Vertebral body enhancement mimicking sclerotic osseous lesions in the setting of bilateral brachiocephalic vein thrombosis.

Contrast enhancement of the vertebral body marrow may be seen secondary to collateral venous blood flow via the vertebral venous plexus in the setting of superior vena cava obstruction. We report a 48-year-old woman presenting with bilateral brachiocephalic vein obstruction and multilevel thoracic spine hyperdensities as seen on venous-phase CT angiography (CTA), initially concerning for sclerotic neoplastic lesions. A contrast-enhanced CT of the neck obtained 1 day prior to the chest CTA did not demonstrate any osseous abnormality, and inspection of the chest CTA demonstrated filling of perivertebral venous collateral vessels. The abnormal vertebral body enhancement was therefore feltsecondary to retrograde collateral venous flow via the basivertebral venous plexus in the setting of functional SVC obstruction. Vertebral body enhancement should be considered in patients with thoracic central venous obstruction when enhancement or apparent sclerosis of the vertebral bodies is seen on CTA.

MRI manifestations of pancreatic disease, especially pancreatitis, in the pediatric population.

OBJECTIVE: Although pancreatitis is an uncommon entity in children, the pediatric population can develop serious and long-lasting complications, including pseudocyst, necrosis, hemorrhage, vascular thrombosis, vascular pseudoaneurysm, abscess, and pancreaticopleural fistula. CT has historically been the mainstay for noninvasive imaging of the pancreas. This modality is limited in the pediatric population because of poorly developed retroperitoneal fat planes, difficulty in evaluating the ductal anatomy, and the use of ionizing radiation. MRI with MRCP provides superior soft-tissue resolution and improved visualization of ductal anatomy and can delineate complications of pancreatitis, while avoiding exposure to potentially harmful radiation. CONCLUSION: For these reasons, we advocate abdominal MRI with MRCP as the preferred modality for pancreatic evaluation in the pediatric population. The purpose of this article is to briefly discuss the normal anatomy and embryologic development of the pancreas, review standard sequences for routine abdominal MRI and MRCP in pediatric patients, discuss the normal appearance of the pancreas and biliary tree on MRI sequences, and use examples to illustrate the MRI appearance of common and uncommon manifestations of pancreatic disease in pediatric patients.