American Journal of Obstetrics and Gynecology, 2001
Uterine artery pseudoaneurysm is a rare but serious complication of pelvic surgery. Radiology has... more Uterine artery pseudoaneurysm is a rare but serious complication of pelvic surgery. Radiology has an important role in its diagnosis and primary management. We believe that this complication and its management are of importance to those assessing for complications following pelvic surgery.
Venous thrombosis is a well-recognised complication of central venous catheters (CVC). The aim of... more Venous thrombosis is a well-recognised complication of central venous catheters (CVC). The aim of the study was to assess the value of magnetic resonance venography (MRV) in assessing venous patency in children with suspected venous thrombosis. Contrast studies through the CVC (linogram) and Doppler ultrasonography were the initial investigations performed in children with suspected CVC-related thrombosis. Two-dimensional gated inflow and phase contrast MRV also was performed to assess the extent of venous thrombosis and to locate patent veins for replacement CVC. When the MRV identified a suitable patent vein, the CVC was reinserted by direct venous cut down or the percutaneous method under a general anaesthetic. A total of 25 children (median age, 5 years; range, 2 months to 17 years) who had multiple CVC insertions (median, 3; range, 1-9), underwent MRV for suspected venous thrombosis. Of 10 patients in whom the catheter was completely occluded, MRV identified extensive thrombosis of the central veins in 6. In 7 other children the linogram showed adherent thrombus at the tip of the CVC only. In 5 of these 7 children MRV showed extensive thrombosis of the vein in which the catheters were placed. Doppler ultrasonography diagnosed thrombotic occlusion of the neck veins in 7 children. The MRV studies showed more extensive thrombosis in 4 of these 7 patients. Additionally, MRV showed thrombosis of the intrathoracic veins in 11 patients who had patent neck veins on ultrasound scan. MRV identified a patent vein for reinsertion of CVC in 22 of 25 children. At operation, venous patency was confirmed in 20 patients (91%). MRV in children with suspected CVC-related thrombosis is more accurate than Doppler ultrasonography, and contrast studies for defining the extent of venous thrombosis. MRV correctly shows venous anatomy and patency for reinsertion of CVC.
The development of fast, single-shot heavily T2weighted sequences able to provide motion-free ima... more The development of fast, single-shot heavily T2weighted sequences able to provide motion-free images of static fluids has greatly increased interest in MR imaging of the small bowel. However, poor distension of normal bowel loops in basal conditions has led researchers to perform small bowel MR studies using an oral contrast agent in order to distend the bowel lumen. We evaluated an oral iso-osmotic polyethyleneglycol solution as an oral contrast agent for MR imaging of the small bowel in a population of healthy volunteers.
Atlanto-axial rotatory ®xation (AARF) is a rare condition which occurs more commonly in children ... more Atlanto-axial rotatory ®xation (AARF) is a rare condition which occurs more commonly in children than in adults. The terminology can be confusing and the condition is also known as`atlanto-axial rotatory subluxation' and`atlanto-axial rotary dislocation'. Rotatory ®xation is the preferred term, however, as in most cases the ®xation occurs within the normal range of rotation of the joint. By de®nition, therefore, the joint is neither subluxed nor dislocated. AARF is a cause of acquired torticollis. Diagnosis can be dicult and is often delayed. The radiologist plays a key role in con®rming the diagnosis. The classi®cation system proposed by Fielding in 1977 is most frequently used and will be discussed in detail. Given that this classi®cation system was devised in the days before computed tomography (CT), as well as the fact that combined atlanto-axial and atlanto-occipital rotatory subluxation (AORF) is omitted from the classi®cation, we propose a modi®cation to the classi®cation of this rare but signi®cant disorder. The radiological ®ndings in six cases of AARF will be illustrated, including a case with associated atlanto-occipital subluxation. The pertinent literature is reviewed and a more comprehensive classi®cation system proposed. The imaging approach to diagnosis and the orthopaedic approach to management will be discussed. Roche, C. J. et al. (2001). Clinical Radiology 56, 947±958.
The objective of our study was to evaluate the morphologic appearances of small-bowel lymphoma us... more The objective of our study was to evaluate the morphologic appearances of small-bowel lymphoma using MR enterography to identify key morphologic traits capable of providing an association between imaging manifestations and likely histologic diagnosis. Over a 54-month period, 10 patients with subsequently confirmed small-bowel lymphoma were imaged using a standardized MR enterography technique. Retrospective chart review was performed to detect associated disease processes, such as celiac disease. The morphologic characteristics of each segment with lymphomatous involvement were evaluated with respect to tumor location, tumor size, mural characteristics, fold features, loop dilatation, luminal stricturing, mesenteric or antimesenteric distribution, mesenteric involvement, and signal intensity. Nineteen distinct segments of lymphomatous involvement were identified in 10 patients, and underlying celiac disease was confirmed in six of the 10 patients. This patient group comprised 10 patients with non-Hodgkin's lymphoma (NHL) of various subtypes. No cases of Hodgkin's lymphoma were encountered. Analysis revealed celiac NHL enteropathy to have a tendency toward localization to a single, long (> 10 cm), smooth continuous bowel segment, often with aneurysmal loop dilatation, in the absence of a distinct mesenteric or antimesenteric distribution. Luminal stricturing was encountered in cases of low-grade lymphoma, whereas mesenteric fat infiltration represented a characteristic of high-grade disease. We describe the characteristics of small-bowel lymphoma on MR enterography, identifying a number of key features that may help the interpreting radiologist in suggesting the underlying histologic subtype and whether the presence of underlying celiac disease is likely.
AIMS: To measure the range of rotation and determine the instantaneous axis of rotation of the at... more AIMS: To measure the range of rotation and determine the instantaneous axis of rotation of the atlanto-axial joint in healthy volunteers using magnetic resonance imaging (MRI) and to highlight the appearances of the rotated atlanto-axial joint on computed tomography (CT) and MRI. MATERIALS AND METHODS: Twenty-eight healthy volunteers were examined using MRI during maximal head rotation. In addition, an anatomical specimen of the atlanto-axial joint, fixed in varying degrees of rotation, was imaged using CT. RESULTS: At the extremes of physiological rotation in healthy subjects there is striking but incomplete loss of contact between the articular surfaces of the atlas (C1) and the axis (C2). The range of rotation to the right was 20–48·5° (mean 32·4°) and to the left was 13–52·75° (mean 34·2°). There was no significant difference between rotation to the right and left (P = 0·455). Total rotation was 45–88·5° (mean 69·25°). The instantaneous axis of rotation was located within the odontoid peg. CONCLUSION: There is a wide range of atlanto-axial rotation in normal subjects. The instantaneous axis of rotation lies within the odontoid peg. The appearances of the rotated atlanto-axial joint are striking and may be misinterpreted as subluxation. Roche, C. J. et al. (2002). Clinical Radiology57, 103–108.
The objective of our study was to evaluate the morphologic appearances of small-bowel lymphoma us... more The objective of our study was to evaluate the morphologic appearances of small-bowel lymphoma using MR enterography to identify key morphologic traits capable of providing an association between imaging manifestations and likely histologic diagnosis. Over a 54-month period, 10 patients with subsequently confirmed small-bowel lymphoma were imaged using a standardized MR enterography technique. Retrospective chart review was performed to detect associated disease processes, such as celiac disease. The morphologic characteristics of each segment with lymphomatous involvement were evaluated with respect to tumor location, tumor size, mural characteristics, fold features, loop dilatation, luminal stricturing, mesenteric or antimesenteric distribution, mesenteric involvement, and signal intensity. Nineteen distinct segments of lymphomatous involvement were identified in 10 patients, and underlying celiac disease was confirmed in six of the 10 patients. This patient group comprised 10 patients with non-Hodgkin's lymphoma (NHL) of various subtypes. No cases of Hodgkin's lymphoma were encountered. Analysis revealed celiac NHL enteropathy to have a tendency toward localization to a single, long (> 10 cm), smooth continuous bowel segment, often with aneurysmal loop dilatation, in the absence of a distinct mesenteric or antimesenteric distribution. Luminal stricturing was encountered in cases of low-grade lymphoma, whereas mesenteric fat infiltration represented a characteristic of high-grade disease. We describe the characteristics of small-bowel lymphoma on MR enterography, identifying a number of key features that may help the interpreting radiologist in suggesting the underlying histologic subtype and whether the presence of underlying celiac disease is likely.
The cervical spine is a common focus of destruction from rheumatoid arthritis, second only to the... more The cervical spine is a common focus of destruction from rheumatoid arthritis, second only to the metacarpophalangeal joints. Joint, bone and ligament damage in the cervical spine leads to subluxations which can cause cervical cord compression resulting in paralysis and even sudden death. Because many patients with signi®cant subluxations are asymptomatic, the radiologist plays a key role in recognizing the clinically important clues to instability on plain radiographs of the cervical spine±often dicult in rheumatoid arthritis when the bony landmarks are osteoporotic or eroded. This review focuses on the signs of instability on plain radiographs of the cervical spine, using diagrams and clinical examples to illustrate methods of identifying signi®cant subluxations in rheumatoid arthritis. Roche, C. J., Eyes, B. E. and Whitehouse, G. H. (2002) Clinical Radiology 57, 241±249.
Retroperitoneal cystic lymphangiomas are extremely rare and the majority are symptomatic during c... more Retroperitoneal cystic lymphangiomas are extremely rare and the majority are symptomatic during childhood. Although benign, they can compress and infiltrate vital structures. Surgery is curative but is associated with a high complication rate. An alternative treatment strategy is image-guided percutaneous catheter drainage of the lymphangioma followed by sclerotherapy. Resolution of a large retroperitoneal cystic lymphangioma in a 4-year-old child treated by this technique is reported. To our knowledge, this technique has not been previously described in this condition and we believe that it offers significant advantages over surgery.
Certain pathologic conditions have classic radiologic manifestations that resemble various types ... more Certain pathologic conditions have classic radiologic manifestations that resemble various types of food. These "food signs" are highly memorable and easily recognizable and include findings that resemble various fruits and vegetables; meat, fish, and egg dishes; pasta, rice, grains, and bread (carbohydrates); desserts, cakes, and candy; and dishes, cutlery, condiments, and so on. It is important that radiologists recognize these classic signs, which will allow confident diagnosis on the basis of imaging findings alone or narrowing of the differential diagnosis.
Vascular injuries resulting from closed fractures of the humerus are rare. We describe two patien... more Vascular injuries resulting from closed fractures of the humerus are rare. We describe two patients who developed unsuspected pseudoaneurysms following closed humeral fracture. Both patients presented with a mass, suspicious for malignancy. In each case, diagnosis was made by magnetic resonance imaging.
Vascular injuries resulting from closed fractures of the humerus are rare. We describe two patien... more Vascular injuries resulting from closed fractures of the humerus are rare. We describe two patients who developed unsuspected pseudoaneurysms following closed humeral fracture. Both patients presented with a mass, suspicious for malignancy. In each case, diagnosis was made by magnetic resonance imaging.
We report the case of a patient with multiple myeloma (MM) and extensive lytic bone disease who p... more We report the case of a patient with multiple myeloma (MM) and extensive lytic bone disease who presented with a short history of back pain and leg weakness. Magnetic resonance imaging (MRI) of the lumbar spine revealed a sacral insufficiency fracture complicated by an epidural haematoma. Bleeding tendency in this case can be accounted for by platelet function defects, often described in plasma cell disorders in the absence of obvious coagulation abnormalities. Surgical intervention was contraindicated as a result of poor overall patient performance status (poor surgical candidate due to extensive myelomatous bone disease, previous vertebral compression fractures requiring orthopaedic stabilisation, and requiring opiate analgesia for bone pain) and management was conservative. Patients presenting with back pain and documented bone disease in the setting of myeloma should be managed with a high index of clinical suspicion and considered for urgent MR imaging to avoid missing this serious and potentially reversible complication. We report the undescribed causative association between sacral insufficiency fracture and lumbo-sacral epidural haematoma. We illustrate the MRI signal and contrast enhancement pattern of an acute presentation of epidural haematoma.
The cross-sectional characterization of duodenal abnormalities is plagued with inadequacy, a refl... more The cross-sectional characterization of duodenal abnormalities is plagued with inadequacy, a reflection of the meandering course of this segment of the bowel. We consider the imaging appearance of such abnormalities at MRI small-bowel follow-through, illustrating the typical manifestations of each pathologically confirmed condition. MRI small-bowel follow-through allows confident duodenal evaluation because of a combination of sufficient luminal distention and multiplanar versatility. Diseases of the duodenum may have a variety of manifestations at MRI small-bowel follow-through, the knowledge of which may aid in confident noninvasive patient diagnosis.
The purpose of our study was to evaluate the potential role of an MR small-bowel follow-through (... more The purpose of our study was to evaluate the potential role of an MR small-bowel follow-through (SBFT) technique in the investigation of suspected pediatric small-bowel abnormalities. Between September 2003 and January 2008, 280 MR SBFT examinations were performed for investigation of known or suspected small-bowel abnormalities, including 19 of 280 examinations in 17 children (mean age, 13 years; age range 6-17 years), representing the current study population. A standardized technique was used in all cases, including axial and coronal steady-state free precession acquisitions at successive time intervals until completion. Retrospective analysis of the studies obtained was performed by two radiologists, who blindly and independently scored predefined small-bowel segments according to the degree of luminal distention achieved. Any pathologic lesions detected were also noted. Indicators of examination success as a whole (volume, tolerability, and side effects of oral contrast material) were also noted, as were details pertaining to examination duration (number of visits to the MR table, total table time). Oral contrast medium was ingested and subsequent imaging was possible in all patients; 84.2% of patients tolerated the oral contrast material well and 15.8% showed moderate tolerance. The MR table time ranged from 2 to 4 minutes, without early termination of the examination in any case. The average number of visits to the MR table was 1.3 (range, 1-3). The mean duration for complete small-bowel evaluation was 25 minutes (range, 20-60 minutes). The mean distention scores were well within the diagnostic range in all small-bowel segments for both observers, with a substantial degree of interobserver agreement in score assignment (kappa = 0.73). Pathologic lesions were identified in 53% of studies. MR SBFT represents a promising, and perhaps optimal, technique for pediatric small-bowel evaluation for a variety of reasons, including its high tolerability, lack of ionizing radiation, avoidance of duodenojejunal intubation, and excellent luminal distention achieved. Furthermore, this technique allows "pseudodynamic" functional imaging while also showing extraluminal disease, without known biologic risk.
To evaluate the mean distance from the odontoid process of C2 to the standard skull-base lines (C... more To evaluate the mean distance from the odontoid process of C2 to the standard skull-base lines (Chamberlain's, McGregor's, and McRae's lines) on computed tomography (CT) imaging. To compare these measurements to previously documented plain radiograph and magnetic resonance imaging (MRI) measurements.Reformatted midline sagittal CT images of 150 adults were retrospectively evaluated. The shortest perpendicular distance was measured from the Chamberlain's, McGregor's and McRae's baselines for each subject to the odontoid tip. Statistical analysis was performed to compare the CT data with the previously obtained MRI and plain film data.The mean position of the odontoid process was 1.4 mm below Chamberlain's line (median 1.2 mm, SD 2.4 mm), 0.8 mm (median 0.9 mm, SD 3 mm) below McGregor's line and 5 mm (median 5 mm, SD 1.8 mm) below McRae's line. There is no significant difference between male and female results (p > 0.05) or between these CT and previous MRI measurements (p > 0.05).These results provide the mean and range of normal distance from the odontoid process to the most frequently used skull-base lines on the current population on CT.
American Journal of Obstetrics and Gynecology, 2001
Uterine artery pseudoaneurysm is a rare but serious complication of pelvic surgery. Radiology has... more Uterine artery pseudoaneurysm is a rare but serious complication of pelvic surgery. Radiology has an important role in its diagnosis and primary management. We believe that this complication and its management are of importance to those assessing for complications following pelvic surgery.
Venous thrombosis is a well-recognised complication of central venous catheters (CVC). The aim of... more Venous thrombosis is a well-recognised complication of central venous catheters (CVC). The aim of the study was to assess the value of magnetic resonance venography (MRV) in assessing venous patency in children with suspected venous thrombosis. Contrast studies through the CVC (linogram) and Doppler ultrasonography were the initial investigations performed in children with suspected CVC-related thrombosis. Two-dimensional gated inflow and phase contrast MRV also was performed to assess the extent of venous thrombosis and to locate patent veins for replacement CVC. When the MRV identified a suitable patent vein, the CVC was reinserted by direct venous cut down or the percutaneous method under a general anaesthetic. A total of 25 children (median age, 5 years; range, 2 months to 17 years) who had multiple CVC insertions (median, 3; range, 1-9), underwent MRV for suspected venous thrombosis. Of 10 patients in whom the catheter was completely occluded, MRV identified extensive thrombosis of the central veins in 6. In 7 other children the linogram showed adherent thrombus at the tip of the CVC only. In 5 of these 7 children MRV showed extensive thrombosis of the vein in which the catheters were placed. Doppler ultrasonography diagnosed thrombotic occlusion of the neck veins in 7 children. The MRV studies showed more extensive thrombosis in 4 of these 7 patients. Additionally, MRV showed thrombosis of the intrathoracic veins in 11 patients who had patent neck veins on ultrasound scan. MRV identified a patent vein for reinsertion of CVC in 22 of 25 children. At operation, venous patency was confirmed in 20 patients (91%). MRV in children with suspected CVC-related thrombosis is more accurate than Doppler ultrasonography, and contrast studies for defining the extent of venous thrombosis. MRV correctly shows venous anatomy and patency for reinsertion of CVC.
The development of fast, single-shot heavily T2weighted sequences able to provide motion-free ima... more The development of fast, single-shot heavily T2weighted sequences able to provide motion-free images of static fluids has greatly increased interest in MR imaging of the small bowel. However, poor distension of normal bowel loops in basal conditions has led researchers to perform small bowel MR studies using an oral contrast agent in order to distend the bowel lumen. We evaluated an oral iso-osmotic polyethyleneglycol solution as an oral contrast agent for MR imaging of the small bowel in a population of healthy volunteers.
Atlanto-axial rotatory ®xation (AARF) is a rare condition which occurs more commonly in children ... more Atlanto-axial rotatory ®xation (AARF) is a rare condition which occurs more commonly in children than in adults. The terminology can be confusing and the condition is also known as`atlanto-axial rotatory subluxation' and`atlanto-axial rotary dislocation'. Rotatory ®xation is the preferred term, however, as in most cases the ®xation occurs within the normal range of rotation of the joint. By de®nition, therefore, the joint is neither subluxed nor dislocated. AARF is a cause of acquired torticollis. Diagnosis can be dicult and is often delayed. The radiologist plays a key role in con®rming the diagnosis. The classi®cation system proposed by Fielding in 1977 is most frequently used and will be discussed in detail. Given that this classi®cation system was devised in the days before computed tomography (CT), as well as the fact that combined atlanto-axial and atlanto-occipital rotatory subluxation (AORF) is omitted from the classi®cation, we propose a modi®cation to the classi®cation of this rare but signi®cant disorder. The radiological ®ndings in six cases of AARF will be illustrated, including a case with associated atlanto-occipital subluxation. The pertinent literature is reviewed and a more comprehensive classi®cation system proposed. The imaging approach to diagnosis and the orthopaedic approach to management will be discussed. Roche, C. J. et al. (2001). Clinical Radiology 56, 947±958.
The objective of our study was to evaluate the morphologic appearances of small-bowel lymphoma us... more The objective of our study was to evaluate the morphologic appearances of small-bowel lymphoma using MR enterography to identify key morphologic traits capable of providing an association between imaging manifestations and likely histologic diagnosis. Over a 54-month period, 10 patients with subsequently confirmed small-bowel lymphoma were imaged using a standardized MR enterography technique. Retrospective chart review was performed to detect associated disease processes, such as celiac disease. The morphologic characteristics of each segment with lymphomatous involvement were evaluated with respect to tumor location, tumor size, mural characteristics, fold features, loop dilatation, luminal stricturing, mesenteric or antimesenteric distribution, mesenteric involvement, and signal intensity. Nineteen distinct segments of lymphomatous involvement were identified in 10 patients, and underlying celiac disease was confirmed in six of the 10 patients. This patient group comprised 10 patients with non-Hodgkin's lymphoma (NHL) of various subtypes. No cases of Hodgkin's lymphoma were encountered. Analysis revealed celiac NHL enteropathy to have a tendency toward localization to a single, long (> 10 cm), smooth continuous bowel segment, often with aneurysmal loop dilatation, in the absence of a distinct mesenteric or antimesenteric distribution. Luminal stricturing was encountered in cases of low-grade lymphoma, whereas mesenteric fat infiltration represented a characteristic of high-grade disease. We describe the characteristics of small-bowel lymphoma on MR enterography, identifying a number of key features that may help the interpreting radiologist in suggesting the underlying histologic subtype and whether the presence of underlying celiac disease is likely.
AIMS: To measure the range of rotation and determine the instantaneous axis of rotation of the at... more AIMS: To measure the range of rotation and determine the instantaneous axis of rotation of the atlanto-axial joint in healthy volunteers using magnetic resonance imaging (MRI) and to highlight the appearances of the rotated atlanto-axial joint on computed tomography (CT) and MRI. MATERIALS AND METHODS: Twenty-eight healthy volunteers were examined using MRI during maximal head rotation. In addition, an anatomical specimen of the atlanto-axial joint, fixed in varying degrees of rotation, was imaged using CT. RESULTS: At the extremes of physiological rotation in healthy subjects there is striking but incomplete loss of contact between the articular surfaces of the atlas (C1) and the axis (C2). The range of rotation to the right was 20–48·5° (mean 32·4°) and to the left was 13–52·75° (mean 34·2°). There was no significant difference between rotation to the right and left (P = 0·455). Total rotation was 45–88·5° (mean 69·25°). The instantaneous axis of rotation was located within the odontoid peg. CONCLUSION: There is a wide range of atlanto-axial rotation in normal subjects. The instantaneous axis of rotation lies within the odontoid peg. The appearances of the rotated atlanto-axial joint are striking and may be misinterpreted as subluxation. Roche, C. J. et al. (2002). Clinical Radiology57, 103–108.
The objective of our study was to evaluate the morphologic appearances of small-bowel lymphoma us... more The objective of our study was to evaluate the morphologic appearances of small-bowel lymphoma using MR enterography to identify key morphologic traits capable of providing an association between imaging manifestations and likely histologic diagnosis. Over a 54-month period, 10 patients with subsequently confirmed small-bowel lymphoma were imaged using a standardized MR enterography technique. Retrospective chart review was performed to detect associated disease processes, such as celiac disease. The morphologic characteristics of each segment with lymphomatous involvement were evaluated with respect to tumor location, tumor size, mural characteristics, fold features, loop dilatation, luminal stricturing, mesenteric or antimesenteric distribution, mesenteric involvement, and signal intensity. Nineteen distinct segments of lymphomatous involvement were identified in 10 patients, and underlying celiac disease was confirmed in six of the 10 patients. This patient group comprised 10 patients with non-Hodgkin's lymphoma (NHL) of various subtypes. No cases of Hodgkin's lymphoma were encountered. Analysis revealed celiac NHL enteropathy to have a tendency toward localization to a single, long (> 10 cm), smooth continuous bowel segment, often with aneurysmal loop dilatation, in the absence of a distinct mesenteric or antimesenteric distribution. Luminal stricturing was encountered in cases of low-grade lymphoma, whereas mesenteric fat infiltration represented a characteristic of high-grade disease. We describe the characteristics of small-bowel lymphoma on MR enterography, identifying a number of key features that may help the interpreting radiologist in suggesting the underlying histologic subtype and whether the presence of underlying celiac disease is likely.
The cervical spine is a common focus of destruction from rheumatoid arthritis, second only to the... more The cervical spine is a common focus of destruction from rheumatoid arthritis, second only to the metacarpophalangeal joints. Joint, bone and ligament damage in the cervical spine leads to subluxations which can cause cervical cord compression resulting in paralysis and even sudden death. Because many patients with signi®cant subluxations are asymptomatic, the radiologist plays a key role in recognizing the clinically important clues to instability on plain radiographs of the cervical spine±often dicult in rheumatoid arthritis when the bony landmarks are osteoporotic or eroded. This review focuses on the signs of instability on plain radiographs of the cervical spine, using diagrams and clinical examples to illustrate methods of identifying signi®cant subluxations in rheumatoid arthritis. Roche, C. J., Eyes, B. E. and Whitehouse, G. H. (2002) Clinical Radiology 57, 241±249.
Retroperitoneal cystic lymphangiomas are extremely rare and the majority are symptomatic during c... more Retroperitoneal cystic lymphangiomas are extremely rare and the majority are symptomatic during childhood. Although benign, they can compress and infiltrate vital structures. Surgery is curative but is associated with a high complication rate. An alternative treatment strategy is image-guided percutaneous catheter drainage of the lymphangioma followed by sclerotherapy. Resolution of a large retroperitoneal cystic lymphangioma in a 4-year-old child treated by this technique is reported. To our knowledge, this technique has not been previously described in this condition and we believe that it offers significant advantages over surgery.
Certain pathologic conditions have classic radiologic manifestations that resemble various types ... more Certain pathologic conditions have classic radiologic manifestations that resemble various types of food. These "food signs" are highly memorable and easily recognizable and include findings that resemble various fruits and vegetables; meat, fish, and egg dishes; pasta, rice, grains, and bread (carbohydrates); desserts, cakes, and candy; and dishes, cutlery, condiments, and so on. It is important that radiologists recognize these classic signs, which will allow confident diagnosis on the basis of imaging findings alone or narrowing of the differential diagnosis.
Vascular injuries resulting from closed fractures of the humerus are rare. We describe two patien... more Vascular injuries resulting from closed fractures of the humerus are rare. We describe two patients who developed unsuspected pseudoaneurysms following closed humeral fracture. Both patients presented with a mass, suspicious for malignancy. In each case, diagnosis was made by magnetic resonance imaging.
Vascular injuries resulting from closed fractures of the humerus are rare. We describe two patien... more Vascular injuries resulting from closed fractures of the humerus are rare. We describe two patients who developed unsuspected pseudoaneurysms following closed humeral fracture. Both patients presented with a mass, suspicious for malignancy. In each case, diagnosis was made by magnetic resonance imaging.
We report the case of a patient with multiple myeloma (MM) and extensive lytic bone disease who p... more We report the case of a patient with multiple myeloma (MM) and extensive lytic bone disease who presented with a short history of back pain and leg weakness. Magnetic resonance imaging (MRI) of the lumbar spine revealed a sacral insufficiency fracture complicated by an epidural haematoma. Bleeding tendency in this case can be accounted for by platelet function defects, often described in plasma cell disorders in the absence of obvious coagulation abnormalities. Surgical intervention was contraindicated as a result of poor overall patient performance status (poor surgical candidate due to extensive myelomatous bone disease, previous vertebral compression fractures requiring orthopaedic stabilisation, and requiring opiate analgesia for bone pain) and management was conservative. Patients presenting with back pain and documented bone disease in the setting of myeloma should be managed with a high index of clinical suspicion and considered for urgent MR imaging to avoid missing this serious and potentially reversible complication. We report the undescribed causative association between sacral insufficiency fracture and lumbo-sacral epidural haematoma. We illustrate the MRI signal and contrast enhancement pattern of an acute presentation of epidural haematoma.
The cross-sectional characterization of duodenal abnormalities is plagued with inadequacy, a refl... more The cross-sectional characterization of duodenal abnormalities is plagued with inadequacy, a reflection of the meandering course of this segment of the bowel. We consider the imaging appearance of such abnormalities at MRI small-bowel follow-through, illustrating the typical manifestations of each pathologically confirmed condition. MRI small-bowel follow-through allows confident duodenal evaluation because of a combination of sufficient luminal distention and multiplanar versatility. Diseases of the duodenum may have a variety of manifestations at MRI small-bowel follow-through, the knowledge of which may aid in confident noninvasive patient diagnosis.
The purpose of our study was to evaluate the potential role of an MR small-bowel follow-through (... more The purpose of our study was to evaluate the potential role of an MR small-bowel follow-through (SBFT) technique in the investigation of suspected pediatric small-bowel abnormalities. Between September 2003 and January 2008, 280 MR SBFT examinations were performed for investigation of known or suspected small-bowel abnormalities, including 19 of 280 examinations in 17 children (mean age, 13 years; age range 6-17 years), representing the current study population. A standardized technique was used in all cases, including axial and coronal steady-state free precession acquisitions at successive time intervals until completion. Retrospective analysis of the studies obtained was performed by two radiologists, who blindly and independently scored predefined small-bowel segments according to the degree of luminal distention achieved. Any pathologic lesions detected were also noted. Indicators of examination success as a whole (volume, tolerability, and side effects of oral contrast material) were also noted, as were details pertaining to examination duration (number of visits to the MR table, total table time). Oral contrast medium was ingested and subsequent imaging was possible in all patients; 84.2% of patients tolerated the oral contrast material well and 15.8% showed moderate tolerance. The MR table time ranged from 2 to 4 minutes, without early termination of the examination in any case. The average number of visits to the MR table was 1.3 (range, 1-3). The mean duration for complete small-bowel evaluation was 25 minutes (range, 20-60 minutes). The mean distention scores were well within the diagnostic range in all small-bowel segments for both observers, with a substantial degree of interobserver agreement in score assignment (kappa = 0.73). Pathologic lesions were identified in 53% of studies. MR SBFT represents a promising, and perhaps optimal, technique for pediatric small-bowel evaluation for a variety of reasons, including its high tolerability, lack of ionizing radiation, avoidance of duodenojejunal intubation, and excellent luminal distention achieved. Furthermore, this technique allows "pseudodynamic" functional imaging while also showing extraluminal disease, without known biologic risk.
To evaluate the mean distance from the odontoid process of C2 to the standard skull-base lines (C... more To evaluate the mean distance from the odontoid process of C2 to the standard skull-base lines (Chamberlain's, McGregor's, and McRae's lines) on computed tomography (CT) imaging. To compare these measurements to previously documented plain radiograph and magnetic resonance imaging (MRI) measurements.Reformatted midline sagittal CT images of 150 adults were retrospectively evaluated. The shortest perpendicular distance was measured from the Chamberlain's, McGregor's and McRae's baselines for each subject to the odontoid tip. Statistical analysis was performed to compare the CT data with the previously obtained MRI and plain film data.The mean position of the odontoid process was 1.4 mm below Chamberlain's line (median 1.2 mm, SD 2.4 mm), 0.8 mm (median 0.9 mm, SD 3 mm) below McGregor's line and 5 mm (median 5 mm, SD 1.8 mm) below McRae's line. There is no significant difference between male and female results (p > 0.05) or between these CT and previous MRI measurements (p > 0.05).These results provide the mean and range of normal distance from the odontoid process to the most frequently used skull-base lines on the current population on CT.
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Papers by Clare Roche