Computed tomography of the sternum and its articulations

The chest wall presents diagnostic difficulties for both the clinician and the radiologist. Because of normal variations in anatomy and ossification, analysis of the sternal region can be particularly confusing. We reviewed the normal computed tomographic (CT) appearance of the sternum in 354 patients. Important normal sternal variants included cortical unsharpness along the posterior aspect of the manubrium, lateral surfaces of the body, and at the sternal fibrocartilaginous articulations; soft tissue prominence at the junction of the sternum and costochondral cartilage; and bony sclerosis at the transitions from manubrium to body and from body to xiphoid. In seven patients with clinically significant sternal abnormality, key CT features were abnormal soft tissue mass (7/7), destruction or irregularity of the cortical contour (7/7), and abnormal increased attenuation of bone (1/7). CT should be the radiologic study of choice in patients with suspected abnormality of the sternum and its articulations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46774/1/256_2004_Article_BF00349494.pd

Retroperitoneal mucinous cystadenoma

A case of retroperitoneal mucinous cystadenoma histologically confirmed in a 21-year-old woman is reported. Although ultrasound, CT and MR detected the tumor, a preoperative diagnosis could not be established by imaging methods. The cystic tumor was removed and microscopic examination revealed a mucinous cystadenoma, Mullerian mesothelial metaplasia of peritoneal invagination into the retroperitoneal space is the most likely explanation for the histogenesis of these tumors. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved

Screening for abdominal aortic aneurysms during routine lumbar CT scan - Modification of the standard technique

Introduction: Abdominal aortic aneurysms (AAAs) are often incidental findings in patients undergoing US, CT or MRI studies. The recommended field of view (FOV) for standard CT examinations of the spine is 14 cm. This FOV does not allow full visualization of the abdominal aorta. Purpose: To justify a larger FOV for male smokers older than 55 years and women older than 65 years, with a higher incidence of AAA. Materials and methods: The lumbar CT examinations of 100 consecutive patients (age: mean 68 years, range 55-85 years) presented with low-back pain were retrospectively reviewed. Measurements of the abdominal aorta and lumbar abnormalities were analysed. A control study in 850 patients who underwent abdominal CT scans for other causes was available for comparison. Results: There were three men with AAAs measuring 4.5, 5.5 and 5.6 cm (mean 5.2 cm). Findings related to the clinical problem were disk prolapse or herniation, spondylosis, spinal stenosis and grade I spondylolesthesis. In the control group, 17 patients were found with AAAs with diameter greater than 4 cm (2%). Conclusions: Patients with low-back pain, older than 55 years of age, examined with lumbar spine CT, should also be screened for aortic disease, since the prevalence of AAA is similar with that of an age-matched control group. Appropriate modification in the applied FOV is recommended. (C) 2004 Elsevier Inc. All rights reserved

Diagnostic efficacy and safety of MRI of the liver with superparamagnetic iron oxide particles (SH U 555 A)

The purpose of this study was to evaluate the diagnostic efficacy and safety of an intravenous injection of magnetic resonance imaging (MRI) contrast agent, SH U 555 A, in adult patients with known focal liver lesions. Pre- and post-contrast image sets were obtained in 19 patients after injection of SH U 555 A as a part of a phase III clinical trial (patients <60 kg body weight received 0.9 mL and patients >60 kg received 1.4 mL). Three blinded readers evaluated the post-contrast images. Blood pressure and heart rate were recorded and laboratory tests were performed at baseline, during and immediately after the procedure, and four and 24 hours after the MR procedure. On post-contrast MRI, there was statistically significant improvement in diagnostic confidence, visualization, delineation, and contrast between the lesions and the healthy parenchyma in comparison to precontrast. Twenty more lesions were detected on post-contrast images. The management in six patients (31.7%) was changed after post-contrast imaging. Changes in vital signs and laboratory tests were minimal and did not affect the patients’ clinical condition. Only a moderate allergic reaction (diffuse erythematous rash) was recorded. SH U 555 A is an effective and safe contrast agent for MRI of the liver. (C) 2001 Wiley-Liss, Inc

REVERSIBLE CT FINDINGS OF THE LIVER AFTER RADIOTHERAPY

We report the computed tomographic (CT) findings in a case of radiation therapy of the abdomen which affected the left lobe of the liver. The post-radiotherapy CT demonstrated a low density area involving the left lobe of the liver. One month later in a new CT this finding disappeared. We conclude that low density areas in the liver parenchyma following radiotherapy should be analysed with caution, especially when secondary deposits are considered in the differential diagnosis

Brain MR post-gadolinium contrast in multiple sclerosis: the role of magnetization transfer and image subtraction in detecting more enhancing lesions

Our purpose was to evaluate the role of magnetization transfer and image subtraction in detecting more enhancing lesions in brain MR imaging of patients with multiple sclerosis (MS). Thirty-one MS patients underwent MR imaging of the brain with T1-weighted spin echo sequences without and with magnetization transfer (MT) using a 1.5 T imager. Both sequences were acquired before and after intravenous injection of a paramagnetic contrast agent. Subtraction images in T1-weighted sequences were obtained by subtracting the pre-contrast images from the post-contrast ones. A significant difference was found between the numbers of enhanced areas in post-gadolinium T1-weighted images without and with MT (p=0.020). The post-gadolinium T1-weighted images with MT allowed the detection of an increased (13) number of enhancing lesions compared with post-gadolinium T1-weighted images without MT. A significant difference was also found between the numbers of enhanced areas in post-gadolinium T1-weighted images without MT and subtraction images without MT (p=0.020). The subtraction images without MT allowed the detection of an increased (10) number of enhancing lesions compared with post-gadolinium T1-weighted images without MT. Magnetization transfer contrast and subtraction techniques appear to be the simplest and least time-consuming applications to improve the conspicuity and detection of contrast-enhancing lesions in patients with MS

CASE-REPORT - MAGNETIC-RESONANCE-IMAGING OF SPINAL-CORD COMPRESSION IN THALASSEMIA BEFORE AND AFTER RADIATION TREATMENT

Thalassaemia is a genetic disorder of haemoglobin synthesis, characterized by anaemia and haemosidirosis [1]. A complication of this disease is extramedullary haemopoiesis in the spinal extradural space, causing compression of the spinal cord. The rapid onset of neurological deficit prompts immediate neuroradiological investigation and early treatment [2]. The magnetic resonance imaging (MRI) findings in such lesions have been described previously by some of the present authors [3]. A further case is presented to illustrate the value of spinal MRI before and after radiation treatment of extramedullary haemopoiesis

Large lipoma of the vulva

Vulvar lipoma is a rare entity. A 52-year-old woman presented with a large mass arising in the right major labium. CT scan revealed that the mass contained adipose tissue. During operation a lipomatous tumor was found which at histologic examination proved to be a lipoma. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved

SPINAL NEURILEMOMAS AND NEUROFIBROMAS - CENTRAL DOT SIGN IN POSTGADOLINIUM MRI

The MR studies of three histologically proven spinal neurilemmomas and neurofibromas were reviewed retrospectively. There were two benign neurilemmomas (schwannomas) and one neurofibroma. The common characteristic of these cases was a central low intensity focus (”dot”) seen on postcontrast T1-weighted imaging. The low intensity foci corresponded histologically to a congeries of changes including edema, microcysts, foam cells, hyalinization of blood vessels, old hemorrhage, and dystrophic calcification