Cough-associated headache in patients with Chiari I malformation: CSF Flow analysis by means of cine phase-contrast MR imaging.

The purpose of this study was to analyze the CSF flow in patients with Chiari I to determine differences between patients with and without CAH. Thirty patients with Chiari I malformation underwent cine-PC CSF flow imaging in the sagittal plane. CSF flow pulsations were analyzed by placing regions of interest in the anterior cervical subarachnoid space. Maximum CSF systolic (craniocaudal) and diastolic (caudocranial) velocities as well as the durations of CSF systole and diastole (measured in fractions of the cardiac cycle) were determined. In the region of interest just below the foramen magnum, patients with CAH had a significantly shorter CSF systole and longer diastole (P=.02). A CSF diastolic length of ≥0.75 of the cardiac cycle was 67% sensitive and 86% specific for CAH. Our results indicate that Cine-PC imaging can show differences in CSF flow patterns in patients with Chiari I with and without CAH.

Intraligamentous ganglion cysts of the anterior cruciate ligament: MR findings with clinical and arthroscopic correlations.

OBJECTIVE: Magnetic resonance findings with clinical and arthroscopic correlation of intraligamentous cysts of the anterior cruciate ligament (ACL) are presented. MATERIALS AND METHODS: Three cases of intraligamentous cysts of the ACL were identified out of 681 knee MRI examinations over a 2-year period. Arthroscopy and postoperative MRI were performed in all three patients, each of whom experienced knee pain with extreme flexion and extension. RESULTS: In all three cases the intraligamentous cyst was homogeneously hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging relative to the ACL. Two of the three ACL cysts required a 70 degrees scope for adequate visualization and establishment of posteromedial and posterolateral portals for arthroscopic treatment. One cyst could not be visualized arthroscopically and probing of the ACL from the anterior portal resulted in drainage of the cyst. No patient had presence of ACL cyst on follow-up MRI or recurrence of symptoms at a mean of 24 months. CONCLUSION: Intraligamentous cyst of ACL is a rare cause of knee pain. It should be suspected in patients having chronic pain with extremes of motion. Magnetic resonance findings are diagnostic and help to guide arthroscopy.

Childhood onset of myxopapillary ependymomatosis: MR features.

We report a 12-year-old girl who at presentation had diffuse myxopapillary ependymomatosis of uncertain primary site. The MR appearance and mechanism of metastases of the tumor are discussed.

MRI of the hip with a shoulder surface coil in off-coronal plane.

OBJECTIVE: We describe an inexpensive and simple method for optimal visualization of the hip with MRI. MATERIALS AND METHODS: A flexible shoulder surface coil and off-coronal planes of section oriented parallel to the long axis of the femoral neck are used for MR studies of the affected hip. RESULTS: From January 1993 through December 1993, 155 hip MR examinations were performed on 143 patients who were referred to radiology for evaluation of hip pain. No patient had to be rescanned as a result of poor imaging technique or hip pathology not in the field-of-view (FOV). The placement of the shoulder surface coil is simple with no significant time loss for setup. Off-coronal, small FOV MRI obtained with the shoulder surface coil are superior to those obtained with body coil imaging. Specifically, spatial resolution, tissue contrast, and lesion characterization are improved without significant degradation of signal-to-noise ratio. CONCLUSION: The study demonstrates an inexpensive and simple method for optimal visualization of the hip with MRI applying the compound benefits of an available shoulder surface coil and the off-coronal plane of section.

Colonic pseudo-obstruction: decompression with a tricomponent coaxial system under fluoroscopic guidance.

A tricomponent coaxial system (TAS) suitable for colonic decompression with fluoroscopic guidance is described. The TAS was successfully used in four of four patients, two with acute pseudo-obstruction, one with sigmoid volvulus, and one with recurrent colonic pseudo-obstruction. All patients had acute abdominal distention with cecal diameter of at least 12 cm, and nonsurgical management was unsuccessful. Complete colonic decompression was observed in all four patients, with no recurrence in three of three patients after removal of the decompression catheter. The decompression catheter was left in place in one patient for her comfort until she died of hepatic failure 4 days later. There was no associated colonic bleeding or perforation in any of the four cases. The procedure lasted approximately 20-90 minutes. The TAS promises to be a useful and inexpensive tool with which to perform colonic decompression in selected patients.