Shaken baby syndrome diagnosed by magnetic resonance imaging.

We report an infant with Shaken Baby syndrome (SBS) who presented with status epilepticus. The initial evaluation with computerized axial tomography (CAT scan) of the head was normal, and there was no history or physical finding consistent with physical abuse or shaking. This prompted an extensive evaluation to determine the etiology of the seizures. An ophthalmology consultation revealed the presence of severe bilateral retinal hemorrhages, which raised the possibility of SBS. Magnetic resonance imaging (MRI) showed cerebral hemorrhages, hemorrhagic contusions, and bilateral subtemporal subdural hematomas. This is the first reported case of SBS diagnosed by magnetic resonance imaging following a normal initial CAT scan. MRI may be a valuable tool in the diagnosis of brain injury in SBS and may be particularly valuable when the CAT scan of the head is normal, the etiology of neurologic injury is unclear, and the presence of retinal hemorrhages raises the suspicion of SBS.

MRI of the upper aerodigestive tract and neck.

The application of new technology has improved the ability of MR to image the upper aerodigestive tract and neck. Improved resolution along with inherent high tissue contrast and multiplanar capability now allow clear definition of detailed anatomic and pathologic tissue planes. MR currently rivals other imaging modalities in this region. At present, it is often better in demonstrating the depth of tumor infiltration and the presence of nodal metastasis. Initial studies also suggest that MR can effectively image postoperative sites and discriminate chronic fibrosis from recurrent tumor. Localization of abnormal parathyroid glands, particularly for re-exploration, is a promising technique. If the present limitations are recognized, such as identification of soft tissue calcification, MR can play an important role in the evaluation of the face and neck. With additional investigation and continued technologic improvements it is likely that this role will continue to increase.

MR imaging of recurrent colorectal carcinoma versus fibrosis.

Locally recurrent cancer can be difficult to distinguish from postoperative and radiation fibrosis on most imaging modalities. We report a case in which magnetic resonance imaging suggested the presence of both fibrosis and recurrent tumor in a patient following abdominoperineal resection for colorectal carcinoma, and demonstrate its role for precise needle placement when percutaneous biopsy is recommended.

Spondyloarthropathy of the cervical spine in long-term hemodialysis.

Changes stimulating osteomyelitis have recently been described in patients undergoing long-term hemodialysis. These consist of disk-space narrowing and irregularity of adjacent end plates. However, the characteristic prevertebral mass and clinical evidence of infection are often absent. In the appropriate clinical situation, although plain radiography and computed tomography have been helpful, magnetic resonance imaging may be more definitive in excluding infection and may obviate biopsy. The authors' imaging experience with five patients with this entity forms the basis of this report.