Indications for MR mammography. A Belgian study.

The problem of dynamic MR mammography remains its low specificity. Therefore, the examination is only useful when it is performed as a complementary examination and only for good indications. The aim of the study was to analyse the indications for MR mammography in 12 Belgian hospitals and to evaluate whether MRI was useful for these indications. The two most frequent reasons for which MR mammography was performed in these hospitals were a diagnostic problem after clinical examination, mammography and ultrasound, and differentiation between post-therapeutic changes and recurrent disease, both of which are good indications. MRI examinations in the 12 hospitals were useful in patients receiving the examination for a good indication. However, in the group of the known poor indications we see much false positive MRI results.

MRI after successful lumbar discectomy.

Our aim was to establish the normal range of MRI findings after successful lumbar discectomy. We prospectively examined 34 consecutive patients with an excellent clinical outcome by MRI 6 weeks and 6 months after surgery. All examinations included sagittal and axial spin-echo (SE) T1-weighted images before and after intravenous gadolinium-DTPA and fast SE T2-weighted images. Contrast enhancement along the surgical tract was seen in all patients 6 weeks and 6 months after surgery. After 6 months minimal or no mass effect on the dural sac by epidural scar was seen. In 20% of patients there was recurrent disc herniation, with mass effect. Enhancing nerve roots were seen in 20% of patients 6 weeks postoperatively, and half of these were associated with recurrent disc herniation at the same side. None of these patients still showed nerve root enhancement 6 months after surgery. Postoperative MRI studies must be interpreted with great care since the features described in the failed back surgery syndrome are also found, to some extent, in asymptomatic postoperative patients.

Whiplash injuries: is there a role for imaging?

Whiplash describes the manner in which a head is moved suddenly to produce a sprain in the neck and typically occurs after rear-end automobile collisions. It is one of the most common mechanisms of injury to the cervical spine. Although considered by some to be a form of compensation neurosis, evidence suggests that whiplash injuries are real and that they are a potential cause of significant impairment. Symptoms of cervical whiplash injury include neck pain and stiffness, interscapular pain, arm pain and/or occipital headache, and many whiplash patients have persistent complaints. Cervical roentgenography and conventional or computed tomography (CT) may show dislocations, subluxations and fractures in severely traumatized patients, but often fail to determine or visualize the cause for a whiplash syndrome. Magnetic resonance imaging (MRI), however, is able to assess different types of soft-tissue lesions related to whiplash injuries. Dynamic imaging may show functional disturbances. More widespread use of flexion/extension views, high-resolution static MRI and especially dynamic MRI should improve the correlation between imaging findings and patients' complaints.

Unusual presentation of ovarian pathology on CT.

A prospective study including seventy-seven consecutive patients suspected of having ovarian tumoral or pseudotumoral pathology on CT was carried out. Fifty-nine patients had surgery with histological diagnosis. When comparing the CT and histological findings in benign and malignant lesions we obtained an overall accuracy of 95% with only three misdiagnosed cases on CT. False positive diagnosis of malignancy was established in a case of abdominal actinomycotic infection, a case of chronic appendicitis, and in a ruptured ectopic pregnancy. These three cases are discussed in detail.