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Tuesday, November 10, 2009
Desmoid Tumour-MRI
Desmoid tumors are classified as extra-abdominal, intra-abdominal, or located within the abdominal wall. Abdominal wall desmoid tumors arise most commonly from the aponeurosis of the rectus abdominus muscle with out without intraabdominal extension.. Extra-abdominal tumors typically occur in the shoulder, chest wall, thigh, inguinal region, and back. Clinical symptoms are masked by the slow growth of the tumor and depend on the site to tumor involvement. Desmoid tumors have a similar attenuation to muscle on contrast-enhanced CT images. However, CT cannot distinguish a desmoid tumor from similar soft tissue tumors, making histological diagnosis necessary. MRI enables better tissue characterization of desmoid tumors by demonstrating intratumoral areas of low signal intensity on all pulse sequences. The low signal intensity is due to the presence of abundant collagen within the lesion. Desmoid tumors appear as low-signal intensity masses in a background of high-signal intensity fat on T1-weighted MR images. These tumors have variable signal intensity on T2-weighted MR images. In mature desmoids, areas of abundant fibrosis results in low signal intensity on T2-weighted images. Longstanding tumors are low in signal intensity on T1 and T2-weighted MR images and enhance only minimally after intravenous gadolinium chelate. In the acute phase, tumors may have regions of high signal intensity on T2-weighted images that also show heterogeneous increased enhancement. Tumor recurrence is a frequent finding after surgery and is easily detected using MRI.
CT scanning is the diagnostic modality of choice . The typical appearance of a perinephric abscess on a CT scan is that of a soft-tissue mass (20 Hounsfield unit) with a thick wall that may enhance after introduction of intravenous contrast material (ie, the Rind sign).
The mass are isointense or slightly higher signal than surrounding muscles on T1- and heterogeneously high signal on T2-weighted images. This is 4 yr old biopsy proven case of rhabdomyosarcoma with residual/recurrent mass.
This is 9 yr old male who came to us with the complaints of pain in left hip.MRI hip was performed. Bone marrow edema of infero-medial wall of acetabulum displaying low signal on T1, high signal on T2 and Stir images is seen along with left hip joint effusion. Axial fat suppressed image shows an irregular low signal focus in acetabular roof suspicious of tumour nidus. Differential diagnosis includes early changes of tubercular osteomyelitis, perthes’s disease (though femoral head involvement is more frequently seen). Discussion: Osteoid osteoma is a benign bone tumour constituting about 3% of all primary bone tumours. Males are more commonly affected with M:F = 3:1. Most patients are 5-25 yrs of age and involve long tubular bones of lower extremities. Fusiform sclerosis and central nidus are seen on radiographs, CT and MRI. Soft tissue effusion and bone marrow edema are common accompaniments. Pain is an invariable symptom. CT is more useful diagnostic tool as it well depicts the hypodense nidus with surrounding sclerosis.
This is MRI lumbar spine of a 70 yr old male who came to us with complaints of back pain and pain in both lower limbs. It shows evidence of osseous destruction along with marorw signal abnormality of multifocal vertebral bodies involving all lumbar vertebral bodies, sacral ala. There is epidural soft tissue component with involvement of the posterior elements, appearing heterogeneously hyperintense on STIR and hypointense on T1W along with compromise of neural sac. Discussion: Four MR patterns of vertebral metastatic disease are seen – focal lytic, focal sclerotic, diffuse inhomogenous, diffuse homogenous. The most common among them is focal lytic lesions characterized by low signal intensity on T1 and high on T2. Pedicle destruction is more in favour of metastatic etiology. Pathologic compression fractures are also seen and show comparatively low signal intensity on T1 and high signal on T2 as compared to benign osteoporotic fractures which are mostly isointense on all sequences.
Our patient is 73 yr old female presented to us with a solid lump in left breast. Craniocaudal and medio-lateral oblique views of left breast show an asymmetric nodular density in left breast with minimally iregular margins and punctate foci of microcalcifications.Small lymphnodes are seen in left axillary region.
BIRADS Scores
0 Incomplete Your mammogram or ultrasound didn't give the radiologist enough information to make a clear diagnosis; follow-up imaging is necessary Need to review prior studies and/or complete additional imaging 1 Negative There is nothing to comment on; routine screening recommended Continue routine screening 2 Benign A definite benign finding; routine screening recommended Continue routine screening 3 Probably Benign Findings that have a high probability of being benign (>98%); six-month short interval follow-up Short-term mammogram follow up at 6 mths, then every 6-12 mths for 1-2 yrs 4 Suspicious Abnormality Not characteristic of breast cancer, but reasonable probability of being malignant (3 to 94%); biopsy should be considered Perform biopsy, preferably needle biopsy 5 Highly Suspicious of Malignancy Lesion that has a high probability of being malignant (>= 95%); take appropriate action Biopsy and treatment as necessary. 6 Known Biopsy Proven Malignancy Lesions known to be malignant that are being imaged prior to definitive treatment; assure that treatment is completed
DISH diagnostic criteria include the following : Flowing calcifications and ossifications along the anterolateral aspect of at least 4 contiguous vertebral bodies, with or without osteophytes. Preservation of disk height in the involved areas and an absence of excessive disk disease. Absence of bony ankylosis of facet joints and absence of sacroiliac erosion, sclerosis, or bony fusion, although narrowing and sclerosis of facet joints are acceptable. Lower thoracic spine involvement is typical of DISH, but the lumbar and cervical spine also can be affected. The left side of the spine typically is spared or less involved, which probably is attributable to the pulsating aorta.
This is a six year old boy with history of measles and neurological complaints. Subacute sclerosing panencephalitis (SSPE) is a progressive, slow virus infection of the brain, caused by the measles virus, attacking children and young adults. In the early period, lesions are in the grey matter and subcortical white matter. They are asymmetrical and had a predilection for the posterior parts of the hemispheres.
Marked edema is evident within the heel pad, the flexor digitorum brevis, and within the calcaneus s/o plantar myo-fascitis with enthesopathy. Reported by Teleradiology Providers
Ossification of posterior longitudinal ligament (OPLL) is a well-documented cause of cervical spine stenosis and myelopathy among Japanese patients. Its etiology still remains obscure. This entity is rarely seen in Indians. OPLL occurs after the age of 40 years and the most commonly affected region is the cervical spine, usually at C4/5, although the thoracic and lumbar regions are not exempt. The frequency of involvement diminishes as the level descends as follows: cervical 70-75%, thoracic 15-20% and lumbar 10%. The unexplained intimate relationship of OPLL with cervical spondylosis and diffuse idiopathic skeletal hyperostosis (DISH) is well known. This is post laminectomy CT scan of a case of OPLL.
Optic nerve glioma (also known as optic pathway glioma) is the most common primary neoplasm of the optic nerve. In 66% of NF-1 patients with optic nerve glioma, the growth involves the intraorbital optic nerve. In the absence of NF-1, the optic chiasm is most commonly involved, as is, less often, the intraorbital optic nerve. Optic nerve glioma may involve various portions of the retrobulbar visual pathway, including the optic nerve, chiasm, tracts, and radiations. Malignant lesions can invade the hypothalamus, basal ganglia, and internal capsule directly, or they may spread to the leptomeninges or subpial surfaces. On T1-weighted images, optic nerve gliomas are usually isointense to the cortex and hypointense to white matter. Invariably, the lesions are hypointense to orbital fat. On T2-weighted images, lesions demonstrate a mixed appearance that is isointense to hyperintense relative to white matter and the cortex. Following contrast administration, intense enhancement is common.
This is a 25 year old post cholecystectomy status female with collection in the GB fossa and suspected Bismuth type I injury. The overall incidence of ductal injury during laparoscopic cholecystectomy is 1.2% or less. Postoperative bile duct injury may be classified as a leak, stricture, or complete transection and excision of a segment of duct, with or without obstruction of the proximal biliary tree by surgical clips. According to Bismuth classifications of traumatic bile duct injury--
Type I is injury more than 2 cm distal to biliary bifurcation.
Type II is less than 2 cm from biliary confluence.
Type III injury involves entire common hepatic duct and leaves confluence intact.
Type IV is complete or partial destruction of biliary bifurcation.
"According to J Telemed Telecare 2009;15:373-376 , in Brazil twelve videoconferences were recorded by the Health Channel and transformed into TV programmes, both for conventional broadcast and for access via the Internet. According to RUTE network has been used, a high-speed national research and education network. "
According to the latest article in AJR 2009; 193:1–4 In severe or potentially fatal cases radiography shows peripheral lung opacities. CT revealed peripheral ground-glass opacities suggesting peribronchial injury in severe cases of the same. Full text is available.
INTRAVENTRICULAR EPIDERMOID-MRI Epidermoids represent 0.2-1% of all intracranial masses. They arise from inclusion of epithelial remnants trapped during 3-5 weeks of fetal life (remember that choroid plexus are also formed from invagination of ectodermal tissues). Intraventricular epidermoids are more in 4th ventricle followed by lateral ventricles. More common in middle age; very rare in children If ruptured, aseptic meningitis occurs. Long T1 and T2 are due to keratin in solid crystalline state. Epidermoids have restricted ADC and complex FLAIR signal, unlike arachnoid cysts.
FINDINGS An expansive intraventricular lesion in lateral ventricle, iso-intense on T1-weighted image and hypo-intense on T2-weighted image with few cystic areas, demonstrating restricted diffusion suggestive of INTRAVENTRICULAR EPIDERMOID. Differential diagnosis includes Intraventricular Neurocytoma and Oligodendrogliomas but calcification is hallmark for their diagnosis. Case by- Teleradiology Providers
Dorsal dermal Sinus with Intramedullary Abscess Formation--MRI
Dorsal dermal sinus, a congenital abnormality associated with spinal dysraphism, can serve as a path for spread of infection inside the spinal thecal sac with its sequelae. Intramedullary abscess formation is an uncommon complication and very few have been reported in the English literature. Case by Dr Sangeeta Aneja, MD Associate Professor & Head of Dept. LLRM Medical College.
"TechNavio, the market intelligence platform of Infiniti Research published its a new research report on the teleradiology market. The report says that the global market for teleradiology was around $6 billion in 2008, and is expected to grow at double digit rates in the next five years. The report says that “Technological advances and requirement to lower the healthcare costs have encouraged the healthcare services providers to outsource the diagnosis of radiology images to developing and low-cost countries. Also, the ease of entry for the new entrants in the teleradiology market has resulted in a higher competition in the market, and a greater number of teleradiology service providers.” Source: TechNavio
It is a common congenital fragmentation or synchondrosis of the patella. It occurs in approximately 1% of population but some have observed a much higher incidence; most remain asymptomatic, but direct trauma may disrupt the synchondroses, causing symtoms that mimic those of fracture. Symptomatic cases are identified on MRI with marrow edema as in our case of a 11 yr old with pain for last 6 months. Second opinion- Teleradiology Providers
Sumer Sethi is the author of very popular handbook "Review of Radiology"for medical students. CEO of the company-"Teleradiology Providers". This site is an online Radiology Magazine, which has been featured in the Times of India, Radiographics, BMJ, Journal of Thoracic Imaging, RT image magazine & International Society of Radiology. Creator of the concept of Radiology Grand Rounds. Course director of DAMS, Delhi Academy of Medical Sciences, leading institute for MD/MS/MCI screening Tests. Editor in chief of Internet Journal of Radiology and Neuroradiology Section Editor in Journal of Radiology Cases Reports.
