The Usefulness of Magnetic Resonance Imaging in the Diagnosis of Anterolateral Impingement of the Ankle

The purpose of this study is to assess the sensitivity and specificity of magnetic resonance imaging (MRI) in the diagnosis of anterolateral impingement of the ankle and to assess the most helpful sequence in making the diagnosis. Twenty-four patients who had undergone ankle arthroscopy were chosen. Twelve patients had arthroscopically documented anterolateral impingement, and 12 patients with no impingement on arthroscopy served as controls. Two musculoskeletal radiologists and an orthopedic surgeon, blinded to the operative diagnosis, retrospectively reviewed selective MRI images in the sagittal, axial, and coronal planes. The sensitivities and specificities were calculated for all 3 reviewers. The Kendall coefficient of concordance was calculated for overall agreement among reviewers. Sensitivities varied from 0.75 to 0.83, whereas specificities varied from 0.75 to 1.00. Using the Fisher exact test of contingency, the sensitivities and specificities showed that all reviewers' interpretations were statistically significant with P = .039, .001, and .012, respectively. The axial images were felt to be most helpful in making the diagnosis. The physicians felt that the sagittal images were helpful in 67%, 83%, and 100%, respectively. MRI is a useful tool that can aid the clinician in the diagnosis of anterolateral impingement of the ankle. T1 sagittal images demonstrating displacement of the normal fat signal anterior to the fibula by scar can be useful and help to confirm the diagnosis.     

Intra-articular arteriovenous malformation of the knee

Two young men with longstanding suprapatellar masses are presented. The initial clinical diagnosis was of a synovial or soft tissue tumour. Magnetic resonance imaging showed the features of an arteriovenous malformation (AVM). Surgical exploration and biopsy confirmed the diagnosis. AVMs, although rare, should be considered as a possible diagnosis of a peri-articular swelling of the knee.     

Vascular Centerline Extraction in 3D MR Angiograms for Phase Contrast MRI Blood Flow Measurement

The accuracy of 2D phase contrast (PC) magnetic resonance angiography (MRA) depends on the alignment between the vessels and the imaging plane. PC MRA imaging of blood flow is challenging when the flow in several vessels is to be evaluated with one acquisition. For this purpose, semi-automatic determination of the plane most perpendicular to several vessels is proposed based on centerlines extracted from 3D MRA. Arterial centerlines are extracted from 3D MRA based on iterative estimation-prediction, multi-scale analysis of image moments, and a second-order shape model. The optimal plane is determined by minimizing misalignment between its normal vector and the centerlines’ tangent vectors. The method was evaluated on a phantom and on 35 patients, by seeking the optimal plane for cerebral blood flow quantification simultaneously in internal carotids and vertebral arteries. In the phantom, difference of orientation and of height between known and calculated planes was 1.2° and 2.5 mm, respectively. In the patients, all but one centerline were correctly extracted and the misalignment of the plane was within 12° per artery. Semi-automatic centerline extraction simplifies and automates determination of the plane orthogonal to one vessel, thereby permitting automatic simultaneous minimization of the misalignment with several vessels in PC MRA.     

齿状突骨折的MRI诊断

目的分析齿状突骨折的MRI表现,探讨MRI扫描在诊断齿状突骨折中的价值。方法回顾性分析我科CT确诊的52例齿状突骨折患者的MRI资料,MRI扫描包括横断面、矢状面、冠状面的T1WI及T2WI像。结果根据骨折部位将齿状突骨折分为三型,Ⅰ型:尖端骨折,本组3例;Ⅱ型:基底骨折,本组35例;Ⅲ型:枢椎椎体部骨折,本组14例。所有患者中,并发脊髓损伤16例,韧带损伤8例,3例合并颈椎脱位。结论MRI能清晰显示齿状突骨折线,确定骨折类型,显示椎旁软组织损伤,脊髓损伤。对于齿状突骨折患者,MRI对临床治疗有重要指导价值。     

Pitfalls in diagnosis of aortic dissection by angiography: Algorithmic approach utilizing CT and MRI

Dissection of the thoracic aorta is a life-threatening event requiring imaging studies to define the level of the tear and the intinmal flap. The “gold standard” has been angiography. This method may fail to demonstrate the dissection, however, due to overlap of the true and false lumens or a very thin flap that is imaged en face rather than tangentially. Computed tomography has a diagnostic accuracy of 95%, but can fail to image the dissection due to technical factors or a thrombosed false hunen. Magnetic resonance imaging requires a hemodynamically stable and cooperative patient. A diagnostic algorithm is proposed for diagnosis of aortic dissection based on renal function and the surgeon's imaging modality preference.     

颈静脉球瘤的MR诊断

目的探讨MR检查在颈静脉球瘤诊断中的应用价值。方法对15例病变进行回顾性分析,重点分析其部位、信号及其侵袭性表现等情况。结果15例患者中,右侧病变8个(8/15),左侧7个(7/15);肿瘤形态为类圆形或不规则形,12例较大病变不同程度侵犯颈静脉孔区、乳突、岩骨、岩尖、斜坡等处骨质;肿瘤信号欠均匀,12个(12/15)肿块在MR平扫出现“盐和胡椒征”,以“胡椒”表现最为显著;13个肿块(13/13)均有明显强化,其中10个肿块出现“盐和胡椒征”。9例行MRA检查,颈内动脉和颈内静脉不同程度移位和包绕。结论根据肿瘤的部位、“盐和胡椒征”等MR表现,可在手术前正确诊断颈静脉球瘤。     

腹膜转移瘤的影像学诊断

目的探讨腹膜转移瘤的影像学表现特点。方法回顾性分析经手术及穿刺活检证实的35例腹膜转移瘤的影像学表现,并与手术结果对照,35例做CT平扫及增强扫描,5例行MR I检查。结果(1)腹膜转移瘤常表现为大量腹水(22/35);(2)腹膜结节状增厚(23/35);(3)大网膜饼形增厚(16/35)和大网膜污垢样改变(12/35);(4)肠系膜污垢样改变(12/35)及结节状改变(9/35);(5)腹腔单发或多发囊性改变,有占位效应(4/35)。结论CT/MR I是发现腹膜转移灶的重要影像学方法。     

磁共振脑功能成像指导脑肿瘤切除的意义

脑外科手术的目的是最大限度地切除脑肿瘤并尽可能保留功能,提高脑肿瘤患者的术后生存质量。脑外科医师需要在术前明确肿瘤区域与存留功能区域的空间关系,拟定手术切除计划,尽量回避对存留功能区的损伤,并预测术后可能发生的功能损害;术后需要了解手术区域脑功能的恢复状况,评价手术疗效。目前,能够进行空间定位的脑功能的评价措施包括多导脑电图(EEG)、脑磁图(MSI)、正电子发射断层(PET)和磁共振脑功能成像(fMR I)。本文主要介绍了磁共振脑功能成像评价脑肿瘤患者脑功能应用研究现状。1脑肿瘤的磁共振脑功能成像磁共振脑功能成像原理…     

自发性颅内低压综合征的影像学特点

自1938年Schaltenbrand第一次描述1例自发性颅内低压综合征病例以来,该病症逐渐为人们认识。颅内低压综合征的诊断主要根据临床有典型的体位性头痛症状(直立位出现或加重,平卧位减轻或消失),同时腰椎穿刺测脑脊液压力低于8kPa(60mmH2O)。自20世纪90年代以来,文献报道的本综合征神经影像学表现越来越多,并使其诊断发生了革命性的变化。本文将就其影像学特点及发生的病理生理机制进行简要介绍。1自发性颅内低压综合征影像学表现的病理生理基础腰椎穿刺脑脊液压力低于8kPa(60mmH2O)是诊断自发性颅内低压综合征的主要依据,脑脊液压力降低也一…     

Large colloid cyst in lateral ventricle simulating brain tumour

Summary This case report describes a patient presenting with symptoms of increased intracranial pressure, whose computerized tomographic (CT) scan was highly suggestive of a large low-grade glioma invading the basal ganglia. Magnetic resonance imaging (MRI) revealed a well-demarcated space-occupying mass of increased intensity in the left lateral ventricle and adjacent white matter. Following stereotactic biopsy, which yielded a homogeneous jelly-like material, the mass was removed microsurgically and was found to be most like a colloid cyst on histological examination. Discussion focusses on the clinical and differential diagnostic implications of this very unusual combination of findings.