Cirrhosis: spectrum of findings on unenhanced and dynamic gadolinium-enhanced MR imaging

The appearance of the cirrhotic liver on computed tomography can be difficult to evaluate and can frustrate the radiologist distinguishing benign from malignant lesions. Hepatic edema, fibrosis, atrophy, and vascular abnormalities are common in the cirrhotic liver and produce derangements in morphology, attenuation, and perfusion, limiting the accurate characterization of hepatic masses. With the development of fast magnetic resonance (MR) sequences and dynamic postgadolinium-enhanced imaging, most hepatic lesions with uncertain etiology on computed tomography can be accurately characterized on MR imaging. We describe MR imaging techniques useful for imaging cirrhosis and its complications. We also illustrate the spectrum of findings in the cirrhotic liver on dynamic gadolinium-enhanced MR imaging, including reticular and confluent fibrosis, fatty infiltration, hemochromatosis, regenerating nodules, dysplastic nodules, hepatocellular carcinoma, and sequela of portal hypertension. Received: 16 November 2000/Revision accepted: 7 February 2001     

Ankylosing spondylitis complicated by pseudoarthrosis and secondary spinal stenosis

When a patient with longstanding ankylosis spondylitis presents with acute back pain, one should always consider the possibility of a pseudoarthrosis. Magnetic resonance imaging is important in the evaluation of this complication because of the association of spinal stenosis.     

Radiographic manifestations of eosinophilic gastroenteritis

Eosinophilic gastroenteritis (EG) is a rare inflammatory disease of unknown etiology, characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract. Although little over 250 cases of EG have been reported in the literature, EG is probably more common than reports in the literature would indicate. A retrospective review of 25 patients with EG along with a review of the literature was done to identify clinical, laboratory, radiographic, and therapeutic features. An allergic disorder was present in 14 (56%) and a peripheral eosinophilia was present in 24 (96%) of our patients. The most common radiographic manifestations of the stomach and small bowel included stenosis and fold thickening, respectively. Thirteen patients had esophageal involvement, with the esophageal stricture being the most common abnormality found in these patients. Steroids produced a good therapeutic result in most patients; the remaining patients responded to cromolyn and/or surgery.Presented at the ARRS 94th Annual Meeting, New Orleans, Louisiana, USA, April 24–29, 1994; received Bronze Medal Award     

The role of stress radiographs for the severe ankle sprain: A 7-year prospective study

Ankle sprains are common. They are the most common musculoskeletal injury in athletes and account for about 2 million emergency department visits annually in the United States. Although ankle radiographs are often indicated to rule out fractures of the acutely sprained ankle, the need for additional imaging work-up, such as stress radiographs, to evaluate the severity of ligamentous injury is not clear. One hundred five patients with severe ankle sprains diagnosed by stress radiographs were randomized into three conservative modes of therapy (Schantz wrap, cast brace, cast) and followed prospectively for 7 years. There was no statistically significant difference among treatment groups for mechanical outcome at 1 year (P=0.27) or for functional outcome at 5 years (P=0.39) and 7 years (P=0.27) after injury. We conclude that: (a) there currently is no recommendation for stress radiographs in the setting of the acutely sprained ankle, and (b) a larger multicenter study is needed to confirm these findings.