Cranial MR imaging with clinical correlation in preeclampsia and eclampsia.

PURPOSE: Our aim was to determine the distribution and nature of cranial MRI findings in preeclampsia/eclampsia, and also to correlate them with clinical and laboratory data. MATERIALS AND METHODS: MR imaging was performed in 39 patients with preeclampsia (n=30) and eclampsia (n=9), and the distribution and signal patterns of the lesions were documented. Clinical findings, blood pressures, and laboratory data were compared statistically in patients with and without MR imaging findings. RESULTS: MR imaging was normal in 21 of the patients. In 18 patients, cortical-subcortical lesions, which appeared iso-/hypointense on T1W and hyperintense on T2W images, were detected. The occipital lobe was involved in all patients, followed by the parietal, frontal, and temporal lobes, and basal ganglia and pons. The lesions showed watershed distribution in 13 patients. When the patients with and without MR imaging findings were compared, there was a statistically significant difference regarding visual disturbances, depression of consciousness, and seizures (p=0.042, p=0.006, p=0.000, respectively). Although patients with MR imaging findings showed higher blood pressures as compared to those without MR imaging findings, there was no statistically significant difference (p=0.074). In patients with MR imaging findings, lactate dehydrogenase (LDH), uric acid, and creatinine levels were significantly higher than those without MR imaging findings (p=0.006, p=0.010, p=0.005, respectively). CONCLUSION: Increased permeability of the blood-brain-barrier related to endothelial injury plays a major role in the pathogenesis of preeclampsia/eclampsia. Relatively minor increases in blood pressure may cause cerebral lesions. However, when the cerebral autoregulation mechanism is considered, the distribution of cerebral lesions in the posterior circulation and watershed zones, which are relatively sparsely innervated by sympathetic nerves, provides evidence that the main determinant of pathogenesis is acute fluctuations in blood pressure.

Intra- and interobserver variability of Kleerekoper's method in vertebral fracture assessment.

Radiographically detected vertebral fractures (VF) are a hallmark of osteoporosis. Several approaches to describe VF have been proposed. The objective of this study was to evaluate the intra- and interobserver variability of semiquantitative Kleerekoper's method in osteoporotic VF assessment. Sixty-seven postmenopausal osteoporotic (L2-4 T-score < or =-2.5) women with a mean age of 65.2+/-7.51 years were included into the study. Lateral radiographs of thoracic and lumbar spine were evaluated in all patients. Kleerekoper's method was used to define VF. Two observers evaluated all radiographs independently. To investigate intraobserver reproducibility, the first observer reevaluated all radiographs a month later on a separate occasion. Intra- and interobserver agreement was calculated using the kappa statistic. The agreement between two readings for the first observer was 86.3% with a corresponding kappa score of 0.573 (95% confidence limits of kappa score were 0.505-0.642). Interobserver agreement was 87.7% with a corresponding kappa score of 0.660 (95% confidence limits were 0.602-0.718). We observed a moderate agreement for Kleerekoper's method in vertebral fracture assessment. There is no gold standard or standardized measurement or description for VF. Quantitative assessment of VF is essential in epidemiologic studies and in clinical drug trials, but a semiquantitative technique, which is done by experienced observers, should also be added to evaluate the entire spectrum of visible features that are helpful in identifying deformities.

Craniocervical artery dissection: diagnosis and follow-up with MR imaging and MR angiography.

BACKGROUND: Our aim was to determine the value of MR angiography (MRA) in combination with MRI in the diagnosis and follow-up of craniocervical artery dissections (CCAD) and to document the effectiveness of conservative medical treatment in these patients. MATERIAL/METHODS: In seven patients, six internal carotid artery dissections and two vertebrobasilar artery dissections were studied with 2D and 3D TOF MRA and fat-saturated T1W images. MRA projection images, source images, and T1W images with fat saturation were evaluated for the presence or absence of criteria for dissection. RESULTS: MRA projection images showed narrowing and/or occlusion of lumen in all patients. Dissection flap was identified in 5 of the 8 dissections. Both MRA source images and T1W images with fat saturation were useful in showing the increased external diameter of the dissected vessel and the mural hematoma; although the latter proved to give better results. Almost complete resorption of hematoma and normalization of flow were achieved between 1.5 to 7 months. CONCLUSIONS: This study further supports the approach that MRA accompanied by T1W images with fat saturation should be the method of choice in the diagnosis and follow-up of CCAD. Fat-suppressed T1W images improve detection of the mural hematoma, especially in the late sub-acute phase and during follow-up. Conservative medical treatment may be effective, obviating the need for aggressive treatment options.

Giant fusiform basilar artery aneurysm causing obstructive hydrocephalus.

A 58-year-old man presented with a sudden onset gait disturbance and urinary incontinence. Magnetic resonance (MR) imaging and MR angiography showed a fusiform basilar artery aneurysm, 2 cm in diameter and 5 cm long. The aneurysm was thrombosed except the ectatic basilar artery flowing through it. Compression of the cerebrospinal fluid (CSF) pathways caused obstructive hydrocephalus with resultant transependymal CSF leakage. Conventional angiography missed the aneurysm. A one-sided ventriculoperitoneal shunt was placed to treat the patient's hydrocephalus. The patient's symptoms improved after surgery. MR imaging and MR angiography were useful noninvasive methods of detecting the aneurysm, defining its relationship with surrounding structures, and determining the cause of the hydrocephalus.