The effects of hyperbaric oxygen on MRI findings in rheumatoid arthritis: A pilot study.

Background: Rheumatoid arthritis is a debilitating and destructive disease for which limited therapeutic options exist. Objective: This report summarizes serial magnetic resonance imaging (MRI) findings from nine study participants treated with hyperbaric oxygen (HBO2) therapy and expands upon an earlier pilot study that showed improvement in disease activity and joint pain as determined by multiple, validated clinical measures. Methods: Rheumatoid arthritis patients received 30 hyperbaric oxygen treatments over six to 10 weeks. MRI with and without contrast was completed at baseline, and at three- and six-month intervals following initiation of HBO2 therapy. Ratings were based on Outcome Measures in Rheumatology Clinical Trials (OMERACT) Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) criteria, the standard method for quantification of inflammation and damage by MRI in RA trials. Results: Using RAMRIS criteria, nine of nine patients demonstrated no radiologic progression of erosions, synovitis, or bone marrow edema at three- and six-month scans. Conclusion: Our findings suggest that HBO2 therapy may be useful as an adjunctive or alternative treatment to disease-modifying drugs for rheumatoid arthritis.

Hernia Following Rectus Sheath Hematoma.

Rectus sheath hematomas (RSH) are increasing in prevalence, presumably correlating with increased use of anticoagulation medications and an aging population. Comorbidities such as blood dyscrasias, atherosclerosis, and hypertension are associated with an increased risk of developing an RSH. Iatrogenic origin of RSH, secondary to treatment of various abdominal pathologies, is not uncommon. Due to its exceptionally non-specific array of clinical signs and symptoms, RSH can be challenging to diagnose in the clinical setting without the aid of radiological images. Abdominal computed tomography (CT) is generally the modality of choice through which the RSH can be successfully identified and characterized. CT imaging can play an important role in the planning of RSH management, as effective management varies depending on the size and position of the RSH. Recurrent bleeding, hypovolemic shock, abdominal compartment syndrome, myonecrosis, and infection have been traditionally considered as the more prominent complications of RSH. However, with more cases occurring, more complications are being described in the literature. The following case presents a previously unreported complication of RSH, that of bowel herniation into a potential space created by a previously treated RSH.

Polymethylmethacrylate Pulmonary Embolism Following Vertebroplasty.

Polymethylmethacrylate (PMMA) is a commonly used substrate in vertebroplasty procedures. Well-known for its dependable strength and relative lack of toxic side effects, PMMA administration is useful for the stabilization of vertebral bodies in the setting of common spinal pathologies such as osteoporosis. Unfortunately, as the popularity of vertebroplasty has increased, so has the incidence of a potentially lethal complication of the procedure, PMMA pulmonary embolism. Extravasation of PMMA from the vertebral body into the adjacent vasculature can provide a route through which PMMA may travel until it becomes lodged in the pulmonary vasculature, thereby forming a PMMA pulmonary embolism. While the vast majority of PMMA embolism cases are relatively mild, others are severe and demand swift recognition and potentially life-saving intervention. Despite the increasing incidence of PMMA embolism, a clear algorithm for management does not yet exist. Controversy abounds regarding the most effective strategies to diagnose and manage patients with PMMA embolism. Described is a case of delayed diagnosis of a PMMA embolism in a patient who underwent percutaneous vertebroplasty for an osteoporotic vertebral body fracture. Multiple visits to the emergency department (ED) for chest discomfort or cough after the vertebroplasty eventually led to cross-sectional imaging that revealed the diagnosis. Her acute symptoms resolved with conservative management. Given that her final outcome was positive with no long-term morbidity, the aim of this report is to explore the current treatment algorithms for PMMA embolism and to consider whether or not this patient would have been managed differently had the correct diagnosis been uncovered earlier.

Esophageal Neoplasms: Radiologic-Pathologic Correlation.

The epidemiology and clinical management of esophageal carcinomas are changing, and clinical imagers are required to understand both the imaging appearances of common cancers and the pathologic diagnoses that drive management. Rare esophageal malignancies and benign esophageal neoplasms have distinct imaging features that may suggest a diagnosis and guide the next steps clinically. Furthermore, these imaging features have a basis in pathology, and this article focuses on the relationship between pathologic features and imaging manifestations that will help an informed imager maintain clinical relevance.

Neuroimaging of Traumatic Brain Injury.

The purpose of this article is to review conventional and advanced neuroimaging techniques performed in the setting of traumatic brain injury (TBI). The primary goal for the treatment of patients with suspected TBI is to prevent secondary injury. In the setting of a moderate to severe TBI, the most appropriate initial neuroimaging examination is a noncontrast head computed tomography (CT), which can reveal life-threatening injuries and direct emergent neurosurgical intervention. We will focus much of the article on advanced neuroimaging techniques including perfusion imaging and diffusion tensor imaging and discuss their potentials and challenges. We believe that advanced neuroimaging techniques may improve the accuracy of diagnosis of TBI and improve management of TBI.

MR Imaging of Cardiac Masses.

Cardiac masses present a diagnostic challenge given their relative rarity and the overall difficulty imaging the heart. With the increasing frequency and quality of imaging in general, however, the incidental discovery of cardiac masses is increasing. Cardiac masses seldom produce symptoms, and they are more commonly found during imaging for noncardiac indications. While echocardiography is useful in the initial evaluation of a suspected mass, cardiac magnetic resonance (MR) imaging is the best imaging modality to characterize cardiac tumors due to its superior tissue characterization and its higher contrast resolution. Due to the risk of embolization and arrhythmia, most benign cardiac tumors are removed, and imaging plays an important role in treatment planning. While primary resection remains the mainstay of treatment, new treatment strategies may prolong survival and slow the growth of metastases. A fundamental knowledge of common cardiac masses is vital to all radiologists, and here, we discuss the most pertinent imaging approach to cardiac masses emphasizing MR imaging.