Only visual impressions are almost always present in long-term memories, and reported completeness, accuracy, and verbalizability of recollections increase with age

PURPOSE: To stage advanced cervical carcinoma with conventional or pharmacokinetic magnetic resonance (MR) imaging by correlating imaging findings with whole-mount specimens and histopathologic findings. MATERIALS AND METHODS: Twenty-six adult patients with primary cervical cancer (stages IIB-IVA) underwent T2-weighted turbo spin-echo (SE) MR imaging; gadolinium-enhanced, T1-weighted SE MR imaging; and gadolinium-enhanced, saturation-recovery, turbo fast low-angle shot MR imaging. All imaging findings were correlated with the whole-mount specimens and histopathologic findings. Signal intensity changes versus time were analyzed by using a pharmacokinetic model and parameter values displayed as a color-coded overlay. RESULTS: Histopathologic stages were IIB (n = 9), IIIB (n = 1), and IVA (n = 16). The overall accuracy for tumor staging was 73% for T2-weighted, 81% for T1-weighted, and 92% for pharmacokinetic MR imaging. Pharmacokinetic MR imaging was accurate (90%) in the diagnosis of tumor extension into the bladder and/or rectal wall but inaccurate (69%) in that of parametrial invasion. T2-weighted images were most accurate (86%) in the assessment of parametrial tumor extension but less accurate (69%) in that of bladder or rectal invasion. CONCLUSION: T2-weighted turbo SE images are still superior to contract medium-enhanced T1-weighted SE or pharmacokinetic MR images in the diagnosis of parametrial infiltration by uterine cervical carcinoma. However, pharmacokinetic MR imaging is a promising method for demonstrating and staging IVA disease.     

Magnetic resonance imaging of primary skeletal neoplasms

The primary role of magnetic resonance (MR) imaging of skeletal neoplasms is that of staging. Understanding the staging process and selection of the proper imaging planes and pulse sequences is essential for proper staging. To date, image features are not specific for histologic type. In addition, there are still pitfalls with MR imaging for evaluating recurrent tumor or following therapeutic response to treatment. Dynamic gadolinium studies and spectroscopy may improve the future overall specificity for MR imaging.     

Magnetic resonance imaging of the musculoskeletal system. Part 9. Primary Tumors

Magnetic resonance imaging, because of its exquisite soft tissue contrast, has dramatically improved the ability to preoperatively stage primary osseous and soft tissue neoplasms. This technique also has allowed the monitoring of the effects of chemotherapy and the screening for recurrence of neoplasms. The role of magnetic resonance imaging in the preoperative evaluation of the patient with a suspected primary osseous or soft tissue neoplasm is outlined, instances where magnetic resonance imaging potentially may make a specific diagnosis are outlined, the importance of gadolinium enhancement as an adjunct to native magnetic resonance imaging is stressed, and an algorithm for followup of patients after chemotherapy or definitive surgical treatment is presented. In all cases, the magnetic resonance images should be correlated with the plain film, which is still an important aspect of the diagnosis of osseous lesions.     

Leiomyosarcoma of the inferior vena cava and magnetic resonance imaging

Venous leiomyosarcomas are rare and predominantly arise in the inferior vena cava (IVC). The clinical findings, often not very suggestive and nonspecific, sometimes precede the diagnosis by several years. According to the literature, leiomyosarcoma of the IVC generally occurs in middle-aged women. Modern imaging techniques, especially magnetic resonance imaging (MRI) can now establish the diagnosis of leiomyosarcoma of the IVC with a high probability and allow assessment of operability. The authors report a case of leiomyosarcoma of the IVC in a 24-year-old male patient, confirmed by intravenous biopsy. They present the MR features of this malignant tumour, rarely reported in the literature, and emphasize the value of this examination in the operability staging. The 3D imaging provided by MRI allows intra and extraluminal staging and involvement of adjacent organs. It also allows optimal evaluation of the effects on flow, circulatory slowing or thrombosis and, due to its high contrast resolution, it is more sensitive to distinguish clot from tumour nodule.     

Magnetic resonance imaging of the musculoskeletal system. Part 4. The knee

Since its introduction to musculoskeletal imaging in the early 1980s, magnetic resonance imaging has proven to be an excellent technique for evaluating patients with knee problems. Studies have shown it to be accurate in the identification of abnormalities of the menisci, ligaments, patellofemoral joints, and other soft tissue and osseous structures in the knee. The main advantages of magnetic resonance imaging are its noninvasive nature and its high accuracy and negative predictive value in evaluating the menisci and anterior cruciate ligament. Magnetic resonance imaging has been shown to be useful in the detection and diagnosis of various traumatic and nontraumatic knee abnormalities. It has also proved useful in the diagnosis of occult or unsuspected bone lesions. Magnetic resonance imaging can therefore help in the selection of those patients who need therapeutic arthroscopy. There is evidence that magnetic resonance imaging of the knee is a cost effective screening technique when used in conjunction with the clinical findings in patients who are candidates for arthroscopy. Magnetic resonance imaging of the knee is still a relatively expensive modality.     

Calcium channel blocker decreases pentagastrin-stimulated alkaline-tide: a role for extracellular calcium in gastric acid secretion

The value of magnetic resonance imaging (MRI) in the diagnosis and staging of endometrial carcinoma was studied in 43 cases of clinically suspected endometrial carcinoma and 7 normal women. All of the 43 cases showed abnormal endometria measured by MRI, among which were pathologically proven 40 cases of endometrial carcinoma, 2 cases of endometrial polyps and 1 case of adenomyosis. This suggested that MRI showed a high susceptibility in the diagnosis of endometrial carcinoma, and a lack of specificity. MRI could predict myometrial invasion, its accuracy being verified by surgico-pathological findings in 11 of 13 cases. MRI staging was correct in 10 of the 13 primarily operated cases, and only half of the clinical staging was in conformity with surgical staging. The results suggest that MRI is useful in the staging of endometrial carcinoma and therefore is of value in the choice of treatment planning, although it is not yet an ideal diagnostic aid to detect small metastatic pelvic lesions.     

An unusual cause of low back pain. Osteomyelitis of the spinous process

STUDY DESIGN: A case report of osteomyelitis of the spinous process. OBJECTIVE: To describe the diagnosis and successful treatment of a patient with spinous process osteomyelitis. SUMMARY OF BACKGROUND DATA: Spinous process osteomyelitis is exceedingly rare and may be misdiagnosed as paraspinal muscle strain, discitis, or vertebral body osteomyelitis. The clinical presentation of spinous process osteomyelitis is subtle, laboratory findings are nonspecific, and radiographs are often normal. METHODS: The diagnosis, treatment, and outcome of two patients with spinous process osteomyelitis (an adult and a child) with insidious, nonspecific lumbar pain and fever are reviewed. RESULTS: Magnetic resonance imaging with and without gadolinium enhancement demonstrated increased signal of the spinous process with paraspinous musculature enhancement, a finding consistent with spinous process osteomyelitis. Biopsy results demonstrated the presence of staphylococcus aureus in the child and no organisms in the adult. Treatment with intravenous antibiotics led to resolution in both cases. CONCLUSIONS: The use of magnetic resonance imaging technology permitted the early and accurate diagnosis of spinous process osteomyelitis.     

Magnetic resonance imaging in breast cancer staging

For many solid carcinomas, high-resolution cross-sectional imaging has changed cancer staging, the evaluation of therapeutic response, the detection of recurrence, and even how therapy is selected and performed. Such imaging has not yet had similar effects on breast cancer. Evaluations of therapeutic response in breast carcinomas have been impeded by the current limited methods of evaluating breast tumor size and extent: clinical palpation, ultrasonography, and mammography. The use of magnetic resonance imaging (MRI) of the breast in the evaluation of breast tumors brings the advantages of high-resolution cross-sectional imaging to breast cancer staging and treatment evaluation and is likely to greatly enhance research efforts in this complex disease. MRI of the breast has evolved to be the most accurate noninvasive technique for local staging of breast cancer. MRI is most accurate in measuring tumor size and detecting multicentric disease. These staging characteristics affect the selection of therapy and initial determination of prognosis; therefore, MRI of the breast can change the assessment of fundamental parameters on which treatment is selected. Because clinical trials of new cancer treatments are predicated on proper and accurate characterization of the tumor, MRI also should affect how clinical trials are performed and evaluated.     

Pretherapeutic staging of laryngeal carcinoma. Clinical findings, computed tomography, and magnetic resonance imaging compared with histopathology

BACKGROUND: An accurate pretherapeutic staging of laryngeal carcinoma is required for most treatment planning as well as for evaluation and comparison of the results of different treatment modalities. Neoplastic invasion of the laryngeal cartilage may have important therapeutic implications. To our knowledge, no data are available comparing the impact of endoscopic examination, computed tomography (CT), and magnetic resonance (MR) imaging on pretherapeutic staging accuracy. The purpose of our study was to determine which imaging should be used as an adjunct to other clinical examinations in the pretherapeutic staging of laryngeal carcinoma. METHODS: In this study, 40 consecutive patients with neoplasms of the larynx, who were treated surgically, were included in a prospective pretherapeutic staging protocol that included indirect laryngoscopy, direct microlaryngoscopy, contrast-enhanced CT, and gadolinium-diethylenetriamine pentaacetic acid-enhanced MR imaging at 1.5 Tesla. The surgical specimens were cut in whole-organ slices parallel to the plane of the axial CT and MR images. The histologic findings were compared with the clinical findings including the CT and MR images. The impact of each diagnostic method on pretherapeutic staging was analyzed. RESULTS: Clinical/endoscopic evaluation failed to correctly stage 17 tumors due to invasion of the paraglottic space (1 tumor), preepiglottic space (2 tumors), and extralaryngeal soft tissues (14 tumors), resulting in a pretherapeutic staging accuracy of 57.5%. Neoplastic invasion of cartilage was present in 28 patients and absent in 12 patients. Although MR imaging was more sensitive in detecting neoplastic invasion of cartilage than CT (94% vs. 67%; P = 0.001), MR imaging was less specific than CT (74% vs. 87%; P = 0.007). There was no difference between the overall accuracy of CT and MR imaging in detecting neoplastic invasion of cartilage (80% vs. 82%). The accuracy of combined clinical/endoscopic examination and CT staging was 80% and the accuracy of combined clinical/endoscopic examination and MR imaging staging was 87.5%; the difference was not statistically significant. CONCLUSIONS: Clinical/endoscopic examination alone failed to identify tumor invasion of the laryngeal cartilages and of the extralaryngeal soft tissues, resulting in a low staging accuracy (57.5%). Many pT4 (according to the International Union against Cancer TNM Staging System) tumors were clinically unrecognized. The combination of clinical/endoscopic evaluation and an additional radiologic examination, either CT or MR imaging, resulted in significantly improved staging accuracy (80% vs. 87.5%). MR imaging is significantly more sensitive but less specific than CT in detecting neoplastic cartilage invasion. Therefore, MR imaging tends to overestimate neoplastic cartilage invasion and may result in overtreatment, whereas CT tends to underestimate neoplastic cartilage invasion and may lead to inadequate therapy.     

Narrow resection of cutaneous melanoma

We report the case of a young pregnant woman with a malignant tumour of the kidney suggestive of oncocytoma. Because of the pregnancy, preoperative staging consisted of abdominal ultrasound and magnetic resonance imaging. Caesarean section was performed. Several days later, surgical exploration of the kidney was performed with tumourectomy and frozen section analysis: radical nephrectomy was finally performed. The definitive histology was chromophobe renal cell carcinoma. This is a rare tumour of the kidney, with its own characteristics allowing histopathological diagnosis and with a better prognosis than renal cell carcinoma. In the literature, pregnancy, a situation of immune depression, does not increase the prevalence of malignant neoplasms.     

Mediastinal masses: diagnostic approach

In most clinical situations the modern radiological approach to a mediastinal mass consists of performing a CT scan following the chest radiograph. Magnetic resonance imaging is indicated when CT findings are equivocal and as the first-line method in particular situations such as suspected involvement of the posterior mediastinum. In both techniques, tissular components of the mass assessed by density or signal intensity analysis, together with the precise location, are the leading edge of the radiological diagnosis. This review deals mainly with the differential diagnosis of primary neoplasms according to CT and MRI findings.     

Chondroblastoma: classic and confusing appearance at MR imaging

PURPOSE: To define the characteristics of chondroblastoma at magnetic resonance (MR) imaging and the combination of findings that are diagnostic for chondroblastoma. MATERIALS AND METHODS: From January 1987 through December 1992, 22 patients with histologically confirmed chondroblastoma and prior MR imaging examinations were seen. Patients included 16 men and six women, aged 10-58 years (median, 17 years). Retrospective analysis of findings at MR imaging, plain radiography, computed tomography, and bone scanning was performed. RESULTS: Low to intermediate heterogeneous signal intensity, lobular internal architecture, and fine lobular margins were well defined with high-resolution T2-weighted (repetition time > or = 1,500 msec, echo time > or = 70 msec) MR imaging. Adjacent bone-marrow and soft-tissue edema and periosteal reactions were more dramatically demonstrated on MR images than on radiographs. Bone marrow edema was prominent in all but five cases. Obvious periosteal reaction and adjacent soft-tissue edema were visible in 17 cases. CONCLUSION: Knowledge of the MR imaging findings of chondroblastoma will allow accurate diagnosis and help avoid confusion with infection and aggressive neoplasms.     

The role of imaging in pancreatic cancer

The clinical diagnosis of pancreatic cancer is notoriously difficult, and modern radiological imaging methods are critical to the diagnosis and accurate staging of the disease. Furthermore, endoscopic and interventional radiological techniques have now replaced surgery in palliating those patients with nonresectable disease.     

Non-squamous cell neoplasms of the larynx: radiologic-pathologic correlation

A variety of benign and malignant non-squamous cell neoplasms may affect the larynx. Most of these uncommon laryngeal neoplasms are located beneath an intact mucosa, making diagnosis difficult with endoscopy alone, and sampling errors may occur if only traditional superficial biopsies are performed. In some laryngeal neoplasms, radiologic evaluation allows the correct diagnosis. Hemangiomas have very high signal intensity at T2-weighted magnetic resonance (MR) imaging and strong enhancement at both computed tomography (CT) and MR imaging after administration of contrast material. Phleboliths, which are pathognomonic for hemangiomas, are easily identified at CT. Chondrogenic tumors typically manifest with coarse or stippled calcifications at CT. Because of their high water content, chondrogenic tumors have very high signal intensity on T2-weighted MR images, whereas only moderate enhancement is observed after administration of contrast material. Lipomas typically manifest at both CT and MR imaging as homogeneous nonenhancing lesions. They are isoattenuating to subcutaneous fat at CT and isointense relative to subcutaneous fat with all MR pulse sequences. Metastases from renal adenocarcinoma typically demonstrate strong contrast enhancement and flow voids at MR imaging, and metastases from melanotic melanoma usually have high signal intensity on T1-weighted MR images and low signal intensity on T2-weighted images owing to the paramagnetic properties of melanin. Although radiologic findings are nonspecific in most other non-squamous cell neoplasms of the larynx (eg, Kaposi sarcoma, hematopoietic tumors, tumors of the minor salivary glands, metastases from amelanotic melanoma), cross-sectional imaging can play an important role in the diagnostic work-up of these unusual tumors by delineating the extent of submucosal tumor spread and directing the endoscopist to the appropriate site for the deep, transmucosal biopsies needed to establish the diagnosis. In addition, CT and MR imaging are crucial for posttherapeutic monitoring and early detection of local recurrence.     

Brain imaging and its clinical application in psychiatry

The common structural and functional brain imaging techniques are described from a practical, clinical point of view. The clinical indications for brain imaging in psychiatry are reviewed in relation to the specific limitations and advantages of each technique. The clinical applications of computerized tomography (CT), magnetic resonance imaging (MRI) and single photon emission computerized tomography (SPECT) are discussed in relation to the differential diagnosis between organic and functional psychiatric disorders. In a 55-year-old man with late onset of behavioral changes but without neurological signs the application of structural brain imaging (CT and MRI) in case management was demonstrated. The imaging findings involved the differential diagnosis between depression and focal brain lesions. In a 38-year-old man with personality changes and depression following a traumatic brain injury, time interval repeated functional brain imaging (SPECT) was used. Brain imaging reflected improvement in clinical status following treatment and was able to differentiate between reversible and permanent traumatic brain injuries. The superior yield of time interval repeated functional imaging in diagnosis and management of postconcussion syndrome is discussed.     

Magnetic resonance imaging of penile rupture: aid to diagnosis

We report on a patient with atypical clinical findings in whom magnetic resonance imaging confirmed the suspicion of penile rupture. The tear appeared as an obvious discontinuity of the low signal intensity of the tunica albuginea and was associated with a hematoma. We conclude that magnetic resonance imaging is useful for confirming the diagnosis of penile rupture when clinical findings are atypical, indicating surgical repair.     

Magnetic resonance imaging of the musculoskeletal system. Part 6. The Shoulder

The role of magnetic resonance imaging in the diagnosis and treatment of patients with shoulder pain has increased remarkably in recent years, largely because of improved resolution of images and increased experience of musculoskeletal radiologists. In rotator cuff disease/impingement and instability, magnetic resonance imaging adds a new dimension to the clinical findings through the noninvasive visualization of either the pathology itself or frequently associated abnormalities. It is the associated abnormalities that are depicted in instability: glenoid irregularities, labral tears, capsular laxity, and Hill-Sachs deformities. Glenoid, labral, and Hill-Sachs abnormalities can be assessed with either magnetic resonance imaging or computed tomography arthrography. Magnetic resonance imaging has the advantages of noninvasiveness, multiplanar imaging capability and exquisite soft tissue contrast. In rotator cuff disease, magnetic resonance imaging depicts the status of the rotator cuff itself, revealing partial and full thickness tears, allowing an estimation of size and quality of tendon edges. Possible impingement sites can be identified. Primary instability with secondary impingement may be first suspected on magnetic resonance imaging. Postoperative complications, including recurrent tendon detachment, deltoid dehiscence, and infection, are clarified. Unsuspected but clinically important lesions, such as neoplasm, osteonecrosis, and ganglion with entrapment of the suprascapular nerve, each have characteristic magnetic resonance imaging appearances.     

Reliability and validity of imaging diagnosis of temporomandibular joint disorder

The purpose of this article is to review reliability and validity of imaging diagnosis of temporomandibular joint disorders. Plain-film and tomography are basic imaging techniques for assessment of the temporomandibular joint. These can be used for evaluation of osseous disease and as a baseline for follow-up. In patients with symptoms from the joint, plain-film and tomography are rarely definitive, and evaluation of the soft tissues is frequently necessary. Arthrography, computed tomography, and magnetic resonance imaging have all been used for evaluation of the soft-tissue components of the joints. Accuracy studies of these techniques have demonstrated the highest diagnostic accuracy for magnetic resonance imaging. Arthrography is relatively insensitive for detection of medial and lateral displacements. Magnetic resonance imaging accurately depicts both hard and soft tissues, and this technique is emerging as the prime diagnostic imaging technique in patients presenting with clinical signs and symptoms of a disorder of the temporomandibular joint. The most frequent findings when patients with clinical symptoms of temporomandibular joint disorders are "imaged" are different forms of disc displacement and degenerative joint disease. Studies have demonstrated a high prevalence of different forms of disc displacement in patients, although these abnormalities are also seen in some asymptomatic volunteers. Future research should further refine imaging techniques to come closer to an understanding of the association between morphologic alterations and patient symptoms.     

The many faces of osteosarcoma

Osteosarcoma is the most common primary malignant tumor of bone in adolescents and young adults. It accounts for approximately 15% of all primary bone tumors confirmed at biopsy. There are numerous types of primary osteosarcoma, including intramedullary (high grade, telangiectatic, low grade, small cell, osteosarcomatosis, and gnathic), surface (intracortical, parosteal, periosteal, and high-grade surface), and extraskeletal. Osteosarcoma may also occur as a secondary lesion in association with underlying benign conditions. The identification of osteoid matrix formation and aggressive characteristics usually allows prospective radiologic diagnosis of osteosarcoma. As with all bone tumors, differential diagnosis is best assessed with radiographs, whereas staging is performed with computed tomography or magnetic resonance imaging. Understanding and recognition of the variable appearances of the different varieties of osteosarcoma allow improved patient assessment and are vital for optimal clinical management including diagnosis, biopsy, staging, treatment, and follow-up.     

The role of magnetic resonance angiography in the assessment of intracranial vascular disease

Magnetic resonance techniques have a significant role in the evaluation of intracranial vascular diseases; however, to achieve an appropriate diagnosis, a combination of both magnetic resonance imaging and angiography are needed. It is extremely important for the interpreting physician to be aware of the potential limitations of the techniques being used. With this knowledge, magnetic resonance techniques can eliminate the need for more invasive procedures. An overview of the current methods and their applications and limitations is provided.