Prospective evaluation of MR arthrography performed with high-volume intraarticular saline enhancement in patients with recurrent anterior dislocations of the shoulder.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of high-volume saline-enhanced MR arthrography in assessing the labrum, the ligaments, and the bony components of the glenohumeral joint. SUBJECTS AND METHODS: Forty-four patients with recurrent anterior dislocations of the shoulder underwent MR arthrography after intraarticular injection of 15-40 ml of saline solution. Two-dimensional fast low-angle shot and T1-weighted spin-echo sequences were prospectively evaluated by two observers. Anterior (Bankart) lesions, superior labral lesions extending from anterior to posterior, and Hill-Sachs lesions were diagnosed. Glenohumeral ligaments (GHLs) were identified and classified using a standard system. MR imaging results were compared with those of arthroscopy (n = 32) or open surgery (n = 12), either of which was the gold standard. RESULTS: Bankart lesions and superior labral lesions extending from anterior to posterior were revealed with a sensitivity of 93% and 89%, respectively, and a specificity of 80% and 89%, respectively. Diagnostic accuracy was 89% for both types of lesions. All six patients with bony Bankart lesions had high fat-marrow signal intensity within the fragment on T1-weighted MR images. For GHLs, MR imaging results and arthroscopy correlated in 25 of the 31 patients. In three patients all three GHLs were visible on MR imaging, but only two GHLs were detected with arthroscopy. In three patients two GHLs were detected on MR imaging but all three were visible on arthroscopy. Hill-Sachs lesions were revealed with a sensitivity of 95%, a specificity of 50%, and an accuracy of 81%. CONCLUSION: High-volume saline-enhanced MR arthrography is accurate in revealing the labrum, the ligaments, and the bony components of the glenohumeral joint Saline solution is inert and inexpensive, two advantages over gadopentetate dimeglumine.

Brain hemangiomas of infancy. Sonographic detection and follow-up.

Vascular birthmarks of the skin can be associated with hemangiomas or arteriovenous malformations of different organs. Computed tomography and magnetic resonance imaging (MRI) combined with angiography are the diagnostic tools used in children, adolescents, and adults to depict vascular malformation or bleeding. In infants, ultrasound examination through the anterior fontanelle is possible. This report describes 2 mature infants with brain hemangiomas primarily detected by real-time sonography: In both the brain lesions were associated with cutaneous and other vascular birthmarks. MRI was used to verify the brain hemangiomas. Subsequent follow-up evaluations during therapy were easily performed by ultrasonography.

[A proposal for the MR staging of early rheumatoid arthritis in the metacarpophalangeal and proximal interphalangeal joints]. / Vorschlag einer MR-Stadieneinteilung der frühen rheumatoiden Arthritis an den Metakarpophalangeal- und proximalen Interphalangealgelenken.

PURPOSE: MRI can demonstrate pathology of joint disease in the early course of rheumatoid arthritis prior to destructions seen on conventional radiographs. In a prospective study, we tried to develop a systematical classification of joint pathology demonstrated by MRI, which would be essential for scoring the course of the disease. PATIENTS AND METHOD: Metacarpophalangeal and interphalangeal joints of 48 patients suffering from early rheumatoid arthritis (mean disease duration: 6.4 months) were evaluated by MRI using a high-resolution transmitter-receiver coil. Examinations included 2 mm sliced T2-, T1- and gadolinium enhanced T1-SE sequences in coronal and axial orientation. In consideration of pathological findings on MRI and histopathogenetical pathways of destruction in rheumatoid arthritis a MR-score (0-5) was established. RESULTS: This allowed to score each joint examined: score 0 (normal) in 47.8%/49.5%, score 1 in 35.5%/50.5%, score 2 in 4.2%/0%, score 3 in 10.8%/0%, score 4 in 1.5%/0% of the metacarpophalangeal/interphalangeal joints, respectively. CONCLUSIONS: Using the MR-score a relative individual destruction number can be calculated, which may be used to follow up patients in the early course of rheumatoid arthritis (e.g. drug therapy studies). The presented MR scoring system has to be evaluated further in longitudinal studies and must be correlated to radiographical and clinical findings.

Glutaric aciduria type I: a serious pitfall if diagnosed too late.

We report the MR imaging findings in two children with glutaric aciduria type I (GA I). It is important to consider this disorder in the differential diagnosis in a child presenting with an unclear hydrocephalus or atrophy. The imaging findings consist of basal ganglia changes, frontotemporal atrophy, and retarded myelination. A definite diagnosis with an urine test and a dietary treatment can avoid encephalopathy with irreversible changes.

MRI and radiographic findings in Currarino's triad.

Currarino's triad is a rare complex of a congenital sacral bony abnormality, anorectal malformation and a presacral mass. Intractable constipation since birth is the leading symptom of this triad, which follows an autosomal dominant mode of heredity. We report conventional radiographic and MR findings in one family consisting of a mother and her two daughters. In all three cases, radiography revealed an abnormality of the os sacrum, the so-called scimitar sacrum. MR examination, undertaken next in our institution, was applied with T1-, T2- and proton density weighted sequences in all three orientations before and after i. v. application of gadolinium diethylene-triamine-pentaacetic acid (Gd-DTPA). In two patients we were able to diagnose the complete form of the triad and in one patient an incomplete form. In any case of a radiographically diagnosed scimitar sacrum in combination with constipation, Currarino's triad should be considered. MRI, as the method of choice, should be the next step to detect a presacral mass and any anomalies of the spinal canal. The importance of early recognition lies in the high morbidity and mortality rates resulting from this disorder.

MRI of hepatic schistosomiasis mansoni.

Magnetic resonance imaging (MRI) was performed in a patient with hepatic schistosomiasis mansoni. On T1-weighted images periportal zones appeared isointense to the surrounding liver, but strongly enhanced after injection of Gd-DTPA. This finding equals periportal enhancement in postcontrast CT studies and does not discriminate between periportal inflammation in early stages of the disease and portal venous and hepatic artery collaterals in late stages of periportal fibrosis. However, on T2-weighted images periportal zones appeared as high signal bands throughout the liver suggesting periportal inflammatory changes with edema. Thus T2-weighted spin echo sequences should be performed and may be helpful to assess activity of periportal inflammation.

Functional results of radioiodine therapy with a 300-Gy absorbed dose in Graves' disease.

The aim of this study was to assess the results of high-dose radioiodine therapy given to 43 patients with recurrent hyperthyroidism due to Graves' disease between 1986 and 1992. We chose an intrathyroidal absorbed dose of 300 Gy and determined the applied activity individually, which ranged from 240 to 3120 MBq with a median of 752 MBq. Hyperthyroidism was eliminated in 86% of cases after 3 months and in 100% after 12 months. No patient required a second radioiodine treatment. The incidence of hypothyroidism was 63% after 3 months and 93% after 18 months. Neither the pretherapeutic thyroid-stimulating immunoglobulin level nor the degree of co-existing endocrine ophthalmopathy was correlated with the time at which hypothyroidism developed. Patients with previous radioiodine therapy developed hypothyroidism earlier than patients with previous thyroid surgery. The results show that ablative radioiodine therapy with a 300-Gy absorbed dose is a very effective treatment of hyperthyroidism in Graves' disease, but it should be restricted to patients with recurrent hyperthyroidism combined with severe co-existing disorders or episodes of unfavourable reactions to antithyroid drugs.