The gymnasts' hip and groin: a magnetic resonance imaging study in asymptomatic elite athletes.

OBJECTIVE: Specific patterns of developmental adaptation of the proximal femur have been recognized in some sports. Gymnastics are characterized by repetitive axial loading and hip rotations in combination with extreme hip positions. It is unknown how and if these forces can affect an immature skeleton in the long term. We sought to evaluate this, by means of magnetic resonance imaging of the hip and groin of such elite asymptomatic athletes. MATERIALS AND METHODS: We performed a case-control comparative MR imaging study of both hips and groin of 12 (7 male, 5 female) skeletally mature young (mean age 18.6 years) asymptomatic international level gymnasts with a minimum of 10 years' training with age-matched non-athletes. At the time of recruitment, none of the athletes had a recorded musculoskeletal complaint or injury in the anatomical area around the hip. RESULTS: The study showed that elite gymnasts share four common morphological characteristics on MRI that deviate from normal and are considered to be the result of adaptational changes to the specific sport: high centre-column-diaphysis angle (coxa valga140° on average), ligamentum teres hypertrophy, friction of the iliotibial band with oedema surrounding the greater trochanter, and a high incidence (62.5 %) of radiological appearances of ischiofemoral impingement. CONCLUSION: Our study showed that elite gymnasts share four common morphological characteristics on MRI that deviate from normal. These findings were in asymptomatic subjects; hence, radiologists and sports physicians should be aware of them in order to avoid unnecessary treatment.

Anterior and posterior meniscofemoral ligaments: MRI evaluation.

Although meniscofemoral ligaments are distinct anatomic units, their anatomy and function are controversial from an anatomic and radiologic point of view. Five hundred knee MR examinations were retrospectively studied in an effort to demonstrate the incidence and variations regarding sex and age distribution, as well as the anatomy of the meniscofemoral ligament at magnetic resonance imaging. Patients were mostly men, three hundred and twelve, in contrast with women who were fewer, one hundred eighty-eight patients. The mean age of the patients who were included in this study was 46 years. More than half of them were between 20 and 40 years old; one hundred thirty-three patients among 20 to 30 years old and one hundred and one patients among 31 and 40 years old, in total two hundred thirty-four patients.

A new variant of Todani type I choledochal cyst. Imaging evaluation.

BACKGROUND AND AIM: Choledochal cysts are congenital segmental aneurysmal dilatations of any portion of bile ducts, most commonly of the main portion of the common bile duct. The classification system of choledochal cysts is based on the site of the cyst or dilatation and currently includes 5 major types. The purpose of our study is to describe the imaging findings of a new variant of choledochal cyst. MATERIALS AND METHODS: Six patients (4 children and 2 adults, 4 females and 2 males, 3-67 year old) were evaluated by US, CT, CT-cholangiography, MRI, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP), because of jaundice, abdominal pain and a palpable mass. RESULTS: A new type of choledochal cyst was demonstrated in all cases. In this new variant apart from the dilatation of the common hepatic and the common bile duct, dilatation of the central portion of the cystic duct was also observed, giving a bicornal configuration to the cyst. CONCLUSION: The imaging findings of a new variant of choledochal cyst with participation of the cystic duct are described. We propose the classification of this type of choledochal cyst as a new subtype of Todani I cyst, namely Todani ID.

Pituitary stalk interruption syndrome: the role of MRI and review of the literature.

Magnetic resonance imaging (MRI) in patients with congenital growth hormone deficiency (GHD) has revealed several morphological abnormalities of the hypothalamo-pituitary region which include hypoplasia of the anterior pituitary lobe, the absence or marked thinning of the pituitary stalk and ectopia of the posterior pituitary lobe (EPP). This triad of abnormalities is called pituitary stalk interruption syndrome (PSIS). Our study reports the imaging findings of 23 patients with idiopathic GHD and short stature who were examined by MRI. The majority of the patients had abnormal MR studies with findings indicating the presence of the pituitary stalk syndrome. The high correlation between the clinical profile and the MR findings in cases of pituitary dysfunction (most often GHD), defines the significant role of MRI as additional tool for the diagnosis of pituitary hormone deficiency.

CT guided percutaneous adrenal biopsy for lesions with equivocal findings in chemical shift MR imaging.

PURPOSE: The aim of this study was to evaluate the usefulness of CT guided adrenal biopsy in patients with equivocal MR chemical shift imaging findings. MATERIAL AND METHODS: Fifty seven patients, 32 with history of malignancy and 25 without history of malignancy, 30 men and 27 women (33-82 years, mean age:58.8 years), with equivocal findings in chemical shift MR imaging, were subjected to CT guided percutaneous adrenal biopsy. RESULTS: From the 57 lesions that were sent for histopathological evaluation, 31 proved to be metastases (54.4%), 20 adenomas (35.1%), 3 cortical carcinomas (5.3%), 1 benign pheochromocytoma (1.8%) and 2 samples were non diagnostic(3.5%). In oncology patients metastases were found in 28/32 of the patients (87.5%) and adenomas in 3/32 (9.4%), while in patients without history of malignancy, metastases were found in 3/25 of the patients (12%) and adenomas in 17/25 (68%). CONCLUSION: CT guided percutaneous adrenal biopsy is a safe and accurate method for a definite diagnosis of adrenal lesions. Since most adrenal lesions are benign, dedicated adrenal imaging is necessary for choosing which of them have to be further evaluated by biopsy. Chemical shift adrenal imaging alone seems to be a reliable method and can be used alternatively to CT enhancement washout technique for selecting which lesions are suspicious of malignancy and have to be investigated with biopsy, especially in cases where iodine contrast media is contraindicated.

Treacher-collins syndrome and associated abnormalities. A case report.

Treacher-Collins syndrome or mandibulofacial dysostosis is an autosomal dominant disorder of craniofacial development. In this familial syndrome there is an arrest in the development of the facial bones, manifested by a depression of the malar bones, an antimonogoloid slant of the palpebral fissures, mandibular hypoplasia with retrognathia, coloboma of the lower eyelids and deformities of the ear structures derived from the branchial arches. Frequently, there is external auditory canal atresia and deformity of the pinnae. Other uncommon anomalies include congenital heart defects and cryptorchidism. This study describes a rare case of Treacher-Collins syndrome associated with congenital cardiopathy and megacolon, with a review of the literature.

Frontoethmoidal Mucoceles: CT and MRI Evaluation.

Paranasal sinus mucocele is an expanded, airless, mucus-filled sinus caused by obstruction of the sinus ostium. It is a benign slow growing epithelial lined lesion, bulging against adjacent anatomical structures, without infiltrating them. The purpose of our study is to describe the CT and MR findings in 19 patients (ten women, nine men, 18-72 years, mean age: 48.1) with surgically confirmed frontoethmoidal mucoceles between 1999-2005. CT scans displayed mucoceles as non enhancing soft tissue density lesions, generally isodense to the brain parenchyma, expanding the sinuses in most cases, eroding adjacent bones and extending intraorbitally or intracranially. Signal intensity in T2WI and T1WI MR images varied, but generally lesions had high signal intensity in T2WI and low to intermediate signal intensity in T1WI. Some of the lesions demonstrated regular linear peripheral enhancement after administration of contrast medium. The causes of mucoceles included mucosal thickening from chronic sinusitis, adhesions from previous operation in the nasal cavity, previous trauma, small nasal polyps and a small osteoma, while in six patients (31.5%) the cause of the mucocele remained unrecognized even after surgery. No underlying malignant tumor was found in any of the cases as the cause of obstruction. CT and MRI established the correct diagnosis in all patients. CT was more sensitive in determining bone erosions, while MRI had the advantage of multiplanar imaging and was much more sensitive for differentiating mucocele from a tumor on the basis of MR signal intensity characteristics. In conclusion, CT and MRI are the methods of choice for diagnosing mucoceles of the paranasal sinuses and are of major importance for the treatment plan. Each method seems to have its own advantages and should be used as complementary investigations of sinonasal pathology. Enhanced CT scan should only be performed in the absence or contraindication for enhanced MR imaging.

Pneumosinus Dilatans Syndrome of the Sphenoid Sinus. A CT Evaluation.

This study discusses the CT findings of pneumosinus dilatans of the sphenoid sinus, highlighting the clinically important CT characteristics. The CT findings of 26 patients with overpneumatization of the sphenoid sinus are presented in correlation with the clinical findings. Twenty-two patients had overpneumatization beyond the boundaries of the body of the sphenoid bone with or without bone remodelling but only two patients reported headaches. Thinning of the bone structures was also present in three patients but only one patient reported headaches. Overpneumatization of the sphenoid sinus with thinning of bunywalls reduced the width of the superior orbital fissure in one patient resulting in a gradual decrease of visual acuity. CT is an accurate method for the evaluation of overpneumatization of the sphenoid sinus due to its high sensitivity in depicting evidence of bone erosion using a bone window as imaging settings.

MRI evaluation of diastematomyelia and associated abnormalities.

Fourteen children were studied with a 1Tesla scanner to assess the role of magnetic resonance (MR) imaging in the recognition and evaluation of diastematomyelia and associated abnormalities. With MRI divided spinal cord was well imaged in its entire craniocaudal extent. Fibrous bands or bony septum when it contained a marrow cavity, were also well depicted. Direct visualization of the spinal cord itself is probably the most rewarding feature of MR imaging compared with other more conventional techniques. MR imaging demonstrated associated syringohydromyelia, segmentation anomalies, scoliosis, low position of the conus medularis and intradural lipoma that they were not detected with other radiologic studies.