Right Intrathoracic Stomach Secondary to Congenital Hiatal Hernia with Organoaxial Torsion: A Report of Two Cases

Right intrathoracic stomach associated with organoaxial torsion is a rare form of congenital hiatal hernia. We report the radiologic findings in two cases of complete or partial right intrathoracic stomach secondary to congenital hiatal hernia. The barium meal test demonstrated the presence of complete or partial right intrathoracic stomach and non-obstructive organoaxial torsion with the greater curvature lying against the right chest wall. The esophagogastric junction was located above the diaphragm. CT revealed a cystic mass in the right posterior mediastinum. This cystic lesion should be differentiated from other congenital mediastinal cysts.

Embryonal Rhabdomyosarcoma of the Retroperitoneum in a Child: A Case Report

Rhabdomyosarcoma is the most common soft tissue sarcoma occurring in children, though retroperitoneal rhabdomyosarcoma is rare. We experienced a case of embryonal rhabdomyosarcoma of the retroperitoneum in a 43-month-old child, and describe the CT , MRI and pathologic findings.

To rsion of the Accessory Spleen with Infarction: CT Features in a Case Report

Torsion of the accessory spleen is a rare entity that can have variable clinical presentations. We report case involving an 11-year-old boy with severe abdominal pain and a mass that was found to be due to infarction of the accessory spleen, which was twisted on its pedicle. CT revealed a low-attenuating mass with peripheral inflammatory changes in the left upper abdomen. The mass was pathologically confirmed as torsion of the ac-cessory spleen with infarction.

Diagnostic Value of Source images of 3D TOF MR Aniography in the Evaluation of the Hemifacial Spasm

PURPOSE: To evaluate the diagnostic value of source images of 3D TOF MR angiography in patients with hemifacial spasm. MATERIALS AND METHODS: Thirteen patients with surgically-confirmed hemifacial spasm and 30 who were not suffering from this condition were included in this study. T1 and T2-weighted images and 3D TOF MR angiography were performed. In 43 randomly-selected individuals, we retrospectively determined whether source images obtained during 3D TOF MR angiography could be used to evaluate symptoms. The results were correlated with surgical findings. RESULTS: Sensitivity was 92% and specificity was 86%. In all 13 patients with hemifacial spasm, neurovascular compression was detected during their operation. Offending vessels were the anterior inferior cerebellar artery (AICA) in four cases, the posterior inferior cerebellar artery (PICA) in seven, both the vertebral artery and PICA in one, and the vertebral vein, also in one. There were ten false-positive cases in the asymptomatic control group, nine of which showed neurovascular contact in the root entry zone of the facial nerve; one case showed indentation of the pons. CONCLUSION: Source images obtained during 3D TOF MR angiography are useful in the preoperative evaluation of hemifacial spasm.

Diagnostic Accurracy of MR Imaging and Pattern of Injury in the Posterior Cruciate Ligament injury

PURPOSE: To evaluate the diagnostic accuracy of MR imaging in posterior cruciate ligament(PCL) injuries, to describe the variety of these injuries and to assess the type and frequency of associated knee injuries. MATERIALS AND METHODS: We retrospetively analysed 75 cases with knee injuries. In all cases, the prescence of a PCL tear was determined by arthroscopy or surgery and the type of tear and patterns of associated knee injuries were described. RESULTS: Twenty-eight PCL tears were identified with arthroscopy or surgery. Figures for the sensitivity, specificity, and accuracy of MR diagnosis for the PCL injury were 86%, 94% and 91% respectively. Twenty-one cases(75%) had complete PCL tears and seven (25%) had partial tears. The commonest tear site was midsubstance(18 cases, 64.3%). Twenty-seven cases(96%) had associated knee injuries ; the remaining patient(4%) had isolated PCL injuries. There were 19 cases(68%) of ligamentous injuries, ten (36%) of meniscal tear, ten (36%)of bony injuries, and 20 (71%) of joint effusions. Of the ligamentous injuries, those involving the medialcollateral ligament were most often seen(10 cases, 36%). CONCLUSIONS: MR imaging is an accurate method for the detection and evaluation of PCL injury and associated knee abnormalities.

Diagnostic Accuracy of Low Tesla MR Imaging in the Internal Derangement of the Knee

PURPOSE: This study is for the evaluation of low tesla(0.064T) MR imaging diagnostic accuracy in the internal derangement of the knee. MATERIALS AND METHODS: We retrospectively analysed the MR images of 36 injured knees of 35 patients. The presence of tear was determined by arthroscopy or surgery in all cases. RESULTS: The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of low tesla MRI for the diagnosis of anterior cruciate ligament injury were 83%, 88%, 86%, 77%, 91%, for the posterior cruciate ligament 75%, 95%, 86%, 92%, 83%, for the medial collateral ligament 83%, 96%, 92%, 91%, 92%, for the lateral collateral ligament 67%, 97%, 94%, 67%, 97%, for the menisci 75%, 93%, 89%, 75%, 93%. CONCLUSION: The low tesla MRI is an accurate method in detection and evaluation of the internal derangement of the knee.

CT and Fluoroscopy Guided Celiac Ganglion Block

PURPOSE: To evaluate the effects and usefulness of fiuroscopy guided celiac ganglion block after marking of needle path with CT scan. MATERIALS AND METHODS: Celiac ganglion block with 100% ethyl alcohol was performed in 50 cancer patients who were inoperable and had intractable abdominal pain. Duration and degree of pain relief after the procedure and its complication were analyzed. RESULTS: Early pain relief was observed in 98% and long term relief in 68% without serious complication. CONCLUSION: Fluoroscopy guided celiac ganglion block after marking of needle path with CT scan was a safe and valuable procedure in relieving intractable pain in terminal cancer patients and reduced the time in the CT room.

MR appearances of intracranial tumors with a low tesla (0.064 T) permanent MR system

In this report we describe twenty-two cases of intracranial tumors studied with an MR imager operating at a field strength of 0.064 T for evaluation of the clinical utility of low tesla MRI. The comfirmed diagnoses were meningioma(9 cases), astrocytoma(4 cases), glioblastoma multiforme(1 case), craniopharyngioma(2 cases), intracranial metastasis(1 case). pituitary microadenoma (1 case), hemangioblastoma (1 case), and trigerminal neurilemmoma(1 case). Meningiomas appeared as well-marginated, homogenous signal intensity masses(67%) in most cases. Most meningiomas showed iso-signal intensity(78%) on T1-weighted images, and high signal intensity on T2-weighted images. After Gd-DTPA enhancement, diffuse homogeneous contrast enhancement(75%) was well see. The multiple hemorrhagic foci within the glioblastoma multiforme were identified, which shoed high signal intensity on T1-weighted images and low signal intensity on T2-weighted images(intracellular methemoglobin), or high signal intensity on both T1 and T2-weighted images(extracellular methemoglobin). One case of cerebellar hemangioblastoma was a well-defined cystic mass with contrast enhanced mural nodule but no identification of characteristic signal void vessels. The remianing tumors showed low signal intensity on T1-weighted images, and high signal intensity on T2-weighted images. Gd-DTPA enhancement was helpful in separating the lesion from the surrounding edema or normal tissue, but had limited diagnostic value in characterizing the nature of the mass. The advantages of low tesla MRI are as follows on requirement of cooling water or electricity, open design, shorter T1 relaxation time compared with high tesla unit that increases the difference of T1-relaxation time between tissues, ease of installation, and cost effectiveness. In conclusion, the low tesla MRI is useful for the detection and evaluation of the brain tumors.