Magnetic resonance imaging compared to echocardiography to assess left ventricular mass in the hypertensive patient.

Echocardiography (ECHO) is useful to document changes in left ventricular mass (LVM) in groups of patients, but may be too variable for use in the individual patient. Magnetic resonance imaging (MRI) may be a more precise and reliable method to quantify the mass of the left ventricule. This study reports the accuracy, precision, and reliability of LVM estimates by MRI as compared to data obtained by ECHO in hypertensive patients. Accuracy referred to the comparison of LVM by MRI to anatomical LVM determined by autopsy. Precision was examined using 34 duplicate MRI images and by blindly reading 24 duplicate M-mode strips. Reliability was assessed by MRI in four subjects over 2 months, and by ECHO in 22 hypertensive patients over 2 weeks. Agreement between MRI and ECHO estimates of LVM was determined in the same 17 hypertensive patients using linear regression. MRI LVM estimates were within 17.5 g (95% CI) of the true LVM. The linear agreement between MRI and ECHO estimates of LVM could be described by the equation MRI = 0.61 x ECHO + 49.57 (r = 0.63, P < .01). The precision of LVM by MRI (11 g) was over twice that observed with ECHO (26 g). The reliability of MRI LVM estimates was more consistent (+/- 8 g) than that for ECHO (+/- 49 g). MRI appears to be a more precise and reliable method for measuring LVM, and would be more suitable than ECHO for the clinical evaluation of the individual patient.

Angiosarcoma of the extremity: preoperative evaluation with CT, MRI, ultrasonography, and angiography.

A patient with a soft tissue forearm mass had the customary surgical approach for excision. A biopsy specimen at that time showed angiosarcoma, and the mass was left in situ. Subsequent imaging with computed tomography, magnetic resonance imaging, ultrasonography, and angiography demonstrated the usefulness and limitations of these modalities. Excisional surgery and radiation therapy were then done.

Detection of bone marrow involvement in breast cancer with magnetic resonance imaging.

PURPOSE: To evaluate the value of magnetic resonance imaging (MRI) in detecting bone marrow metastases in patients with breast cancer. PATIENTS AND METHODS: Twenty-three patients with breast cancer in various stages (stage IV, 11; stage III, five; stage II, seven) were evaluated for bone marrow involvement. MRIs of marrow from lumbar spine, pelvis, and proximal femora were obtained with a 1.5-Tesla unit. All patients underwent bilateral bone marrow aspirations and biopsies for histologic evaluation and immunostaining with monoclonal antibody (MoAB) against low-molecular weight cytokeratin (CAM 5.2). Marrow MRI findings were compared with technetium 99m bone scans. Patients with stage II or III disease were monitored for clinical outcome. Possible correlation of MRI findings with serum alkaline phosphatase level was explored. RESULTS: Fourteen of 23 patients showed MRI abnormalities suggestive of metastatic marrow disease (stage IV, nine; stage III, two; stage II, three). In six patients with abnormal MRIs, histology and MoAB immunostaining confirmed marrow involvement (stage IV, five; stage III, zero; stage II, one). In the other eight patients with MRI abnormalities, neither of these methods confirmed the presence of marrow metastasis. Four of five operable breast cancer (stage II-III) patients with an abnormal initial MRI showed additional abnormalities on follow-up examination and developed metastatic disease within 5 to 18 months demonstrable by conventional clinical methods. Conversely, none of the operable patients with negative MRIs developed recurrent disease at 3 to 16 months (Student's t test, P = .01). Nine patients with a normal MRI had no evidence of marrow involvement with histologic or MoAB immunostaining (stage IV, two; stage III, two; stage II, five). Of 14 patients with abnormal MRIs, bone scans were normal in seven and failed to show corresponding abnormalities in six. Elevated serum alkaline phosphatase levels showed a direct relationship with abnormal bone scans indicating extensive bony involvement, but failed to correlate with positive marrow MRIs. CONCLUSION: MRI is a promising new technique to detect occult marrow involvement in breast cancer patients. There is a good correlation between abnormal marrow MRI and early development of clinical metastatic disease in patients with stage II to III disease.

Retroperitoneal dissemination of cervix cancer following surgical staging.

Retroperitoneal and cutaneous dissemination of cervical carcinoma occurred following an extraperitoneal surgical staging procedure. This type of event may be rare or merely underreported in surgical staging literature. Extraperitoneal and laparoscopic staging procedures that result in piecemeal removal of tissue should be studied for the incidence of this type of recurrence.

Bone marrow MRI: techniques and accuracy for detecting breast cancer metastases.

We investigated the utility of bone marrow MRI for diagnosing marrow metastases from breast cancer compared with radionuclide bone scan, iliac crest marrow biopsy with histology and antibody immunostaining, and clinical follow-up. We report the results of 43 MRI studies in 32 patients and discuss the evolution and comparison of optimal MRI techniques. MRI appears to be the most accurate diagnostic method, and short TI Inversion Recovery (STIR) the most reliable pulse sequence for this group of patients with breast cancer.

The limited role of total parenteral nutrition in the management of pancreatic pseudocyst.

Total parenteral nutrition (TPN) for the nonoperative treatment of acute pancreatic pseudocyst has been of hypothetical benefit. We reviewed pseudocyst hospital admissions in 40 patients treated with TPN who had serial imaging studies. The mean cyst size was 7.4 cm on presentation, decreasing to 5.6 cm after nonoperative treatment with TPN (mean 32.5 days). After a nonoperative period, 68 per cent of cysts regressed, completely in 14 per cent, partially in 54 per cent. Except for a patient with cyst-related obstructive jaundice, there were no complicated pseudocysts. Only 12 (28%) patients underwent cyst drainage. Fifteen patients (35%) sustained catheter-related complication, which included sepsis (26%), pneumothorax (9%), hydropneumothorax (2%), and septic right atrial thrombosis (2%), in the course of hospitalization. The majority of TPN-treated patients had a clinical and radiographic regression of their pseudocyst. However, the increased risk of catheter-related complications in this group suggests that this therapy should be limited to patients who are unable to sustain enteral nutrition.

Successful management of an infant with a giant hemangioma of the retroperitoneum and Kasabach-Merritt syndrome with alpha-interferon.

Giant vascular neoplasms in neonates generally require aggressive medical or surgical therapy for treatment of complications. Steroids, chemotherapy, embolization, radiation, and surgery have all been used with short-term beneficial and sometimes unknown long-term side effects. A new modality of treatment, alpha-interferon, has recently been described. The majority of hemangiomas in children involute by 8 years of age. Occasionally, hemangiomas can endanger vital structures and are associated with a consumption coagulopathy and thrombocytopenia (Kasabach-Merritt Syndrome). These hemangiomas occasionally do not respond to steroids, radiation therapy, cytotoxic drugs, or embolization. The mortality rates approach 50% in nonresponders. Alpha-interferon has been used in these children with life-threatening complications of hemangiomas with relief of symptoms. This case illustrates the potential use of alpha-interferon in the management of giant hemangiomas in children. This emerging form of biological therapy avoids the risks of radiation therapy, embolization, and surgery with only minimal side effects.

Cryptococcal pneumonia occurring as an infiltrative mass simulating carcinoma in an immunocompetent host: plain film, CT, and MRI findings.

Cryptococcosis, a potentially fatal pulmonary infection, rarely occurs in advanced form in immunocompetent individuals. Radiographic findings are variable and include single and multiple mass-like infiltrates, nodules, and segmental infiltrates. MRI manifestations of pulmonary cryptococcosis have not been reported previously. We have compared MRI, CT, and plain film radiographic findings in a case of multisegmental cryptococcal pneumonia occurring as a mass simulating carcinoma in an immunocompetent individual; we have also discussed the differential radiographic evaluation of pulmonary cryptococcosis.

Common bile duct calculus: MRI findings.

Ultrasonography and CT were done in a case of obstructive jaundice. Ultrasonography showed gallstones and a dilated common bile duct; CT revealed multiple hyperdense lesions in the liver, gallbladder calculus, and a dilated common bile duct, which terminated abruptly in an apparent pancreatic mass. MRI confirmed the presence of multiple liver hemangiomas and gallbladder calculi and further revealed an obstructing common bile duct calculus as well as the absence of a pancreatic mass.

Measurement of left ventricular mass in hypertrophic cardiomyopathy using MRI: comparison with echocardiography.

Left ventricular mass (LVM) is an important consideration in the management of cardiac hypertrophy associated with hypertrophic cardiomyopathy (HCM), systemic hypertension, and other diseases. A brief MRI cardiac imaging procedure used to monitor regression of LVM during treatment would be beneficial in management of these patients, since echocardiograms cannot be obtained in all patients and since the volume of a hypertrophic heart can straightforwardly be assessed from a series of tomographic slices. The present study was designed to evaluate a brief cardiac MRI procedure for measurement of LVM in HCM and compare it to echocardiography. MRI images acquired in a simulated transverse body plane were used to evaluate the mass of the left ventricle in 6 ex vivo human hearts obtained at autopsy. The estimates of LVM by MRI in the ex-vivo hearts were within 8% of the actual LVM. MRI images were acquired to evaluate LVM in 5 normal subjects and 12 patients diagnosed with HCM. Echocardiography was accomplished on 4 of the normal subjects and 10 of the patients having HCM. There were no significant differences in LVM by MRI and echocardiographic techniques in normal subjects. Transverse MRI images acquired on normal subjects demonstrated that estimates of LVM are reproducible when repeated over 3-w to 3-mo intervals. Images selected for analysis represented the heart in an early diastolic phase. MRI and echocardiographic techniques demonstrated significant differences in LVM in HCM patients. Estimates of LVM in normal subjects and patients diagnosed with HCM were normalized for body weight. The LVM estimates for HCM patients were very significantly different than normal subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Differentiation of benign from malignant breast masses by time-intensity evaluation of contrast enhanced MRI.

Using gadolinium-DTPA enhanced MRI we analyzed the enhancement characteristics of palpable breast masses in 23 patients--10 cancers and 13 benign lesions. The most specific finding for separating benign from malignant lesions was a ratio of maximum intensity change divided by the time interval during which this first occurred. Designated ranges of this ratio were specific for benign disease and sensitive for malignancy in this small patient group. Three of eight fibroadenomas exhibited enhancement patterns indistinguishable from cancer.

MRI in hyperparathyroidism requiring reoperation.

A 34-year-old woman presented with persistent hyperparathyroidism (HPT) following primary surgical removal of a hypertrophied parathyroid gland. Reevaluation ultrasound (US), computed tomography (CT), and parathyroid scintigraphy studies were negative for parathyroid adenoma. Magnetic resonance imaging (MRI) clearly identified an ectopic parathyroid adenoma within the lateral carotid sheath. Uncomplicated surgical extirpation of the adenoma was accomplished. We discuss the role of US, CT, parathyroid scintigraphy, and MRI in recurrent HPT.

I-131 accumulation in gastric pull-up simulating pulmonary metastases on total-body scan for thyroid cancer.

A follow-up total-body I-131 scan in a patient with follicular thyroid carcinoma demonstrated radionuclide accumulation in the right hemithorax. Originally thought to be pulmonary metastatic thyroid carcinoma, the uptake region proved to be intrathoracic gastric mucosa. The patient had been treated for squamous cell esophageal carcinoma by esophagogastrostomy reconstruction with gastric pull-up. This unusual imaging pattern could have been interpreted as metastatic disease in the absence of complete patient records, an appreciation of normal gastric concentration patterns of I-131, and corroborative imaging study analysis.

Intraorbital tumor as the initial symptom of childhood acute lymphoblastic leukemia. Magnetic resonance imaging findings.

Orbital involvement in leukemia is usually of myelogenous origin and is frequently the initial presentation. Orbital tumor due to lymphocytic leukemia is rare and only one case has been reported as the initial symptom. We report magnetic resonance imaging (MRI) findings of a case of acute lymphocytic leukemia with orbital mass as the initial symptom. The usefulness of MRI, including signal intensity and extent of involvement, is discussed.

Indium-111-leukocyte/technetium-99m-MDP bone and magnetic resonance imaging: difficulty of diagnosing osteomyelitis in patients with neuropathic osteoarthropathy.

Fourteen patients (16 sites) with clinical and/or radiographic evidence of neuropathic osteoarthropathy (Charcot joints) were evaluated with combined indium-111-leukocyte (111In-WBC) and technetium-99m-methylene diphosphonate (99mTc-MDP) bone imaging for suspected osteomyelitis. Magnetic resonance (MR) images were obtained in seven patients. Using a positive bone culture as the criterion for the presence of osteomyelitis, there were four true-positive studies, six true-negative sites, and one false-negative 111In-WBC study. Five of 16 sites (31%) had false-positive 111In-WBC uptake at noninfected sites. There were four true-positive and three false-positive MR studies. All false-positives showed at least moderately abnormal findings by both techniques at sites of rapidly progressing osteoarthropathy of recent onset. In this preliminary study, both techniques appear to be sensitive for detection of osteomyelitis, and a negative study makes osteomyelitis unlikely. However, the findings of 111In-WBC/99mTc-MDP and MR images at sites of rapidly progressing, noninfected neuropathic osteoarthropathy may be indistinguishable from those of osteomyelitis.

Neurilemoma of the tongue: MR findings.

Neural tissue tumors of the oral cavity are rare. They are found most commonly in the tongue and arise from the sheaths of peripheral nerves, neuroglia, and neurons. We report magnetic resonance findings in a case of neurilemoma of the tongue.

Lumbar epidural chordoma: MR findings.

Chordomas derive from persistent nests of notochordal cells that do not regress. They usually arise from the midline within bone of the skull base or spinal column. Typical radiographic findings of chordomas include midline location and bony destruction. We report an unusual epidural chordoma of the lumbar spine.