MR imaging findings in the follow-up of patients with different stages of knee osteoarthritis and the correlation with clinical symptoms

✓ The authors report the case of a 21-year-old woman who presented with headaches, frequent sensations of loss of equilibrium, and intermittent strabismus. A tectal arteriovenous malformation (AVM) was diagnosed based on magnetic resonance (MR) imaging findings. The AVM drained toward the straight sinus and was associated with a tonsillar prolapse (Chiari malformation Type I [CM-I]) and cervical syringomyelia. The tectal AVM was embolized with N-butyl cyanoacrylate, and disconnection of about 80% of the lesion was obtained. All clinical symptoms resolved after embolization, and radiosurgery was proposed to treat the malformation remnant. A control MR image confirmed the regression of the tonsillar prolapse and the disappearance of the syrinx. This report emphasizes that CM-I and syringomyelia may be acquired and related to hydrovenous disorders.

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Non-resolving Findings in a Long-term Radiographic Follow-up of an Infant with Acute Paraffin Oil Aspiration

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.126028 ◽

2014 ◽

Vol 4 ◽

pp. 2 ◽

Cited By ~ 1

Author(s):

George Stathis ◽

Konstantinos N. Priftis ◽

Maria Moustaki ◽

Efthymia Alexopoulou

Keyword(s):

Clinical Symptoms ◽

Male Infant ◽

Mineral Oil ◽

Imaging Findings ◽

Radiological Findings ◽

Lipoid Pneumonia ◽

Paraffin Oil ◽

Computed Tomography Scans

Acute lipoid pneumonia (LP) in children is a rare disorder caused by the aspiration of oil-based substances and is difficult to diagnose due to non-specific clinical symptoms and radiological findings. We report the case of a 5-month-old male infant with acute LP caused by accidental aspiration of a large amount of mineral oil. We present the imaging findings in the computed tomography scans performed during his hospitalization and focus on the residual abnormalities seen on a scan performed 7-years after the incident. This, to the best of our knowledge, is the longest follow-up report of an acute exogenous LP patient and the only case that demonstrates non-resolving abnormalities in a pediatric patient after a single acute episode of mineral oil aspiration.

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Prospective cohort study of mild cervical spondylotic myelopathy without surgical treatment

Journal of Neurosurgery Spine ◽

10.3171/2011.8.spine11395 ◽

2012 ◽

Vol 16 (1) ◽

pp. 8-14 ◽

Cited By ~ 36

Author(s):

Masatoshi Sumi ◽

Hiroshi Miyamoto ◽

Teppei Suzuki ◽

Shuichi Kaneyama ◽

Takako Kanatani ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Mr Imaging ◽

Cervical Spondylotic Myelopathy ◽

Japanese Orthopaedic Association ◽

Rank Test ◽

Imaging Findings ◽

Significant Difference ◽

The Mean

Object Because the main pathology of cervical spondylotic myelopathy (CSM) is spinal cord damage due to compression, surgical treatment is usually recommended to improve patient symptoms and prevent exacerbation. However, lack of clarity of prognosis in cases that present with insignificant symptoms, particularly those of mild CSM, lead one to question the veracity of this course of action. The purpose of this study was to elucidate the prognosis of mild CSM without surgical intervention by evaluation of clinical symptoms and MR imaging findings. Methods Sixty cases of mild CSM (42 males and 18 females, average age 57.2 years) presenting with scores of 13 or higher on the Japanese Orthopaedic Association (JOA) scale were treated initially by in-bed Good Samaritan cervical traction without surgery. These patients were enrolled between 1995 and 2003 and followed up periodically until the date of myelopathy deterioration or until the end of March 2009. The deterioration of myelopathy was defined as a decline in JOA score to less than 13 with a decrease of at least 2 points. As a prognostic factor, the authors used their classification of spinal cord shapes at their lateral sides on axial T1-weighted MR imaging. “Ovoid deformity” was classified as a situation in which both sides were round and convex, and “angular-edged deformity” where one or both sides exhibited an acute-angled lateral corner. The duration of follow-up was assessed as the tolerance rate of mild CSM using Kaplan-Meier survival analysis and compared between 2 groups classified by MR imaging findings. Furthermore, differences between groups were analyzed by various applications of the log-rank test. Results Of the initial 60 cases, follow-up records existed for 55, giving a follow-up rate of 91.7% (38 males and 17 females, average age 56.1 years). The mean JOA score at end point was 14.1, which was not statistically different from the mean of 14.5 at the initial visit. Deterioration in myelopathy was observed in 14 (25.5%) of 55 cases, whereas 41 (74.5%) of 55 cases maintained mild extent myelopathy without deterioration through the follow-up period (mean 94.3 months). The total tolerance rate of mild CSM was 70%. However, there was a significant difference in the tolerance rate between the cases with angular-edged deformity (58%) and cases with ovoid deformity (95%; p = 0.049). Conclusions The tolerance rate of mild CSM was 70% in this study, which proved that the prognosis of mild CSM without surgical treatment was relatively good. However, the tolerance rate of the cases with angular-edged deformity was 58%. Therefore, surgical treatment should be considered when mild CSM cases show angular-edged deformity on axial MR imaging, even if patients lack significant symptoms.

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Distinct imaging patterns of pseudoprogression in glioma patients following proton versus photon radiation therapy

10.21203/rs.3.rs-197830/v1 ◽

2021 ◽

Author(s):

Reed Ritterbusch ◽

Lia M. Halasz ◽

Jerome J. Graber

Keyword(s):

Radiation Therapy ◽

Mr Imaging ◽

Tumor Progression ◽

Clinical Symptoms ◽

Molecular Subtype ◽

Tumor Grade ◽

Photon Radiation ◽

Low Grade ◽

Mean Time

Abstract Purpose Criteria by the Radiologic Assessment in Neuro-Oncology (RANO) group outline the diagnosis of pseudoprogression (Ps) after photon therapy for gliomas based on timing and location. We noted that patients receiving proton therapy manifested radiographic changes that appear different than Ps after photon therapy, which could be interpreted as tumor progression. In this study, we retrospectively reviewed MR imaging after proton or photon radiation for gliomas. We propose criteria to characterize proton pseudoprogression (ProPs) as distinct from Ps seen after photons. Methods Post-treatment MR imaging, clinical and pathological data of low grade glioma patients were reviewed. Overall, 57 patients receiving protons were reviewed for the presence of ProPs, and 43 patients receiving photons were reviewed for any equivalent imaging changes. Data collected included the location and timing of the new enhancement, tumor grade, molecular subtype, chemotherapy received, and clinical symptoms. Results Fourteen patients (24.6%) had new enhancement following radiation therapy that was unique to treatment with protons. The mean time to development of the ProPs was 15.4 months (7–27 months). We established the following criteria to characterize ProPs: located at the distal end of the proton beam; resolves without tumor-directed therapy; and subjectively multifocal, patchy, and small (< 1 cm). In the group receiving photons, none had changes that met our criteria for ProPs. Conclusion Patients who receive protons have unique imaging changes after radiation therapy. ProPs could be mistaken for tumor progression, but typically resolves on follow up. Further studies are needed to understand the radiobiology and pathophysiology underlying these imaging changes.

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Neuro-Behcet's Disease: Initial and Follow-up MR Imaging Findings

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1998.39.3.469 ◽

1998 ◽

Vol 39 (3) ◽

pp. 469

Author(s):

Chan Sung Kim ◽

Sun Seob Choi ◽

Ha Jong Lee ◽

Dong Ho Ha ◽

Yong Il Lee

Keyword(s):

Mr Imaging ◽

Behçet’S Disease ◽

Behcet’S Disease ◽

Behçet's Disease ◽

Imaging Findings ◽

Behcet's Disease

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Clinical Implications of MR Imaging Findings in the White Matter in Very Preterm Infants: A 2-year Follow-up Study

Radiology ◽

10.1148/radiol.11110797 ◽

2011 ◽

Vol 261 (3) ◽

pp. 899-906 ◽

Cited By ~ 79

Author(s):

Francisca T. de Bruïne ◽

Annette A. van den Berg-Huysmans ◽

Lara M. Leijser ◽

Monique Rijken ◽

Sylke J. Steggerda ◽

...

Keyword(s):

White Matter ◽

Mr Imaging ◽

Preterm Infants ◽

Clinical Implications ◽

Imaging Findings ◽

Very Preterm Infants ◽

Very Preterm ◽

Follow Up Study

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Thoracic paravertebral involvement in patients with IgG4-related disease: CT and MR imaging findings

Rheumatology ◽

10.1093/rheumatology/keaa254 ◽

2020 ◽

Vol 59 (12) ◽

pp. 3878-3885

Author(s):

Zaizhu Zhang ◽

Wenmin Guan ◽

Qiang Lin ◽

Wei Yu

Keyword(s):

Mr Imaging ◽

Steroid Therapy ◽

Thoracic Vertebrae ◽

Imaging Findings ◽

Mr Images ◽

Related Disease ◽

Igg4 Related Disease ◽

Contrast Enhanced Ct ◽

The Right

Abstract Objectives To retrospectively evaluate CT and magnetic resonance (MR) imaging thoracic paravertebral findings at baseline and follow-up in patients with IgG4-related disease. Methods The study consisted of 36 patients with IgG4-related disease involving thoracic paravertebral regions (32 men and four women; mean age, 58 years; range, 25–78 years). A total of 36 patients underwent CT or MR imaging at baseline; 20 patients underwent follow-up. CT and MR images were reviewed and analysed in consensus by two radiologists for the various features of thoracic paravertebral lesions. Results All lesions were located around two or more thoracic vertebrae, particularly the lower thoracic vertebrae (n = 36). The right side of vertebrae was predominantly affected in all cases (n = 36). Radiologically, IgG4-related thoracic paravertebral lesions were categorized into three types: solitary or multiple saddle-like masses type (32 patients); multiple nodules type (three patients); and invasively irregular mass type (three patients). All the types showed soft-tissue density on CT images, isointense on T1- and T2-weighted images, and homogeneous enhancement with penetration of small arteries in the lesions on contrast-enhanced CT and MR images. Steroid therapy administered to 20 patients dramatically diminished the mean maximum thickness in 18 patients. One patient with T7-12 vertebrae involved improved after steroid therapy. Conclusion IgG4-related paravertebral lesions occur mainly around the right side of the lower thoracic vertebrae and manifest as three major patterns of CT and MR imaging findings. Recognition of these diagnostic features will assist in the diagnosis and treatment of IgG4-related disease.

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Pelvic Congestion Syndrome: A Missed Opportunity

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1735497 ◽

2021 ◽

Author(s):

Claire Kaufman ◽

Nancy Ann Little

Keyword(s):

Pelvic Pain ◽

Clinical Symptoms ◽

Local Population ◽

Complex Nature ◽

Imaging Findings ◽

Pelvic Congestion Syndrome ◽

Average Body Mass ◽

N 93 ◽

Pelvic Congestion

Abstract Background/Aims Chronic pelvic pain (CPP) is pelvic pain for greater than 6 months with many potential causes one being pelvic congestion syndrome (PCS). PCS is diagnosed by clinical symptoms, exclusion of other etiologies, and imaging. Given the complex nature and diagnosis of CPP, we examined ordering and referral patterns in our local population to understand how the imaging findings of PCS correlate with patient symptoms and referral and treatment. Materials and Methods After IRB approval, we searched all 18 to 70-year-old females with CT of the pelvis between March 2015 and March 2018 with the terms “pelvic” plus “congestion,” “varices,” or “vein dilation” in the dictation. Via electronic medical record and image review we collected data regarding demographics, clinical presentation, symptoms, imaging findings, ordering provider, and any follow-up/referrals or interventions regarding PCS. Results A total of 96 patients were included of the 197 studies, with an average age of 47 years and average body mass index of 19.3 (n = 93) at the time of imaging. The reason for imaging was often acute abdominal or flank pain (n = 22) with 38% of cases ordered from the emergency room. Only 72 patients had documentation of clinical evaluation for symptoms of PCS. Notably, only 20 were referred for their symptoms, and only two patients were referred to IR. Both patients underwent successful endovascular intervention. Conclusion CPP is a common cause of morbidity with PCS representing an underdiagnosed cause. We demonstrate that while imaging findings may be incidental, we are failing to capture and triage patients with clinical symptoms of PCS. Radiologists can play a key role in the care of these patients.

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Problem-Solving MR Imaging for Equivocal Imaging Findings and Indeterminate Clinical Symptoms of the Breast

Magnetic Resonance Imaging Clinics of North America ◽

10.1016/j.mric.2017.12.012 ◽

2018 ◽

Vol 26 (2) ◽

pp. 221-233 ◽

Cited By ~ 2

Author(s):

Ethan Cohen ◽

Jessica W.T. Leung

Keyword(s):

Problem Solving ◽

Mr Imaging ◽

Clinical Symptoms ◽

Imaging Findings

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Magnetic resonance imaging findings in treated spinal dural arteriovenous fistulas: lack of correlation with clinical outcomes

Journal of Neurosurgery Spine ◽

10.3171/2010.11.spine10178 ◽

2011 ◽

Vol 14 (4) ◽

pp. 548-554 ◽

Cited By ~ 25

Author(s):

Timothy J. Kaufmann ◽

Jonathan M. Morris ◽

Andrea Saladino ◽

Jay N. Mandrekar ◽

Giuseppe Lanzino

Keyword(s):

Spinal Cord ◽

Mr Imaging ◽

Clinical Outcomes ◽

Imaging Findings ◽

Urinary Function ◽

Arteriovenous Fistulas ◽

Imaging Characteristics ◽

Dural Arteriovenous Fistulas ◽

Spinal Dural Arteriovenous Fistulas

Object Little information is available on follow-up MR imaging after treatment of spinal dural arteriovenous fistulas (DAVFs). The authors studied MR imaging findings in treated spinal DAVFs in relation to clinical outcomes. Methods A retrospective review of patients with spinal DAVFs who had undergone both pre- and postoperative spinal MR imaging was conducted. Postoperative MR images were obtained as routine follow-up studies or because of subjective or objective clinical deterioration. Several pre- and posttreatment MR imaging characteristics were evaluated by 2 neuroradiologists blinded to the clinical outcome. Clinical outcomes of motor, sensory, and urinary function (in relation to the patient's preoperative status) at the time of the postoperative MR imaging were obtained from the clinical record. The chi-square, Fisher exact, and rank-sum tests were performed to correlate imaging findings and changes with clinical outcomes. Results Thirty-four patients met inclusion criteria. Treatment was surgical in 33 patients and endovascular in 1 patient. Follow-up MR imaging was performed at a mean 168 ± 107 days after treatment. Twenty-seven patients (79.4%) were either clinically stable or improved, and 7 (20.6%) experienced worsening in one or more clinical outcomes. Most patients were found to have improvement of MR imaging changes. However, some degree of persistent spinal cord signal abnormality, enhancement, and swelling was observed in 31 (91.2%), 29 (85.3%), and 18 (52.3%) patients, respectively. Changes in these MR imaging characteristics compared with preoperative MR imaging did not correlate with clinical outcomes (p > 0.05), with the one exception of a significant correlation between change in urinary function and extent of spinal cord contrast enhancement (p = 0.026), a correlation of uncertain importance. Ten of the 34 patients underwent posttreatment digital subtraction angiography, and 3 of these patients had recurrent/residual DAVFs. Worsening of motor function significantly correlated with recurrent/residual DAVF (p = 0.053). Conclusions Spinal cord abnormalities persist on postoperative MR imaging studies in patients with treated spinal DAVFs, and although they tend to mildly improve with time, these changes may not correlate with clinical outcomes. However, regardless of imaging findings, worsening motor function may correlate with a recurrent or residual DAVF.

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