Low-dose contrast-enhanced time-resolved MR angiography at 3T: diagnostic accuracy for treatment planning and follow-up of vascular malformations.

AIM: To assess the accuracy of low-dose contrast-enhanced time-resolved 3T magnetic resonance angiography (MRA) for the morphological and functional assessment of vascular malformations (VM), and to evaluate its diagnostic potential for the depiction of treatment-induced changes. MATERIALS AND METHODS: Twenty-five patients with known VM underwent MRA to evaluate the location and extent of lesions and their haemodynamic characteristics. Three-dimensional (3D) T1-weighted time-resolved sequences were acquired following the administration of 0.05mmol/kg of gadobenate dimeglumine. VM were classified according to their morphology and haemodynamic characteristics. All patients thereafter underwent conventional angiography to confirm the diagnosis and to treat the lesions (embolization or sclerotherapy). Follow-up MRA was performed 30 days after treatment to assess morphological and functional changes. A visual analogue scale (VAS) was used to clinically assess the severity of symptoms before and after therapy. RESULTS: Based on haemodynamic characteristics, VM were classified as predominantly arterial [4 (16%)], artero-venous [19 (76%)] or venous [2 (8%)]. Twenty-three (92%) lesions were classified as high-flow VM and two (8%) as low-flow VM. Intralesional thrombosis was present in 17 (68%) lesions before therapy and in 10 lesions (40%) after therapy. The median VAS scores were 5±1 before treatment and 4±2 after treatment. Very good correlation (Spearman's correlation coefficient: rho=0.87; p=0.000) was noted between the reduction of lesion size on follow-up MRA and pain relief as assessed by VAS. CONCLUSION: Low-dose contrast-enhanced time-resolved 3T MRA can be used to define morphological and functional aspects of VM accurately during treatment planning and follow-up, and can identify post-therapy changes that positively correlate with treatment outcome.

Pathologic findings in synovial tissue of the musculoskeletal system: role of MRI in therapeutic clinic assessment.

OBJECTIVES: The clinical diagnosis of synovial lesions is difficult and radiographic findings may establish a confident diagnosis only in some cases. MR imaging has become the technique of choice in evaluating these lesions, because a presumptive diagnosis can be made in most cases. The purpose of this study was to evaluate the joint synovial disease through intravenous contrast MRI examination and the following histological validation. MATERIALS AND METHODS: Forty-eight patients were considered, twenty-seven women and twenty-one men, with pain relief or collectively determined by a known joint synovial disease, who underwent MRI at our institution between 2000 and the second half of 2010. All patients underwent magnetic resonance imaging using a low field magnet (0.2 Tesla) or high field magnet (1,5Tesla). RESULTS: Only nine patients were diagnosed with an inflammatory arthropathy, in the remaining cases non-inflammatory arthropathy of which the most frequent form was pigmented villonodular synovitis (PVNS) was diagnosed. CONCLUSIONS: MRI is able to provide an accurate representation of all the pathological changes involved in the joint space following acute or chronic inflammation and to define the characteristic features useful in differential diagnosis.

Giant cell tumor of the flexor tendon of the wrist: US and MRI evaluation. Case report.

Giant cell tumor of the tendon sheath (GCTTS) is a benign proliferative lesion of synovial origin that may affect the joints, bursae and tendon sheaths. We report the case of a giant cell tumor of the tendon sheath arising from the carpal tunnel of the wrist in a 47-year-old woman. The patient underwent ultrasound (US) examination and subsequently magnetic resonance imaging (MRI).

Pigmented villonodular synovitis of the knee: A case report.

Pigmented villonodular synovitis (PVNS) is characterized by hyperplasia of the synovial tissue in joints, of tendon sheaths, and of the mucous membranes, or fibrous tissue adjacent to the tendons. Its etiology is unknown. We report a case of diffuse intra-articular PVNS of the right knee in a 38-year-old man. Ultrasound and magnetic resonance imaging (MRI) features of the disease are described.

Breast prosthesis: Management of patients after plastic surgery.

Breast augmentation and breast reconstruction are increasingly common operations. All radiologists need to be able to recognize the normal appearances of the more commonly used implants on various imaging modalities and breast radiologists in particular are facing new challenges when imaging the women involved. This work aims to review the normal and abnormal findings in women undergoing breast implant surgery using ultrasonography, mammography, and magnetic resonance imaging.

Vascular leiomyoma presenting as medial joint line pain of the knee.

Vascular leiomyoma or angioleiomyoma is a rare benign solitary smooth muscle tumor that occurs mostly in the extremities. Most of these tumors are composed of venous vessels, but in some reports small arteries have been detected in the tumors.We present a rare case of a 60-year-old man with a subcutaneous vascular leiomyoma of the right knee. Clinical findings, ultrasound (US), magnetic resonance (MR), and histopathologic features are reported, and the literature is reviewed. The knowledge of specific imaging findings allows to include vascular leiomyoma in the differential diagnosis of lower extremity subcutaneous masses and to achieve an early accurate diagnosis.

Reader variability in reporting breast imaging according to BI-RADS assessment categories (the Florence experience).

The inter- and intraobserver agreement (K statistic) in reporting according to BI-RADS assessment categories was tested on 12 dedicated breast radiologists, with little prior working knowledge of BI-RADS, reading a set of 50 lesions (29 malignant, 21 benign). Intraobserver agreement (four categories: R2, R3, R4, R5) was fair (0.21-0.40), moderate (0.41-0.60), substantial (0.61-0.80) or almost perfect (>0.80) for one, two, five or four radiologists, or (six categories: R2, R3, R4a, R4b, R4c, R5) fair, moderate, substantial or almost perfect for three, three, three or three radiologists, respectively. Interobserver agreement (four categories) was fair, moderate or substantial for three, six, or three radiologists, or (six categories) slight, fair or moderate for one, six, or five radiologists. Major disagreement occurred for intermediate categories (R3=0.12, R4=0.25, R4a=0.08, R4b=0.07, R4c=0.10). We found insufficient intra- and interobserver consistency of breast radiologists in reporting BI-RADS assessment categories. Although training may improve these results, simpler alternative reporting methods (systems), focused on clinical decision-making, should be explored.

Categorizing breast mammographic density: intra- and interobserver reproducibility of BI-RADS density categories.

The inter- and intraobserver agreement (kappa-statistic) in reporting according to Breast Imaging Reporting and Data System (BI-RADS((R))) breast density categories was tested in 12 dedicated breast radiologists reading a digitized set of 100 two-view mammograms. Average intraobserver agreement was substantial (kappa=0.71, range 0.32-0.88) on a four-grade scale (D1/D2/D3/D4) and almost perfect (kappa=0.81, range 0.62-1.00) on a two-grade scale (D1-2/D3-4). Average interobserver agreement was moderate (kappa=0.54, range 0.02-0.77) on a four-grade scale and substantial (kappa=0.71, range 0.31-0.88) on a two-grade scale. Major disagreement was found for intermediate categories (D2=0.25, D3=0.28). Categorization of breast density according to BI-RADS is feasible and consistency is good within readers and reasonable between readers. Interobserver inconsistency does occur, and checking the adoption of proper criteria through a proficiency test and appropriate training might be useful. As inconsistency is probably due to erroneous perception of classification criteria, standard sets of reference images should be made available for training.

Cross-sectional imaging in a case of adventitial cystic disease of the popliteal artery.

Adventitial cystic disease of the popliteal artery is an unusual condition of uncertain etiology, in which a mucin-containing cyst forms in the wall of the artery and produces lower extremity claudication, typically in young and middle-aged men. A diagnosis of adventitial cystic disease of the popliteal artery was made preoperatively in a 47-year-old man by means of several imaging modalities, including angiography, magnetic resonance imaging, and ultrasound. The pathological findings confirmed the suggested diagnosis.

Rehabitation of allograft with bone dehydrated with solvents in reconstruction after removal of bone tumors: MRI evaluation.

It was the purpose of this study to analyze the behavior of Tutoplast bone allograf to fill cavities produced by the removal of benigning bone tumors of those with local malignancy. X-ray and MR images obtained during follow-up demonstrated an increase in the signal in all of the sequences within the graft, indicating complete rehabitation of the grafted area.

[New prospects in the assessment of the knee extensor complex with dynamic magnetic resonance]. / Nuove prospettive nella valutazione con Risonanza Magnetica dinamica del complesso estensore del ginocchio.

INTRODUCTION: Altered patellofemoral biomechanics may result in pain, instability and early involutive processes. Magnetic Resonance Imaging (MRI), with its panoramic capabilities, has proved to be an effective technique in the study of knee extensor complex changes. The diagnostic advantages of dynamic studies of patellofemoral kinetics are reported in the recent scientific literature. We investigated the diagnostic potentials of passive studies of the knee extensor complex with sagittal and axial cine MRI. Then, we developed and optimized an innovative study method overcoming the limitations of the other dynamic techniques for the correct assessment of patellofemoral biomechanics. MATERIAL AND METHODS: We studied the knee with a .2 T permanent magnet dedicated to the limbs and acquired the images in different positions of flexion-extension with T1-weighted SE and T2-weighted GE sequences. We examined 21 healthy volunteers and 37 of 38 patients with anterior knee joint pain of suspected patellofemoral origin. All the images needed for dynamic studies were acquired in about 20 minutes. For the scan planes not to be affected by patellar motion in the different degrees of knee extension, it is necessary to acquire single axial images to be edited in cine motion afterwards. Each acquisition is aligned along sagittal reference planes depiciting always the same patellar aspect. RESULTS: Significant correlations were found between clinical and cine MR findings in 25 patients. In particular we depicted some extensor complex impingement conditions missed at conventional MRI, which clarified the role played by patellar dysplastic changes in cartilage microtraumas. Our technique was accurate, quite easy to perform and repeatable. We performed cost-effective dynamic studies which were useful in the evaluation of patients with anterior knee pain in whom conventional MRI had failed to provide enough information. CONCLUSIONS: Our technique differs from other passive or active dynamic studies reported on in the literature because the patellar volume does not change during acquisitions. This permits to decrease morphological changes and to simplify, on cine MR reconstructions, the specific analysis of patellofemoral dynamics during flexion-extension. Fewer morphological changes also mean a more accurate analysis showing the role of patellar dysplasia in cartilage microtraumas. Our dynamic MR protocol is accurate, easy to perform and to repeat; it allows dynamic studies in the patients with poor static MR findings.

[Role of magnetic resonance in the evaluation of the normal and osteochondrosis hip in early and late childhood]. / Ruolo della Risonanza Magnetica nella valutazione dell'anca normale e osteocondrosica nella prima e seconda infanzia.

INTRODUCTION: Despite MR potentials, few studies investigate the features of normal hips and of hip osteochondrosis in early and late childhood. We report our personal experience with MRI of hip osteochondrosis in pediatric patients. MATERIAL AND METHODS: MR images were obtained with total body MR equipment at medium and high fields. The normal hips were studied in children aged 34 months to 6 years with abdominal-urinary tract disorders and in 9 patients of the same age with unilateral Perthes disease. Hip osteochondrosis was studied in 6 children with Catteral's type III and IV and in 3 with type I and II disease. General anesthesia was never necessary to perform MRI. RESULTS: MRI exactly defined the cephalic anatomic profiles of normal hips which are not depicted with conventional radiography before the femoral head cartilage ossifies completely. MR contrast resolution was very high in depicting the maturation of the epiphyseal nucleus and its exact site in the cartilagineous epiphyseal hemisphere proximal to the femur. The analysis of MR morphological and structural changes permitted to correlate MR findings with the histopathologic features described in the literature. In addition, MRI of childhood hip osteochondrosis showed maked structural changes of the epiphyseal nucleus which are usually missed with conventional radiography. MRI permits early location of the abnormal area and the recognition of growing disk abnormalities; it also shows the whole cephalic cartilage and the changes of the epiphyseal nucleus evolution, which permits to differentiate osteochondrosis evolution from recessive patterns. Finally, MRI clearly showed the increased equatorial diameters of the involved femoral heads and the associated decrease in polar diameters, which is essential to study the biomechanics of hip osteochondrosis and therefore to plan treatment. CONCLUSIONS: MRI, even with coronal sequences and T1-weighting only, permits: 1) to image normal hips and hip osteochondrosis, especially in early and late childhood; 2) to clearly define cephalocotyloid relationships; 3) to depict the actual anatomic margins of the head and its structure; 4) to investigate the head cartilage extent and to locate the ossification nucleus. These morphologic and structural data are very useful to diagnose and manage hip osteochondrosis in the evolutive age. MRI shows abnormal changes in anatomic structures which are not seen with conventional radiography and demonstrates the evolution of the osteochondrosis process over time. In children over six, at the end of the ossification process of the head cartilage, conventional radiography alone is often sufficient to depict cephalocotyloid relationships and the MR diagnostic criteria of bone-cephalic diseases are similar to those used in adult hip studies.

[Nonfamilial cherubism. A clinical case report]. / Cherubismo non famigliare. Descrizione di un caso clinico.

The authors report a rare case of non-familial cherubism with a six-year follow-up. After an analysis of the hereditary transmission of the disease, the authors evaluate the anatomopathological and radiological characteristics and differential diagnosis, and then discuss possible therapies in the light of the latest research. They underline the important role of CT in identifying lesions which may not be diagnosed by simple X-ray with orthopantomography and highlight the importance of taking extreme care to conserve as much dental and bone tissue as possible during surgery.

[Fibrous idiopathic hyperplasia. Report of a case]. / Iperplasia fibrosa idiopatica. Descrizione di un caso.

It is presented a case of fibromatous gingival idiopathic hyperplasy of rare imponence. While describing the clinic characteristic the morphology of the lesion, the provoked functional troubles and the therapeutic program are evidenced. It is also confirmed its pathologic characteristic on hereditary base.