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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During the past three years 27 patients with medullary and/or brainstem cavities were examined with MRI at the Institute of Roentgenology, and we report the radiological MRI correlative findings. Five patients were operated: postoperative MRI examinations were compared with preoperative studies. Syringomyelia was present in 21 cases, syringobulbia in 2, and syringobulbomyelia in 4. Additional pathology such as the Arnold Chiari malformation or hydrocephalus was found at the craniospinal junction in 8 patients. Two instances of associated intraspinal tumours were noted too. In all cases the syringomyelic cavities involved the cervical cord and in most of them the lesion extended down to the thoracic or even lumbar level. Several patients were shown to have multilocular cavities. In the patients with syringomyelia a syringoarachnoidal shunting procedure was performed. This resulted in cyst collapse as proved by postoperative MRI examinations; neurological symptomatology was ameliorated too. Conventional radiological imaging with computed tomography (CT) and myelography was not as efficient as MRI in imaging syringomyelia. The extent of intramedullary cavities as well as the presence of associated pathology is best appreciated on sagittal MRI. The use of special surface coils clearly results in better image quality due to higher resolution. According to our experience MRI should be the primary examination in syringomyelia; myelography and CT are obsolete in the management of syringomyelia; the insertion of a syringoarachnoidal shunt is a convenient surgical procedure, resulting in clinical amelioration in most cases.
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PMID:Magnetic resonance (MR) imaging in the management of primary and secondary syringomyelic cavities, and of other cystic lesions of the spinal cord. 321 40

When patients with syringomyelia fail to improve after operation, factors such as incomplete cyst decompression or type of operation are often implicated. MRI has been used to confirm adequate syrinx decompression post-operatively and to compare the degree of collapse with the type of operation. Foramen magnum decompression was at least as effective in reducing cyst size as syringo-subarachnoid shunting. MRI may also provide a better classification of syringomyelia.
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PMID:MRI measurement of syrinx size before and after operation. 343 4

MRI and CT studies in 18 patients with proximal bronchogenic carcinoma and postobstructive lobar collapse were analyzed retrospectively. The relative abilities of these imaging techniques to identify central tumor by a contour abnormality and to distinguish tumor mass from collapsed lung by CT attenuation values and MRI signal intensities were compared. MRI and CT were equivalent in their ability to identify a contour abnormality, both succeeding in 13 of 18 (72%) patients. CT was more successful than MRI in differentiating tumor mass from collapsed lung. Dynamic computed tomography scanning differentiated tumor from collapsed lung in eight of ten (80%) patients. MRI demonstrated different signal intensities of tumor and collapsed lung in 8 of 18 (44%) patients. T2-weighted images more often separated tumor from collapsed lung than other imaging sequences.
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PMID:Differentiation of proximal bronchogenic carcinoma from postobstructive lobar collapse by magnetic resonance imaging. Comparison with computed tomography. 362 59

Because the available preliminary data strongly indicate that MRI is accurate in diagnosing osteonecrosis, MRI of the hips is recommended in patients suspected of having osteonecrosis, especially if other diagnostic studies are equivocal. MRI also may be useful in following patients who have strong risk factors for osteonecrosis, such as corticosteroid therapy, femoral neck fracture, traumatic femoral head dislocation (Fig. 13), slipped capital femoral epiphysis (Fig. 14), and congenital hip dislocation. In diseases such as systemic lupus erythematosus, both hips eventually may become involved in 50 to 80 per cent of cases. Therefore, the unaffected hip of patients with systemic lupus erythematosus and unilateral nontraumatic osteonecrosis of the hip should be monitored regularly with MRI. The hope is that early diagnosis and treatment of femoral head osteonecrosis will prevent the relentless progression to subchondral collapse and disabling arthropathy. MRI also may be useful in staging patients known to have osteonecrosis. The ability of MRI to image directly in multiple planes facilitates the determination of the volume and location of infarcted segments of bone. This information is important in planning any of the surgical procedures used relatively early in the disease, such as core decompression, rotational osteotomy, or bone graft. Moreover, MRI may prove helpful in evaluating the effectiveness of any therapeutic intervention.
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PMID:Magnetic resonance imaging of osteonecrosis. 371 96

Pericardial effusions may be present in a variety of clinical situations, often presenting challenging clinical diagnostic and therapeutic problems. Although several imaging modalities are available, ECHO has become the diagnostic method of choice due to its portability and wide availability. CT and MRI may also be employed and may be more accurate. A pericardial effusion under pressure may result in hemodynamic compromise and tamponade. Although there are several echocardiographic clues to tamponade (including diastolic chamber collapse, Doppler flow velocity paradoxus, and inferior vena cava phlethora), the diagnosis remains a clinical and hemodynamic one. The clinical signs include elevated jugular venous pressure, hypotension, tachycardia, and pulsus paradoxus. Hemodynamic measurements include equalization of diastolic pressures and decreased cardiac output Treatment of tamponade involves drainage of the effusion and prevention of reaccumulation. Needle pericardiocentesis via the subxiphoid approach is a reasonable initial treatment. However, this may need to be accompanied by catheter drainage or surgical pericardial window. A new catheter based technique--percutaneous balloon pericardiotomy-- appears useful in select patients with malignancy in order to avoid more invasive surgical procedures. Occasionally, in patients with recurrent effusions, instillation of sclerosing agents into the pericardial space or even total pericardiectomy may be necessary.
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PMID:Pericardial effusion and tamponade: evaluation, imaging modalities, and management. 755 15

We performed a randomised trial on 37 hips (33 patients) with early-stage osteonecrosis (ON). After the initial clinical evaluation, including plain radiography and MRI, 18 hips were randomly assigned to a core-decompression group and 19 to a conservatively-treated group. All the patients were regularly followed up by clinical evaluation, plain radiography and MRI at intervals of three months. Hip pain was relieved in nine out of ten initially symptomatic hips in the core-decompression group but persisted in three out of four initially painful hips in the conservatively-treated group at the second assessment (p < 0.05). At a minimum follow-up of 24 months, 14 of the 18 core-decompressed hips (78%) and 15 of the 19 non-operated hips (79%) developed collapse of the femoral head. By survival analysis, there was no significant difference in the time to collapse between the two groups (log-rank test p = 0.79). Core decompression may be effective tin symptomatic relief, but is of no greater value than conservative management in preventing collapse in early osteonecrosis of the femoral head.
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PMID:Preventing collapse in early osteonecrosis of the femoral head. A randomised clinical trial of core decompression. 868 48

In a randomised trial comparing core decompression with conservative treatment we tested the hypothesis that the extent of necrosis at the initial MRI predicts the subsequent risk of collapse of the femoral head. After the initial clinical evaluation, including plain radiography and MRI, 37 hips with early-stage osteonecrosis (ON) in 33 patients were randomly assigned to a core-decompression group or a conservatively-treated group. All were followed regularly by clinical evaluation, plain radiography and MRI at intervals of three months. The extent of ON was estimated on the basis of abnormal signal intensity in the weight-bearing portion of the femoral head as determined from a combination of coronal and sagittal MRIs. The arc of the necrotic portion in the mid-coronal image (A) and that in the mid-sagittal image (B) were used to quantify the extent of necrosis by the formula: (A/180) x (B/180) x 100. There was a strong correlation between this index and the risk of collapse before and after adjustment for age, gender, stage and treatment group. We conclude that the extent of the necrotic portion ascertain by this method is a major predictor of future collapse. We propose a systematic method of determining the index of the necrotic portion which may be clinically useful in the management of early-stage ON of the femoral head.
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PMID:Quantifying the extent of osteonecrosis of the femoral head. A new method using MRI. 868 48

Avascular necrosis of bone (AVNB) is a well-known but rare complication of chemotherapy for lymphoma with a reported incidence ranging from 1 to 10 per cent. Early diagnosis is essential for optimal therapeutic management. Using MRI, the most sensitive means of detecting the earlier stages of AVNB, 100 patients treated with standard chemotherapy for lymphoma were assessed. Fifteen were found to have changes of AVNB, 10 with early changes but five with advanced segmental collapse of the femoral head. None with AVNB had more than the standard course of corticosteroids. Almost a quarter of the study group complained of joint pain during and/or after their treatment, a third of whom were found to have AVNB; a strong indicator to screen all those with pain. However, 40 per cent of those with AVNB were asymptomatic. The clinical significance of the 'silent hip' is yet to be elucidated.
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PMID:Diagnosis of avascular necrosis of the femoral head in patients treated for lymphoma. 762 43

We reviewed the MRI features in eight patients with spinal epidural lymphoma (clinically primary in 4 patients); one patient had multiple lesions. The cervical spine was involved in one patient, the thoracolumbar spine in 5 and the sacrum in two. Mean longitudinal extension of the epidural lesion was 2.6 vertebral segments. The tumours were homogeneously isointense with the spinal cord on T1-weighted images and isointense or hyperintense on proton-density and T2-weighted images. The spinal cord was compressed in four patients but showed signal changes in only one. In five patients the lesions communicated through the intervertebral foramina with paravertebral soft tissue masses. In all but one of the patients diffuse signal changes in the vertebral body marrow consistent with osteolytic or osteoblastic changes were identified adjacent to or at distance from the epidural lesion. Vertebral collapse was observed in two patients.
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PMID:MRI of spinal epidural lymphoma. 766 66

The preoperative radiologic study of female stress urinary incontinence is still incomplete and often not well tolerated. MRI is becoming a major diagnostic tool for pelvis assessment also thanks to its allowing dynamic studies. Therefore, MRI was used for the static and dynamic assessment of the pelvic floor, which is compromised in stress incontinence, in a series of 21 patients. Dynamic studies were reliable in all but two cases. Our MRI technique demonstrated anatomical and functional stress urinary incontinence alterations, such as the increased distance between urethra and pubic symphysis (16 patients), vaginal changes (7 patients), levator ani muscle changes (9 patients) and urethropelvic ligaments changes (9 patients). The functional changes caused by pelvic floor collapse were observed in all the patients with reliable dynamic studies, i.e., the posterior urethrovesical angle was increased and the pelvic floor excessively lowered during pelvic strain. Our preliminary results suggest that MRI can play a major role in the preoperative assessment of stress urinary incontinence, notwithstanding the fact that the exam is performed with the patient supine and therefore with no gravity.
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PMID:[Stress urinary incontinence in women: magnetic resonance assessment]. 771 89


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