CT and MR Imaging Features in Patients with Intracranial Dolichoectasia

PURPOSE: To describe the CT and MR imaging features in patients with intracranial dolichoectasia. MATERIALS AND METHODS: The CT(n=21), MR(n=20) and MRA(n=11) imaging features seen in 28 patients (M:F=12:16 aged beetween 65 and 82 (mean, 65) years with intracranial dolichoectasia were retrospectively reviewed with regard to involved sites, arterial changes(maximum diameter, wall calcification, high signal intensity in the involved artery, as seen on T1-weighted MR images), infarction, hemorrhagic lesion, compression of brain parenchyma or cranial nerves, hydrocephalus and brain atrophy. Involved sites were classified as either type 1 (involvement of only the posterior circulation), type 2 (only the anterior circulation), or type 3 (both). RESULTS: In order of frequency, involved sites were type 1(43%), type 3(36%) and type 2(22%). Dolichoectasia was more frequently seen in the posterior circulation(79%) than in the anterior (57%). Arterial changes as seen on T1-weighted MR images, included dolichoectasia(mean maximum diameter 7.4mm in the distal internal carotid artery, and 6.7mm in the basilar artery), wall calcification(100% in involved arteries) and high signal intensity in involved. Cerebral infarction in the territory of the involved artery was found in all patients, and a moderate degree of infarct was 87%. Hemorrhagic lesions were found in 19 patients(68%); these were either l o b a r ( 53%), petechial(37%), or subarachnoid (16%), and three patients showed intracranial aneurysms, including one case of dissecting aneurysm. In 19 patients(68 %), lesions were compressed lesions by the dolichoectatic arteries, and were found -in order of descending frequency- in the medulla, pons, thalamus, and cerebellopontine angle cistern. Obstructive hydrocephalus was found in two patients (7 %), and 23 (82 % ) showed a moderate degree of brain atrophy. CONCLUSION: In patients with intracranial dolichoectasia, moderate degrees of cerebral infarction and brain atrophy in the territory of involved arteries, as well as hemorrhagic lesions and compression of the brain stem or cranial nerves, were not infrequently seen on CT and MR images. These changes were in addition to the basic arterial change(dolichoectasia, arterial wall calcification and intraluminal high signal intensity) seen on T1-weighted MR images.

Sonographic Evaluation of Plantar Fasciitis

PURPOSE: To evaluate the sonographic findings of plantar fasciitis. MATERIALS AND METHODS: Both feet of 30patients(mean age, 44years) in whom plantar fasciitis had been clinically diagnosed, and those of healthyvolunteers(mean age, 34years) were evaluated with ultrasound(US) using a 7.0MHz linear array transducer. Heel painwas unilateral in 26 patients and bilateral in four. Sagittal sonograms were obtained in the prone position, andthe thickness of the plantar fascia was measured at its proximal end near its insertion into the calcaneus. Wealso evaluated hypoechoic fascia, perifascial fluid collection, fiber rupture, calcaneal spur and calcifications. RESULTS: Plantar fascia thickness was significantly greater in the heels of patients with plantarfasciitis(3.2-8mm; mean, 5.1 +/-1.12) than in their asymptomatic heels(1.3-5mm; mean, 3.5 +/-0.78)(p<0.0001), inwhich it was similar to that of heels of patients in the control group(1.8-5mm; mean, 3.0 +/-0.71)(p<0.0001). Theproximal plantar fascia was hypoechoic in 31 symptomatic heels(91.2%), in four asymptomatic heels(15.4%), and innone of the patients in the control group. Calcaneal spurs were identified in sixteen symptomatic heels(47.1%),and in two which were asymptomatic(7.7%). Perifascial fluid collection was identified in only two symptomaticheels(5.9%). CONCLUSION: In plantar fasciitis, sonography demonstrates that the fascia is thicker as well ashypoechic. For the clinical diagnosis of planter fasciitis, US can therefore be used as an adjunct to clinicaldiagnosis.