Role of IVIR in Limb Fracture

PURPOSE: In evaluation of the limb fracture, MR scan has been used in limited roles as evaluating the associated soft tissue injury not the fracture itself. This study aims at understanding the possible role of MR in fracture. METHODS AND MATERIALS: thirty three sets of MR scans in twenty nine patients were retrospectively analyzed. They included twelve tibial plateau fractures, four pateliar fractures, four distal femur fractures, five epiphyseal fractures and four others. RESULTS: All MRs except two showed better image and more information about the extent of the injury (93.9%). Evaluation of cartilage (which was impossible on other modalities) was possible in 28 MR scans (84.8%). Surrounding marrow change associated with fracture was also able to be evaluated. Associated soft tissue injury or other abnormality could be evaluated-cruciate or collateral ligament injury, meniscus tear, chodromalacia or osteonecrosis. In epiphyseal injury, direct demonstrability of premature bony fusion on MR took a critical role in making a management plan. CONCLUSION: MR scan in fracture has its value in evaluating the extent and degree of the injury and it is especially advantageous in detecting cartilage injury and early complication of growth plate injury.

Reduction of Intussusception by Air Insufflation in Children: Recent Three-year Experience

PURPOSE: This study was conducted to evaluate success and perforation rates of pneumatic reduction and to find the predictors of reduction failure. METHODS AND MATERIALS: We reviewed 224 cases of pediatric intussusception diagnosed by air-enema between July, 1989 and June, 1992. The mean age was 9.8 months(range, 1 month to 3 years). Logistic regression analysis was used to find predictors of reduction failure. RESULTS: Successful reduction was achieved in 197 cases(87.9% of success rate). Bowel perforation occurred in two cases(0.9% of perforation rate). There were two statistically significant predictors of failure;(1) ileoileocolic intussusception(p<.001), (2) long duration of symptom(p<.001). Surgery was performed in 26 cases (11.6%), of which seven required bowel resection. CONCLUSION: Pneumatic reduction is a useful means in the management of pediatric intussusception with a high success rate and no mortality.

Diagnosis and follow-up of a case of nutcracker syndrome with MR angiography

A case of nutcracker syndrome which was initially diagnosed by magnetic resonance angiography (MRA) is reported. On preoperative MRA in an 18-year-old male patient with gross hematuria, left renal vein was obliterated at the level of superior mesenteric artery and there was no connection with inferior vena cava. The follow-up MRA after surgical correction with external prosthesis demonstrated entire course of left renal vein without evidence of obstruction which might suggest a possible usage of MRA for a non-invasive diagnosis of nutcracker syndrome.

Diagnosis and follow-up of a case of nutcracker syndrome with MR angiography

A case of nutcracker syndrome which was initially diagnosed by magnetic resonance angiography (MRA) is reported. On preoperative MRA in an 18-year-old male patient with gross hematuria, left renal vein was obliterated at the level of superior mesenteric artery and there was no connection with inferior vena cava. The follow-up MRA after surgical correction with external prosthesis demonstrated entire course of left renal vein without evidence of obstruction which might suggest a possible usage of MRA for a non-invasive diagnosis of nutcracker syndrome.

MR findings of failed back surgery syndrome

Recurrent disc herniation and postoperative fibrosis are the main disease entities causing failed back surgery syndrome (FBSS) and magnetic resonance (MR) imaging has become a major diagnostic modality in differentiating the two. To observe the variable entities of FBSS and their MR findings, we retrospectively analyzed 15 MR images in 12 patients. The causes of FBSS were as follows; normal (no organic cause), fibrosis, new or recurrent disc herniation, discitis, osteomyelitis, inflammation at operation site, epidural abscess, arachnoiditis, and hematoma. Except a case of hematoma, gadolinium enhancement scan was necessary and informative in the diagnosis of FBSS and MR imaging only was not enough in the diagnosis of arachnoiditis.

MR angiography of the renal arteries

We reviewed MR angiograms to evaluate its efficacy for visualizing the renal arteries and detecting renovascular disease. 41 renal arteries in 19 patients were examined by MR angiography. 3-D time-of-flight technique was used as routine examination method for MR angiography and 2-D time-of-flight technique was added in some particular cases to visualize venous flow. Within two weeks after MR angiography was performed, 23 renal arteries in 10 patients were additionally examined by conventional angiography or intraarterial DSA. The success rates of vessel visualization on MR angiography in normal renal arteries were 100% in main 67.7% in segmental, and 11.8% in intrarenal arteries. As a result of comparative study in normal main renal arteries with MR angiograms and conventional angiograms, overall correspondence in the number and the shape was noted and the caliber discrepancy between two examination did not exceed 3.0 mm. one arteriovenous fistula with aneurysm, one stenotic artery and two occluded arteries were well evaluated One arteriovenous fistula with aneurysm, and two occluded arteries were well evaluated by MR angiography. However three stenotic lesions were misdiagnosed as occlusions on MR angiography. and the overall accuracy was 87%. We conclude that MR angiography has the potential to be a noninvasive and useful screening method for determining the number of renal arteries and for detection of abnormalities of main renal arteries.

CT and MR findings of mycotic infection of the paranasal sinus: differentiation from sinonasal neoplasm

When a soft tissue mass in the bony wall of the paranasal sinus is present, it is difficult to make a distinction between tumor and inflammatory mass on CT. Fungal sinusitis may have soft tissue attenuation on the bony wall of the sinus, bony sclerosis, focal bony destruction, and calcific area on CT. This is a report of four proven cases of fungal sinusitis, asperogillosis in 3 cases and mucormycosis in 1 case, All 4 patients had CT and one patient had MRI, On CT, bony sclerosis and destruction were well visualized in all cases. On MRI, mycetoma in the maxillary sinus was hypointense on T1 weighted images and more hypointense on T2 weighted images. Although CT appears to be the best modality for initial examination of the patient with sinusitis, the differentiation of fungal sinusitis from tumor mass or other entity may be better accomplished with MRI.

Sonographic characterization of tenosynovitis

Tenosynovitis of the extremities is not uncommon but its diagnosis is not easy owing to its non-specific clinical manifestation. Thus it was beyond the field of imaging diagnosis so far. Recently the development of high resolution ultrasonogram has aided preoperative imaging diagnosis of tenosynovitis. The authors performed a retrospective review of 27 patients who had ultrasonography due to tendon pathology(including 18 tenosynovites) by oserving sonographic finding and evaluation the diagnostic value of each finding. The overall diagnostic accuracy was 81.1% and common sonographic findings were focal swelling of the tendon. well-defined margin of the lesion, preserved fibrillar pattern, echo change of the lesion site and fluid collection. Above al,. fluid collection was the only statistically significant criterion for diagnosis of tenosynovitis (p<0.05). But its sensitivity was as low as 50%. In conclusion the ultrasonography is useful in diagnosis of tenosynovitis and fluid collection is of diagnostic value, but the differentiation between nodular tenosynovitis without fluid collection and other benign tumor is still beyond the scope of ultrasonographic diagnosis.