse malignant bone marrow infiltration can be objectively assessed
with SI measurements. 相似文献
12.
目的:分析痛风性关节炎(GA )的M RI表现及临床特点,提高诊断准确率。方法回顾性分析经临床及病理证实的15例GA的M RI及临床资料。结果15例临床均表现为程度不等的关节疼痛,11例同时伴有血清尿酸升高。15例中跖趾关节6例(5例发生于第1跖趾关节),踝关节4例,膝关节3例,肘关节及髋关节各1例,9例为2个以上关节受累。15例M RI均见受累关节软组织偏侧性肿胀及关节软骨程度不等的侵蚀,13例见关节面及邻近骨质不规则压迫、变薄或囊状、穿凿状破坏,并见邻近骨质及骨髓腔水肿、关节积液;11例显示结节状、条块状痛风结节,最大直径约3.5~56mm ,边界较清楚,位于关节滑膜、骨内或关节腔。痛风结节多数呈 T1 WI及 T2 WI较低信号,少部分呈 T1 WI较低T2 WI较高信号。12例伴有程度不等关节间隙狭窄、周边骨质增生硬化;5例出现关节明显畸形。结论 GA的影像学表现多样,M RI有利于显示痛风结节、早期的软组织病变及轻微软骨、骨质破坏,对其诊断具有重要价值。 相似文献
13.
N. Nakahara M. Uetani K. Hayashi Y. Kawahara T. Matsumoto J. Oda 《Skeletal radiology》1996,25(7):639-647
Objective. To determine the usefulness of fat-suppressed gadolinium (Gd)-enhanced MR imaging of the wrist in patients with rheumatoid
arthritis (RA). Design and patients. Fat-suppressed Gd-enhanced T1-weighted spin-echo (SE) images were obtained and compared with other standard techniques in
38 wrists of 27 patients (22–77 years) with RA. Scoring based on the degree of synovial enhancement of each joint was developed
and the total scores (J-score) were correlated with radiographic stage, C-reactive protein (CRP), erythrocyte sedimentation
rate (ESR), and symptomatic change in the follow-up study. Results. Synovial proliferations showed marked enhancement in all the wrists. In addition, contrast enhancement in the bone marrow
and tenosynovium was seen in 36 and eight wrists respectively. Fat-suppressed Gd-enhanced T1-weighted images demonstrated
these abnormalities better than other techniques. The J-scores correlated well with values of CRP (P=0.0034), but not with radiographic stages and ESR. Conclusion. Fat-suppressed Gd-enhanced T1-weighted SE images can clearly demonstrate most of the essential lesions in RA including the
proliferative synovium, bone erosion, bone marrow inflammatory change, and tenosynovitis. Scoring based on the extent of Gd-enhancement
of synovium can be useful in the assessment of the inflammatory status. 相似文献
14.
Gadolinium-DTPA in rheumatoid arthritis and related diseases: first results with dynamic magnetic resonance imaging 总被引:5,自引:0,他引:5
Maximilian F. Reiser Georg P. Bongartz Rainer Erlemann Mathias Schneider Thomas Pauly Harald Sittek Peter E. Peters 《Skeletal radiology》1989,18(8):591-597
Thirty-four joints (19 knees, 15 wrists) of 31 patients suffering from rheumatoid arthritis and related disorders were examined prior to and following intravenous administration of Gadolinium-DTPA (0.1 mmol/kg body weight). T1-weighted spin-echo sequences and the gradient-echo technique FLASH were applied. FLASH scanning was used for the registration of the time-dependent changes of signal intensity following Gd-DTPA. Synovial proliferations exhibited a rapid and marked increase of signal intensity whereas fatty tissue, bone marrow, muscle and synovial effusion demonstrated only minor changes, causing enhanced contrast between synovial pannus and joint effusion or other neighbouring structures. Within the synovial pannus, ratios (absolute signal increase) of 131.3±53.4% and 122.9±51.1% were found in T1-weighted spin-echo and in FLASH sequences respectively. The average signal increase gradient of pannus (108.2±70.6%/min) was significantly (p<0.001) different from muscle (13.4±7.8%/min), fatty tissue (10.2±8.4%/min), bone marrow (5.5±7.1%/min), and joint effusion (14.7±7.8%/min). 相似文献
15.
Camelia G. Whitten M.D. Timothy E. Moore F.R.A.C.R. William T. C. Yuh M.D. Mary H. Kathol M.D. Donald L. Renfrew M.D. Craig W. Walker M.D. 《Skeletal radiology》1992,21(4):215-218
Spin echo T1- and T2-weighted images and intravenously administered gadopentetate dimeglumineenhanced T1-weighted images were obtained in 4 normal volunteers and 11 patients (11 joints) with painful, intermittent, or persistent joint swelling of unknown etiology. These studies were retrospectively reviewed to assess the benefits of contrast-enhanced magnetic resonance imaging (MRI) in evaluating the synovium. Normal synovium and joint fluid showed no visually apparent enhancement on images obtained immediately after intravenous injection of gadopentetate dimeglumine. Abnormal synovium enhanced significantly, allowing the precise identification of equivocal or unsuspected synovial disease processes. These results suggest that, in selected cases, enhanced MRI can be a useful adjunct in the evaluation of suspected synovial disease processes. 相似文献
16.
Toledano TR Fatone EA Weis A Cotten A Beltran J 《Seminars in musculoskeletal radiology》2011,15(3):257-268
One of the most important roles of magnetic resonance (MR) in imaging of the diabetic foot is to differentiate between the common and often comorbid pathologies that present with abnormal bone marrow signal. The primary diagnostic challenges in this setting are to distinguish osteomyelitis from reactive bone marrow edema, neuroarthropathy from osteomyelitis, and the sterile from the superinfected neuropathic joint. Whereas both osteomyelitis and reactive marrow edema share increased T2 signal, osteomyelitis is confirmed by T1 hypointensity in the bone marrow and reactive edema demonstrates isolated T2 signal hyperintensity. In distinguishing osteomyelitis from neuroarthropathy, a localized or contiguously spreading forefoot focus of abnormal bone marrow away from the subchondral surface and adjacent to a skin ulcer, cellulitis, abscess, or sinus tract would be indicative of osteomyelitis. A midfoot, subchondral, periarticular, or polyarticular distribution of findings in the absence of a contiguous focus of skin disruption would strongly support neuroarthropathy. Parameters that have been successfully correlated with acute infection superimposed on neuroarthropathy include diffuse bone marrow signal abnormality, progressive subarticular enhancement, loss of subchondral cysts, and the presence of the MRI "ghost sign." 相似文献
17.
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
18.
Nineteen patients with 28 histologically proven hepatocellular carcinomas (HCCs) were examined using T1- and T2-weighted spin-echo sequences and dynamic gadopentetate dimeglumine-enhanced magnetic resonance imaging (MRI) performed by fast T1-weighted gradient-echo sequence (100/5/80°) which was performed before and repeatedly (12 sets of images) after intravenous bolus injection of gadopentetate dimeglumine (Gd-DTPA) over a period of 10 min. Enhancement of HCC was heterogeneous in 24 lesions (85.7%). Intra-lesional non-enhancing areas were seen in 18 cases (64%). A late-enhancing pseudocapsule was seen in 12 lesions (42.9%). In addition, two groups were distinguished in the examined HCCs: 16 lesions (57.1%) showed stronger enhancement compared to liver parenchyma with maximum positive lesion-to-liver contrast on the 15-s images, while 12 lesions (42.9%) had an enhancement less than normal liver with a maximum negative contrast on the 15-s images. We conclude that the morphologic features most frequently encountered in HCC on dynamic Gd-DTPA-enhanced MRI are inhomogeneity of enhancement, intra-lesional non-enhancing areas, and relatively late enhancement of a pseudocapsule. Taking the degree of enhancement to be representative of the degree of vascularity, we also conclude that HCC can appear either hypervascular or hypovascular in the early phase of the dynamic study.
Correspondence to: B. Hamm 相似文献
19.
Bigot J Loeuille D Chary-Valckenaere I Pourel J Cao MM Blum A 《Journal de radiologie》1999,80(12):1649-1657
AIM: To determine which signs are the most accurate in the diagnosis of sacroiliitis with MRI. MATERIAL AND METHODS: 40 consecutive patients with inflammatory low back pain underwent MRI at 1.5 T with FSE T2 and SE T1 weighted-images before and after Gadolinium-DOTA injection. 22 patients were suffering from spondylarthropathy while the other 18 patients constituted the control group. Each examination was interpreted by two independent observers who analysed 11 different signs. RESULTS: Intra and inter observer reproducibility were high (respectively 76% and 70%). Inter observer reproducibility was excellent for bone marrow edema (89%) but low for bone productions (38%). Three lesions displayed a high positive predictive value: ligamentous contrast enhancement (86%), bone marrow edema (80%) and bone erosions (70%). Intra articular enhancement of the sacro-iliac joint was a less sensitive sign than bone marrow edema. CONCLUSION: This study confirms the excellent positive predictive value of MRI for an early diagnosis of active sacroiliitis. Bone marrow edema seems to be a more pertinent sign than intra articular enhancement. 相似文献
20.
Preoperative evaluation of osteosarcoma: value of gadopentetate dimeglumine-enhanced MR imaging. 总被引:3,自引:0,他引:3
L L Seeger B E Widoff L W Bassett G Rosen J J Eckardt 《AJR. American journal of roentgenology》1991,157(2):347-351
Decisions regarding the surgical approach in osteosarcoma require accurate assessment of tumor extent. In order to determine whether enhancement with gadopentetate dimeglumine could add clinically significant information to that available with unenhanced MR imaging, 21 patients with osteosarcoma underwent preoperative MR imaging. T1- and T2-weighted spin-echo MR images obtained before and after administration of IV gadopentetate dimeglumine were evaluated to determine the conspicuity of marrow and soft-tissue extent of tumor, including tumor involvement of major neurovascular bundles and adjacent joints. MR results were correlated with tumor margins found at surgery. In some instances, use of gadopentetate dimeglumine obscured differentiation of tumor from normal marrow or tumor infiltration into perineurovascular fat, and tumor extension through pseudocapsule could not be differentiated from peritumoral edema after contrast administration. Contrast enhancement did assist in differentiation of intraarticular tumor from effusion; however, synovial invasion could be identified on unenhanced T1-weighted images by loss of synovial fat and cortical disruption. These results indicate that gadopentetate dimeglumine does not assist in defining tumor margins of osteosarcoma. 相似文献