Técnica e indicaciones de la resonancia magnética artrografía. Extremidad superior (I) / Magnetic resonance arthrography indications and technique (I). Upper limb

La resonancia magnética (RM) es el método de imagen más efectivo en el diagnóstico de la patología articular. La RM artrografía (RMA), con inyección intraarticular de gadolinio diluido o suero salino, ha ganado aceptación en los últimos tiempos. El líquido intraarticular facilita la detección de la patología articular al delinear las estructuras articulares, separar estructuras anatómicas antes adyacentes y llenar espacios potenciales que se originan o comunican con la articulación. La RMA proporciona información adicional sobre la integridad de las estructuras articulares, especialmente cartílago, fibrocartílagos y ligamentos. Ha demostrado su utilidad clínica en el hombro, donde se han centrado la mayoría de estudios. La detección de lesiones sutiles del complejo cápsulo-labral es fundamental en la valoración prequirúrgica. La RMA puede ser una técnica complementaria a la RM convencional en algunos casos y en otros ser la técnica de elección inicial. La RMA indirecta con administración de gadolinio endovenoso se basa en el realce del líquido articular que se produce por difusión desde la sinovial al espacio articular. Esta técnica ofrece mejores resultados en las articulaciones con menor capacidad de distensión, como la muñeca, tobillo, mano y pie. Este artículo revisa el papel actual de la RMA. Se hace especial hincapié en la articulación del hombro, donde su utilidad está más claramente establecida. Se describe también la utilidad de esta técnica en otras articulaciones, revisando los aspectos anatómicos más relevantes, la técnica y las aplicaciones

Magnetic resonance (MR) is the most effective imaging technique in the diagnosis of articular pathology. MR arthrography (MRA), with intra-articular injection of diluted gadolinium or physiological saline solution has become more common in recent years. The intra-articular fluid facilitates the detection of articular pathology by delineating the articular structures, separating adjacent anatomic structures, and filling potential spaces that originate in or communicate with the joint. MRA provides additional information about the integrity of the articular structures, especially cartilage, fibrocartilage, and ligaments. MRA has proven especially useful in the shoulder, where most of the studies have been centered. The detection of subtle lesions of the capsule/labrum complex is fundamental for presurgical evaluation. MRA can be used to complement conventional MR imaging in some cases and in others it is the initial technique of choice. Indirect MRA with intravenous gadolinium administration is based on the enhancement of articular fluid caused by diffusion from the synovial space to the articular space. This technique offers better results in articulations with less capacity for distension, such as the wrist, ankle, hand, and foot. This first part of two-part article reviews the current role of MRA in the upper limb. Special emphasis is placed on the shoulder joint, where its usefulness has been most clearly established. The usefulness of this technique in other joints is also described, reviewing the most important anatomic aspects, techniques and applications

Técnica e indicaciones de la resonancia magnética artrografía. Extremidad inferior (II) / Magnetic resonance arthrography indications and technique (II). Lower limb

La resonancia magnética (RM) es la técnica de imagen de elección en la valoración de la patología articular. La RM artrografía (RMA) consiste en la punción directa de la articulación con inyección intraarticular de gadolinio diluido o suero salino. La RMA produce distensión de los recesos capsulares, delinea las estructuras intraarticulares y separa estructuras de difícil valoración por estar anexas, con lo que se consigue mejorar la fiabilidad diagnóstica de la patología articular y periarticular. La RMA permite resolver eficazmente alguno de los problemas diagnósticos de la RM en la valoración de la patología articular, evitando realizar artroscopias diagnósticas y permitiendo un mejor planteamiento terapéutico. En las articulaciones mayores de la extremidad inferior (cadera, rodilla y tobillo) la RMA tiene unas indicaciones claramente establecidas, entre las que destacan la valoración de las lesiones del labrum acetabular en la cadera, el menisco operado de la rodilla y el estudio de los síndromes de «impingement» del tobillo. Este artículo revisa la utilidad actual de la RMA en las articulaciones de la cadera, rodilla y tobillo. Se revisan los aspectos anatómicos más relevantes, la técnica y las aplicaciones. Finalmente, se revisa la utilidad de esta técnica en patologías que pueden afectar a cualquier articulación del organismo como son las lesiones osteocondrales, cuerpos libres y patología sinovial

Magnetic resonance (MR) is the imaging technique of election in the evaluation of the articular pathology. MR arthrography (MRA) consists of the direct punction of the joint with intraarticular injection of diluted gadolinium or saline solution. MRA produces distention of the capsular recess, delineates the intraarticular structures and separates annexed structures of difficult evaluation, with which it is able to improve the reliability diagnoses of the articular and periarticular pathology. MRA allows to solve some of the diagnostic problems of conventional MR imaging in the evaluation of the articular pathology, avoiding to make unnecessary diagnostic arthroscopy and allowing a better therapeutic plan. In the greater joints of the inferior extremity (hip, knee and ankle) MRA has established indications standing out the evaluation of the injuries of the acetabular labrum of the hip, the operated meniscus of the knee and the study of the «impingement» syndromes of the ankle. This article reviews the present utility of the MRA in the hip, knee and ankle joints. The more relevant anatomical aspects, the technique and the applications are reviewed. Finally, the value of this technique in pathologies that can affect any joint of the organism such as osteochondral injuries, loose intraarticular bodies and synovial pathology is reviewed

Magnetic resonance urography: a pictorial overview.

Magnetic resonance urography (MRU) can be performed on the basis of two different imaging strategies: static-fluid MRU, based on heavily T2 weighted turbo spin echo (TSE) sequences, and gadolinium-enhanced excretory MRU. Both MR urographic techniques in combination with standard MRI permit a comprehensive examination of the entire urinary tract. This pictorial review illustrates the MRU features of the a wide spectrum of pathological conditions affecting the urinary tract.

[Magnetic resonance arthrography indications and technique (I). Upper limb]. / Técnica e indicaciones de la resonancia magnética artrografia. Extremidad superior (I).

Magnetic resonance (MR) is the most effective imaging technique in the diagnosis of articular pathology. MR arthrography (MRA), with intra-articular injection of diluted gadolinium or physiological saline solution has become more common in recent years. The intra-articular fluid facilitates the detection of articular pathology by delineating the articular structures, separating adjacent anatomic structures, and filling potential spaces that originate in or communicate with the joint. MRA provides additional information about the integrity of the articular structures, especially cartilage, fibrocartilage, and ligaments. MRA has proven especially useful in the shoulder, where most of the studies have been centered. The detection of subtle lesions of the capsule/labrum complex is fundamental for presurgical evaluation. MRA can be used to complement conventional MR imaging in some cases and in others it is the initial technique of choice. Indirect MRA with intravenous gadolinium administration is based on the enhancement of articular fluid caused by diffusion from the synovial space to the articular space. This technique offers better results in articulations with less capacity for distension, such as the wrist, ankle, hand, and foot. This first part of two-part article reviews the current role of MRA in the upper limb. Special emphasis is placed on the shoulder joint, where its usefulness has been most clearly established. The usefulness of this technique in other joints is also described, reviewing the most important anatomic aspects, techniques and applications.

[Magnetic resonance arthrography indications and technique (II). Lower limb]. / Técnica e indicaciones de la resonancia magnética artrografía. Extremidad inferior (II).

Magnetic resonance (MR) is the imaging technique of election in the evaluation of the articular pathology. MR arthrography (MRA) consists of the direct punction of the joint with intraarticular injection of diluted gadolinium or saline solution. MRA produces distention of the capsular recess, delineates the intraarticular structures and separates annexed structures of difficult evaluation, with which it is able to improve the reliability diagnoses of the articular and periarticular pathology. MRA allows to solve some of the diagnostic problems of conventional MR imaging in the evaluation of the articular pathology, avoiding to make unnecessary diagnostic arthroscopy and allowing a better therapeutic plan. In the greater joints of the inferior extremity (hip, knee and ankle) MRA has established indications standing out the evaluation of the injuries of the acetabular labrum of the hip, the operated meniscus of the knee and the study of the "impingement" syndromes of the ankle. This article reviews the present utility of the MRA in the hip, knee and ankle joints. The more relevant anatomical aspects, the technique and the applications are reviewed. Finally, the value of this technique in pathologies that can affect any joint of the organism such as osteochondral injuries, loose intraarticular bodies and synovial pathology is reviewed.

[Spinal angiolipoma: case report]. / Angiolipoma espinal: presentación de un caso.

Spinal extradural angiolipomas are rare benign tumours, accounting for only 0.14-1.2% of all spinal neoplasms. They are usually localized within the thoracic extradural space of the spinal canal and their common clinical presentation is myelopathy, mainly in the way of a slowly progressive paraparesis and sometimes in an acute form. We report the case of a 85 year old man who complained of bilateral lower limb weakness with sphincter disturbance of acute instauration. The MRI showed a posterior extradural lesion at L1-L2 level that compressed conus medularis and cauda equina. He underwent urgent surgical treatment and we achieved total resection of the lesion via a L1-L2 laminectomy. The pathological examination confirmed the tumour as an angiolipoma.

Angiolipoma espinal: presentación de un caso / Spinal angiolipoma: Case report

Los angiolipomas espinales extradurales son tumores de carácter benigno poco frecuentes, que representan el 0,14-1,2 por ciento de todas las neoplasias raquídeas y se localizan preferentemente a nivel torácico. Clínicamente suelen presentarse como mielopatía, que puede debutar de forma aguda o instaurarse crónicamente. Presentamos el caso de un varón de 85 años con clínica de inicio agudo consistente en paraparesia espástica, acompañada de alteración de esfínteres. En la RM dorso-lumbar se objetivó una neoformación intrarraquídea a nivel L1-L2, que ocupaba el espacio epidural posterior, comprimiendo el cono medular y la cauda equina. El paciente fue intervenido con carácter urgente, realizándose una laminectomía L1-L2 y consiguiéndose la exéresis total de la neoformación. El estudio anatomopatológico fue informado como angiolipoma (AU)

No disponible

[Intradural lumbar disk hernia]. / Hernia discal lumbar intradural.

Intradural disc herniation is a rare complication of degenerative disc disease. A correct diagnosis of this process is frequently difficult. If this entity is not preoperatively diagnosed and is omitted at surgery, severe neurologic sequels may be provoked. We report a case of a pathologically proven intradural disc herniation preoperatively diagnosed by MR imaging. Clinically, it was manifested by sudden onset of right leg ciatalgia and progressive right lower extremity weakness. The patient also referred a one-month history of sexual dysfunction. MR imaging revealed interruption of the low signal of the anulus fibrosus and of the posterior longitudinal ligament at L2-L3 level and a voluminous disc fragment migrated in the dural sac that showed rim enhancement with gadolinium.The clinical, neuroradiological, and surgical management of lumbar intradural disc herniation are reviewed.

Hernia discal lumbar intradural / Intradural lumbar disk hernia

La hernia intradural es una complicación infrecuente de la enfermedad degenerativa discal, de difícil diagnóstico. Si este proceso no se diagnostica preoperatoriamente y se pasa por alto en el acto quirúrgico, puede condicionar importantes secuelas neurológicas. Presentamos un caso de hernia discal intradural diagnosticado preoperatoriamente con resonancia magnética (RM). Clínicamente, se manifestaba por un cuadro de lumbociatalgia derecha de instauración súbita, disminución progresiva de la fuerza en la extremidad inferior derecha y disfunción sexual de un mes de evolución. La RM demostró interrupción de la hiposeñal normal del anillo fibroso discal y del ligamento longitudinal común posterior en L2-L3, así como un voluminoso fragmento discal migrado en el saco tecal, con realce anular tras la administración de contraste. Se revisa la nosología de la hernia discal intradural lumbar, con especial atención a los hallazgos neurorradiológicos y a su abordaje quirúrgico (AU)

Unilateral osteonecrosis in a patient with bilateral os centrale carpi: imaging findings.

The os centrale carpi is one of the accessory ossicles that have been described in the carpus. We report on the imaging findings of a rare case of unilateral osteonecrosis in a patient with bilateral os centrale carpi. The differential diagnosis of this entity and the suggested etiology for the development of osteonecrosis are discussed.

Chronic nontraumatic spinal epidural hematoma of the lumbar spine: MRI diagnosis.

An uncommon case of chronic nontraumatic spinal epidural hematoma of the lumbar spine in a 75-year-old woman is reported. The patient presented with a 7-month history of low back pain and bilateral sciatica. Magnetic resonance imaging enabled a correct preoperative diagnosis revealing a nodular, well-circumscribed epidural mass with peripheral enhancement and signal intensities consistent with chronic hematoma, which extended from L2 to L3. Laminectomy of L2-L3 was performed and the hematoma was totally resected. Histological examination of the surgical specimen demonstrated a chronic encapsulated hematoma. No evidence of vascular malformation was found. The patient recovered fully after surgical treatment.

Adult choroid plexus papilloma of the posterior fossa mimicking a hemangioblastoma. Case report.

The authors report a case of cystic choroid plexus papilloma that originated in the posterior fossa. No connection with the ventricular system was found intraoperatively. Magnetic resonance (MR) and computerized tomography imaging did not furnish a diagnosis, but findings of pathological examinations were consistent with those of choroid plexus papilloma. The authors describe the different appearances of the tumor on MR images and discuss the differential diagnosis with other tumors of the posterior fossa.

Usefulness of gadolinium-enhanced MR imaging in the evaluation of the vascularity of scaphoid nonunions.

OBJECTIVE: The objective of this article is to identify the role of gadolinium-enhanced MR imaging in the preoperative evaluation of the vascular status of the proximal fragment in scaphoid nonunions. SUBJECTS AND METHODS: Thirty consecutive patients (27 men and three women; age range, 19-52 years; mean age, 28 years) with nonunion of the scaphoid were prospectively examined with unenhanced and gadolinium-enhanced MR imaging. MR images and surgical findings were classified in four groups according to the vascular status of the proximal fragment (normal bone, moderate ischemic bone, severe ischemic bone, and avascular necrosis). Sensitivity, specificity, and accuracy of unenhanced and gadolinium-enhanced MR studies were calculated. Surgical findings were used as the gold standard. The postoperative rate of union at 12 months was evaluated for each group. RESULTS: Unenhanced MR imaging showed a global sensitivity of 36%, specificity of 78%, and accuracy of 68% in the preoperative evaluation of the vascular status of the proximal fragment. Correlation with the surgical findings was not statistically significant (p < 0.149). Global sensitivity, specificity, and accuracy of gadolinium-enhanced MR imaging were 66%, 88%, and 83%, respectively. Correlation with the surgical findings was good (p < 0.0001). Gadolinium-enhanced sequences allowed accurate diagnosis and enabled the creation of prognostic groups having better correlation with surgical findings and postoperative results. CONCLUSION: Gadolinium-enhanced MR imaging is the most reliable imaging method for investigating the vascularity of the proximal pole in scaphoid nonunions.

Transjugular biopsy of the liver with an automated device.

PURPOSE: To evaluate the results of transjugular liver biopsies conducted with an automated device. MATERIAL AND METHODS: Transjugular liver biopsies were conducted on 37 patients. The principal indication was coagulation disorders. The biopsies were performed with a 1.3-mm automated device. Each patient underwent three biopsies: anterior, lateral and posterior. A fourth biopsy was conducted if the first three did not produce at least one core sample that was sufficient for the histologic diagnosis. RESULTS: Transjugular liver biopsy was successful in all 37 patients. We performed a mean of 3.06 punctures per patient (average 2.86 samples). The length of the samples varied from 5 to 23 mm (mean 13.6 mm). Biopsy specimens were useful for histologic diagnosis in 97% of the cases. No serious complications were caused by the procedure. CONCLUSION: The transjugular liver biopsy technique is an efficient way of obtaining tissue samples. The procedure shows a high success ratio and a low complication rate.

Perineurioma (storiform perineurial fibroma) of the kidney in a child.

Perineurioma is an extremely rare benign tumor of the peripheral nervous system composed exclusively of perineurial cells. Imaging findings of this tumor are non-specific and the diagnosis is based on histologic studies. We report a case of perineurioma of the kidney in a 7-year-old girl discovered incidentally during the evaluation of a urinary tract infection. This is the first case of renal perineurioma reported in a child. We present the ultrasound and computed tomography findings of this histologically confirmed neoplasm.

[Bronchial embolization in the treatment of hemoptysis]. / Embolización bronquial en el tratamiento de la hemoptisis.

The aim of this retrospective study was to evaluate the efficacy of bronchial artery embolization to treat hemoptysis. Eight hundred sixty-five patients were admitted to our hospital with hemoptysis during the study period. Bronchial arteriographs were obtained for 48, who suffered life-threatening hemoptysis refractory to medical treatment. The likely origin of bleeding was identified in 37: embolization was performed with particles measuring 250 to 1000 micra in size (Contour Emboli, Interventional Therapeutic Corporation, South San Francisco, California, USA) in 35 and with hemostatic collagen sponges in 2. The most common causes of hemoptysis were bronchiectasis (40%), pulmonary tuberculosis (33%), pulmonary aspergilloma (8%) and malignant neoplasm (8%), chronic bronchitis (6%); 4% of the cases were idiopathic. Immediate technical success was achieved in 34 patients (92%) as defined by the absence of hemorrhage for at least 24 hours. All embolized patients were followed until the first recurrence of bleeding or until discharge. Recurrence of hemoptysis (in the first month) was early in 5 patients (13.5%) and late (2 to 96 months) in 9 (24%). The severity of the initial and later episodes of hemoptysis was similar in all early recurrences and most late recurrences. A second embolization was performed six times, and medical and/or surgical treatment was given in all other cases. No significant complications attributable to the technique were observed. The results show that bronchial embolization is valid for the immediate control of life-threatening hemoptysis and has a low rate of severe complication; recurrence is relatively common.