Assessment of the usefulness of magnetic resonance brain imaging in patients presenting with acute seizures

Background

Magnetic Resonance Imaging (MRI) is increasingly available as a tool for assessment of patients presenting to acute services with seizures.

Aims

We set out to prospectively determine the usefulness of early MRI brain in a cohort of patients presenting with acute seizures.

Methods

We examined the MR imaging studies performed in patients admitted solely because of acute seizures to Cork University Hospital over a 12-month period. The main aim of the study was to determine if the MRI established the proximate cause for the patient’s recent seizure. We identified 91 patients who underwent MRI brain within 48 h of admission for seizures.

Results

Of the 91 studies, 51 were normal (56 %). The remaining 40 studies were abnormal as follows: microvascular disease (usually moderate/severe) (n = 19), post-traumatic gliosis (n = 7), remote symptomatic lesion (n = 6), primary brain tumour (n = 5), venous sinus thrombosis (n = 3), developmental lesion (n = 3), post-surgical gliosis (n = 3) and single cases of demyelination, unilateral hippocampal sclerosis, lobar haemorrhage and metastatic malignant melanoma. Abnormalities in diffusion-weighted sequences that were attributable to prolonged ictal activity were seen in nine patients, all of who had significant ongoing clinical deficits, most commonly delirium. Of the 40 patients with abnormal MRI studies, seven patients had unremarkable CT brain. MR brain imaging revealed the underlying cause for acute seizures in 44 % of patients. CT brain imaging failed to detect the cause of the acute seizures in 19 % of patients in whom subsequent MRI established the cause.

Conclusion

This study emphasises the importance of obtaining optimal imaging in people admitted with acute seizures.     

磁共振胰胆管造影结合MRI图像检查在胆总管相对探查指征患者中的应用

目的评价磁共振胰胆管造影(MRCP)结合MRI图像检查在胆总管相对探查指征患者中的应用价值。方法104例具备胆总管相对探查指征患者均行MRCP及MRI图像检查,检查结果由两位富有经验的影像学专家判定;确定性诊断依据术中胆总管探查结果、临床随访及其他影像学检查而定。结果59例(56.7%)患者避免了术中行胆总管探查术,这些患者中5例(4.8%)诊断为其他疾病;依据MRCP和MRI图像检查结果,得到适当治疗患者占84.6%(88/104);MRCP结合MRI图像检查诊断胆总管结石的敏感性、特异性、阳性预测值及阴性预测值分别为96.7%、98.5%、96.7%、98.5%,Kappa系数为0.9。结论MRCP结合MRI图像检查能够有效筛选需行胆总管探查患者,降低胆总管探查的阴性率。     

Magnetic Resonance Imaging in Evaluation of Periventricular Leukomalacia

Background

Improvements in perinatal care have resulted in increased survival of infants born prematurely, however neurological damage due to ischaemic infarction of the periventricular white matter is a problem of enormous medical, social and economic importance. Such vascular insult leads to destruction of the periventricular white matter, termed periventricular leukomalacia (PVL). This abnormality is the leading cause of significant morbidity in the survivors of premature birth. Magnetic Resonance Imaging (MRI) is perhaps the only imaging modality, which can accurately detect and quantify periventricular leukomalacia. Methods: Magnetic Resonance Imaging was carried out in 45 children in the age group of 4 weeks to 8 years, with history of premature birth and perinatal hypoxia. These children had neurological deficits ranging from cortical blindness, spastic diplegia, spastic quadriplegia to severe mental retardation. The procedure was carried out on a 1.5 Tesla (Siemens Magnetom Avanto) MR system using available protocols for imaging the paediatric brain.

Result

The study revealed that MR imaging could accurately identify areas of ischaemic infarction of the periventricular white matter both in the early as well as in the late stages. The pattern of abnormalities detected on MRI of the brain in these patients can be considered specific for PVL in the clinical background of premature birth and perinatal hypoxia.

Conclusion

MRI is the ideal imaging modality to detect, quantify and accurately map the areas of brain affected by this hypoxic-ischaemic process. It is presently the gold standard for evaluating the neuroparenchyma in those with perinatal hypoxia. Advanced MR techniques like Diffusion Weighted Imaging (DWI), Proton MR Spectroscopy and DTI have shown great promise in our understanding of the pathophysiology and anatomic considerations of this disease process.Key Words: Hypoxic ischaemic encephalopathy, Magnetic resonance imaging, Periventricular leukomalacia     

MAGNETIC RESONANCE IMAGING IN INTRACRANIAL TUBERCULOSIS

Tuberculosis (TB) is still a major cause of serious illness in many parts of the world. Intracranially, TB manifests itself variably as meningitis, tuberculoma and tubercular abscess [1]. Although its appearance on MR is not absolutely specific, it is important in the proper clinical setting to recognize the range of possible patterns that can be observed on images [2]. Magnetic Resonance Imaging (MRI) has emerged as a quality imaging tool aiding in the diagnostic evaluation of intracranial TB variably displaying meningeal, parenchymal, osseous and craniovertebral lesions. The MRI characteristics of 18 cases of intracranial TB were reviewed. Results: Multiple lesions occured with a slightly higher incidence at 61%. In all, 11 patients (61%) presented with meningitis. Meningeal lesions without parenchymal or vascular involvement were seen in 16% of cases. 2 patients had extension of enhancing exudates into the spinal subarachnoid spaces. While 6 patients had focal intra-axial tuberculomas, representing 33% cases, 3 patients presented with infarcts. 1 patient presented with haemorrhagic infarct at right middle cerebral artery territory while two other showed multiple small infarcts. Hydrocephalus was identified in 4 patients and epidural lesions were noted in 2 cases. MRI should be considered as the imaging modality of choice for patients with suspected intracranial TB.KEY WORDS: Intracranial tuberculosis, Magnetic resonance imaging, Tubercular meningitis     

MRI对急性主动脉夹层的诊断价值（附31例分析）

目的探讨急性主动脉夹层的MRI表现及诊断价值。方法采用超导型MR扫描机对31例主动脉夹层作不同序列技术的MR成像检查，介绍一种快速平衡稳态进动序列成像检查。结果主动脉夹层诊断准确率100％，磁共振表现为（1）不同信号双腔影；（2）剥离的内膜瓣；（3）破裂口；（4）血栓性主动脉夹层。结论磁共振成像对主动脉夹层的确诊具有重要价值。早期诊断、治疗是降低死亡率的关键。     

MAGNETIC RESONANCE IMAGING IN FAILED BACK SURGERY SYNDROME

The failed back surgery syndrome (FBSS) is a severe, long-lasting, disabling and relatively frequent (5-10%) complication of lumbosacral spine surgery. Wrong level surgery, inadequate surgical techniques, vertebral instability, recurrent disc herniation, and lumbosacral fibrosis are the most frequent causes of FBSS. The results after repeated surgery on recurrent disc herniations are comparable to those after the first intervention, whereas repeated surgery for fibrosis gives only 30-35% success rates, and 15-20% of the patients report worsening of the symptoms. MRI has allowed a differentiation between these two pathologies for selection of different therapies. Gadolinium enhanced MR is at present the single most sensitive and specific imaging modality available to the neuro radiology imager for the evaluation of the post operative lumbosacral spine in the patient presenting with FBSS. Medical imaging specialists and clinicians need to better understand the origins and means of avoiding the FBSS, to more clearly focus the post operative imaging evaluation and to more successfully link the clinical diagnosis and the imaging findings with optimised patient therapy.     

The initial Trinidad experience with Cine MRI in clinical cardiology

We describe the initial Trinidad experience with Magnetic Resonance Imaging (MRI) and Cine MRI as a diagnostic tool in clinical cardiology. Six patients from the following categories were referred for Cine MRI evaluation: congenital heart disease, valvular heart disease, aortic diseases, cardiomyopathy and intracardiac mass. All patients underwent echocardiography. MRI and Cine MRI were performed on all patients using a Siemens Magnetom 1.0 Tesla MR system at MRI Trinidad and Tobago Ltd. Selected patients underwent Angiography and/or computed tomography (CT) scanning. Clinical data and images of the six patients evaluated are described. MRI and Cine MRI provided excellent anatomical and functional details of the heart and aorta in five patients with dissection of the aorta, aneurysm of the ascending aorta, suspected left ventricular apical thrombus, infiltrative cardiomyopathy and arrhythmogenic right ventricular dysplasia. Technical difficulty was experienced with one patient who had a congenital defect (common atrium). In this study, Cine MRI provided excellent images in all but one patient. This new noninvasive technique enhanced diagnostic capabilities and facilitated management in patients with certain cardiovascular diseases.     

前列腺癌的MRI诊断及临床应用进展

磁共振成像（MRI）是目前公认较好的前列腺癌无创检测方法。在MRI基础上出现的几种成像方法如动态对比增强MRI扫描（DCE-MRI）、弥散加权成像（DWI）以及MR波谱成像（MRS）在前列腺癌的临床诊断与治疗有着重要作用。结合国内外文献,本文就这三种成像技术在前列腺癌的临床应用的各个阶段所起的作用展开综述。     

直肠癌术前CEUS与MRI检查对T分期的诊断效果对比观察

目的探讨在直肠癌术前应用超声造影CEUS与核磁共振MRI检查对肿瘤浸润深度(T分期)的诊断效果差异。方法回顾性分析2015年5月~2017年5月于我院就诊的149例直肠癌患者在直肠癌术前CEUS与MRI检查情况,以术后病理结果为金标准,评估两种检查对肿瘤浸润深度(T分期)的诊断效果差异。结果 MRI检查T1分期的诊断符合率显著低于T2~T4(P0.05);CEUS与MRI对T分期的诊断符合率分别为91.95%和79.87%,CEUS显著高于MRI(P0.05)。两种检查对于T4分期的各项诊断效能间无明显的统计学差异(P0.05);CEUS对于T1、T2和T3分期的诊断准确率、特异性和阳性预测值,T3期诊断准确率、灵敏度和特异性均显著高于MRI(P0.05)。结论 MRI检查对直肠癌术前T1分期的诊断效能较低;CEUS对直肠癌术前T分期(尤其是T1~T3分期)的诊断效能优于MRI检查。     

Cardiac MRI in Congenital Heart Disease – Our Experience

A significant recent advance that has occurred world over in the continuously evolving field of Magnetic Resonance Imaging (MRI) practice is the introduction of Cardiac applications. Cardiac MRI has moved to the centre stage of clinical management strategy by non-invasively imaging the structure as well as function of the heart. It has a wide range of specific applications such as delineation of morphological anatomy, quantification of flow and pressure across cardiac valve dysfunction, evaluation of myocardial function, assessment of infarcts, mapping coronary arteries and so on. Evaluation of congenital heart disease (CHD) is an important application of Cardiac MRI since the morphological details of chambers, septum, defects and anomalous connections are depicted accurately. Besides, flow information across valves, chambers, outflow tracts and shunts are also provided. This article describes our experience in the use of cardiac MRI in congenital heart disease.Key Words: Cardiac MRI, Congenital heart disease, Cyanotic and Acyanotic heart disease     

肝脏转移瘤的磁共振成像诊断

本文分析了20例肝脏转移瘤病人的磁共振成像(MRI)资料。大多数病灶(18/26)在T1加权像中呈低信号,其余呈等或稍高于肝脏信号强度;在T2加权像,全部病灶呈高信号强度;显示肝脏转移瘤病灶,MRI优于B超,等于增强CT。     

坐骨结节囊肿的磁共振诊断

目的探讨坐骨结节囊肿的磁共振影像特征。方法回顾性分析15例经手术病理证实的坐骨结节囊肿的磁共振表现,总结其影像特征。结果本组病例共18个病灶,为单发囊性肿块,囊壁厚,内壁不光滑,13个病灶囊内见线状分隔,5个病灶囊内无分隔;6个病灶囊液T1WI上呈低信号,2个病灶呈等信号,10个病灶呈稍高信号,所有病灶囊液在T2WI上呈明显高信号,增强扫描囊壁、间隔轻度或中等度强化,囊液无强化。结论坐骨结节囊肿磁共振表现具有特征性,磁共振诊断坐骨结节囊肿具有很高的价值。     

“Breast within a breast” sign: Mammary hamartoma

Breast hamartomas are uncommon benign tumors of the breast. Imaging appearance of a breast hamartoma can vary widely. “Breast within a breast” sign on mammography is considered pathognomonic of this unusual entity. We describe mammographic and Magnetic Resonance Imaging (MRI) appearance of a case of hamartoma breast.     

A comparative study of whole body DWIBS MRI versus bone scan for evaluating skeletal metastases

Background

Skeletal metastases in oncology patients are identified by Bone scan and/Positron Emission Tomography (PET) scan. But developing countries in the world still lack adequate numbers of these imaging facilities.

Aims

Since Magnetic Resonance Imaging (MRI) is widely available as compared to bone scan or PET scan; a double blind study was undertaken to see if whole body imaging with MRI can give an idea of skeletal metastases.

Method

Diffusion weighted whole body Magnetic Resonance Imaging with background body signal suppression (DWIBS) was performed using 1.5 Tesla (T) MRI on histopathologically proven cases of carcinoma of breast within two months of mastectomy and followed up after a year of surgery. Similarly bone scan was also performed in these patients.

Results

DWIBS MRI demonstrated the presence and extent of bone metastases in 10 out of a total 18 patients included in study while bone scan could demonstrate them in only three cases. A highly significant difference between proportions of the skeletal metastases detected by whole body DWIBS-MRI than that by bone scan at one year follow-up. (i.e. p<0.01, z=2.66) was seen.

Conclusion

DWIBS MRI scores high in demonstrating skeletal metastases. Further comparative studies are necessary to evaluate if DWIBS can replace bone scan or PET scan.     

Septo-optic dysplasia: Magnetic Resonance Imaging findings

Septo-optic dysplasia is a rare congenital disorder involving brain and optic pathways. We present typical Magnetic Resonance Imaging (MRI) findings of a case of Septo-optic dysplasia in a 19 year old female patient.     

滑脱前期腰椎峡部裂影像诊断分析

目的 分析滑脱前期腰椎弓峡部裂(slipping prophase lumbar spondylolysis,SPLS)常规影像检查表现,探讨其诊断策略.方法 收集经影像诊断明确的SPLS患者69例,均因腰腿痛首诊,分别做了不同种类的常规影像学检查,检查前均无临床提示.分析SPLS常规影像学表现,计算X线、多层螺旋CT(MSCT)和MRI首诊率并做统计分析.结果 69例患者中,31例摄X线正侧位片,其中5例同时加摄双斜位片;33例行腰椎间盘MSCT扫描,其中24例及时做了补充扫描;5例行MRI常规扫描.X线、MSCT和MRI首诊率依次为:61.3%(19/31)、72.7%(24/33)和20.0%(1/5).SPLS常规影像表现为:椎弓峡部变细,X线可见透亮线影;MSCT下位椎体上关节突附近发现碎骨块和椎管矢状径增大;MRI峡部皮髓质信号欠连续.结论 SPLS常规影像检查表现隐匿,敏感而及时地发现其蛛丝马迹并进一步做MSCT容积扫描多方位重组或反机架层面扫描是防止SPLS漏诊的关键;后者因其低耗、低辐射和高诊断率,可以作为SPLS筛选和确诊的首选检查方法.     

CT联合MRI用于子宫内膜癌分期诊断的价值分析与效果观察

目的探讨CT联合MRI用于子宫内膜癌分期诊断的临床价值。方法以我院影像科收治的36例经病理证实的子宫内膜癌患者为研究对象,根据其临床资料进行回顾性分析和总结,分别对其进行单纯CT、MRI检查以及CT联合MRI检查,以病理诊断为依据,对比分析其诊断结果。结果单纯CT分期诊断的准确率为55.6%,单纯MRI分期诊断的准确率为66.7%,CT联合MRI分期诊断的准确率为88.9%,CT联合MRI检查的准确率明显高于单纯CT或MRI,P0.05,具有统计学意义。结论 CT联合MRI用于子宫内膜癌分期诊断具有较高的临床价值,与单纯的CT或MRI检查相比,其诊断准确率更高,可以为患者后续治疗提供重要的参考依据,具有较高的临床应用价值,值得推广。     

运用失效模式与效应分析改进住院患者MRI检查执行流程的研究

目的 探讨失效模式和效应分析(failure mode and effect analysis,FMEA)在改进MRI检查执行流程中提高预约执行准时率的效果.方法 组建FMEA项目研究团队,运用FMEA对成都大学附属医院MRI检查执行流程中的失效环节进行风险分析,根据其严重程度(severity,S),发生频度(frequency of occurrence,O),可探测度(liklihood of detection,D),计算各环节风险优先数(risk priority number,RPN),对高风险环节进行流程再造,制定标准操作流程,观察预约执行准时率及医、患满意度改善情况.结果 MRI预约检查执行准时率由改进前的50.00%上升到改进后的86.55%,患者满意度由原来的62.40%上升到87.28%,医护人员的满意度由原来的77.77%上升到87.78%,P均<0.05,有统计学意义. 结论 运用FMEA 对住院患者MRI检查流程进行失效环节改进, 有效改善了MRI的运行效率.     

MRI与高频超声在诊断肩袖损伤中的应用

目的探讨磁共振成像(MRI)与高频超声在诊断肩袖损伤中的应用价值。方法回顾性分析2016年8月~2017年12月间收治的48例肩袖损伤患者临床资料,所有患者均经MRI和高频超声检查。与关节镜检查结果对比,评估MRI、高频超声单独及联合诊断肩袖损伤价值。结果高频超声与MRI诊断完全撕裂、部分撕裂及总体准确率对比,差异无统计学意义(P>0.05);MRI与联合诊断完全撕裂、部分撕裂及总体准确率对比,差异无统计学意义(P>0.05);高频超声与联合诊断完全撕裂准确率对比差异无统计学意义(P>0.05),高频超声部分撕裂、总体诊断准确率低于联合诊断(P<0.05)。结论MRI和高频超声均是诊断肩袖损伤较为准确的影像学技术,联合检查有利于提高高频超声部分撕裂诊断准确性。     

磁共振不同成像序列检查子宫内膜癌的比较简

目的探讨子宫内膜癌磁共振成像（Magnetic Resonatice Imaging,MRI）检查中不同序列的诊断价值。材料和方法回顾分析3O例经病理证实的子宫内膜癌患者的MRI图像,采用（FsE）横轴位T1W1、T2WI脂肪抑制（fS）、EPI—DWI;矢状位、冠状位T2WI脂肪抑制（fS）和矢状面子宫容积超快速的三维成像序列（LAVh）多期动态增强扫描,比较不同序列在子宫内膜癌检查中的应用价值。结果30例患者的图像质量满意,达到诊断要求。T1WI、T2WI—fs、DWI和3D—LAVA动态增强序列对子宫内膜癌的总检出率分别为77％、86％、93％和100％。动态增强扫描能清晰显示子宫的形态、内膜厚度、结合带的完整性和肌层的浸润程度。倍论在子宫内膜癌MRI检查中FSET1WI、T2WI-fs是常规序列,DWI是必不可少的序列,3D-LAVA动态增强扫描序列对子宫内膜癌的检出和诊断起决定性作用。