ABSTRACT
OBJECTIVE: We explored how a novel T1-weighted 3-dimensional (3D) fast spin echo (FSE) sequence (Cube; GE, Waukesha, Wis) might outperform conventional 2-dimensional (2D) FSE techniques for contrast-enhanced imaging of the pituitary and parasellar region. METHODS: Ninety-one patients were imaged with 3D Cube and conventional 2D FSE on a 3.0-T magnetic resonance scanner. Two neuroradiologists independently assessed images for anatomical delineation (infundibulum, optic apparatus, and cavernous sinus), degree of artifact, and confidence in lesion definition or exclusion using a 5-point scale. In addition, the readers were asked to rank overall preference. RESULTS: Readers A and B found 3D Cube to be better or equal to 2D FSE in 84% and 86% of the cases. Three-dimensional Cube provided significantly better images than 2D FSE with respect to delineation of the infundibulum (P < 0.0001), cavernous sinus (P < 0.0001), optic apparatus (P = 0.002 for reader A and P = 0.265 for reader B), and fewer artifacts at the sellar floor (P < 0.0001). Three-dimensional Cube provided greater lesion conspicuity or confidence in lesion exclusion (P < 0.0001). CONCLUSIONS: Three-dimensional Cube provides superior quality with thinner slices as well as diminished artifact and can replace conventional 2D FSE sequences for routine evaluations of the pituitary and parasellar region.
Subject(s)
Image Enhancement/methods , Image Interpretation, Computer-Assisted/methods , Imaging, Three-Dimensional/methods , Magnetic Resonance Imaging/methods , Pituitary Gland/pathology , Pituitary Neoplasms/pathology , Sella Turcica/pathology , Adolescent , Adult , Aged , Algorithms , Child , Contrast Media , Female , Gadolinium , Humans , Male , Middle Aged , Observer Variation , Reproducibility of Results , Sensitivity and Specificity , Spin Labels , Young AdultABSTRACT
This study aimed to investigate whether moderately elevated intracranial pressure is associated with greater cross-filling of the anterior communicating artery on diagnostic cerebral angiography. A retrospective study of 12 patients with subarachnoid hemorrhage was performed. Data on sequential cerebral angiograms and clinical data were used to indirectly estimate intracranial pressure (ICP). Cross-filling of the anterior communicating artery (ACom) was recorded according to our scoring system. Our study included 12 patients with mean age 43 ± 11 yrs. Six patients demonstrated greater ICP associated with greater cross-filling of the ACom on initial angiogram. One patient had greater ICP with greater cross-filling on follow-up angiogram secondary to infarction and midline shift. Two patients had lower ICP yet greater cross-filling on follow-up angiogram due to higher injection rate and volume. One patient with no change in ICP demonstrated the same degree of cross-filling. A markedly elevated ICP is traditionally associated with no cross-filling across the ACom. We propose a counter-intuitive model in which moderately elevated ICP produces greater cross-filling of the ACom. This diagnostic angiographic finding should make the angiographer consider that the patient has moderately elevated ICP, and facilitate more timely clinical management.
Subject(s)
Anterior Cerebral Artery/diagnostic imaging , Intracranial Aneurysm/diagnostic imaging , Intracranial Hypertension/diagnostic imaging , Subarachnoid Hemorrhage/diagnostic imaging , Adult , Cerebral Angiography , Computed Tomography Angiography , Female , Humans , Intracranial Pressure , Male , Middle Aged , Retrospective StudiesABSTRACT
Radiologists are often required to evaluate postoperative spine imaging to assist the surgeon with further clinical management. This article reviews common spine surgical techniques and their proper evaluation on imaging from a surgical perspective. The article attempts to provide a basic surgical foundation for radiologists and a clearer delineation of important points and complications that should be commented on when evaluating the postoperative spine on imaging.
Subject(s)
Postoperative Complications/diagnostic imaging , Spinal Diseases/surgery , Bone Screws , Decompression, Surgical , Equipment Failure , Humans , Laminectomy , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/surgery , Postoperative Complications/surgery , Reoperation , Sacrum/diagnostic imaging , Sacrum/surgery , Spinal Diseases/diagnostic imaging , Spinal Fusion/methods , Spinal Stenosis/diagnostic imaging , Spinal Stenosis/surgery , Tomography, X-Ray Computed , Total Disc ReplacementABSTRACT
Primary or metastatic spine tumors can present with pain and/or neurologic compromise depending on their location within the spinal axis. Metastases and multiple myeloma comprise most of these lesions. Management of spinal tumors includes surgical decompression with stabilization (neo), adjuvant chemotherapy and radiation therapy, curettage, bone grafting, bone marrow replacement, and palliative treatment with vertebral augmentation. Pre- and postoperative imaging plays a critical role in the diagnosis and management of patients with spinal tumors. This article reviews postoperative imaging of the spine, including imaging protocols, immediate and long-term routine imaging findings, and emergent findings in symptomatic patients.
Subject(s)
Neuroimaging/methods , Postoperative Complications/diagnosis , Spinal Neoplasms/surgery , Combined Modality Therapy , Cooperative Behavior , Diffusion Magnetic Resonance Imaging/methods , Equipment Failure , Follow-Up Studies , Humans , Image Interpretation, Computer-Assisted , Interdisciplinary Communication , Magnetic Resonance Imaging/methods , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/surgery , Neoplasm, Residual/diagnosis , Neoplasm, Residual/surgery , Neurologic Examination , Positron-Emission Tomography/methods , Postoperative Complications/surgery , Reoperation , Spinal Fusion/instrumentation , Spinal Neoplasms/diagnosis , Spinal Neoplasms/secondary , Tomography, Emission-Computed, Single-Photon/methods , Tomography, X-Ray Computed/methodsABSTRACT
Embryogenesis is a complex, wide-ranging event. Key processes may proceed simultaneously in different portions of the embryo, or sequentially, with phase offsets as waves of maturation pass outward from an initial point toward the periphery. The molecular signals used to pattern the body commonly serve multiple functions and reiterate as the body plan progresses. This article therefore presents first the anatomic model of the peripheral nervous system, so that the final goal is clear. It then reviews the terminology needed to describe embryogenesis. The article's first section reviews neural development. The main portion of the article addresses the maturation of the fetal nervous system in terms of the evolving gross morphology and the molecular signals that pattern these changes.
