MRI evaluation of the knee meniscus.
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Adolescent↗
Biomedical subjects
P L Munk
Publications and source records attributed to P L Munk.
Diagnosis of osteoid osteoma using STIR magnetic resonance imaging.
Two patients with osteoid osteomas were evaluated with magnetic resonance imaging at 1.5 T using both conventional spin-echo (SE) and short TI inversion-recovery (STIR) sequences. On plain films the classic findings of a radiolucent nidus with a dense surrounding reactive zone of sclerosis were absent. The diagnosis was suspected on observing the presence of marked marrow oedema in the involved bone. Conventional SE images were unimpressive in detecting the bone marrow changes. Increased signal intensity indicating bone marrow oedema was striking on the STIR images and facilitated diagnosis. In cases of suspected osteoid osteoma which do not demonstrate the classic radiologic features, adding the STIR sequence to conventional SE magnetic resonance sequences to enhance detection of bone marrow change is recommended.
Adult↗
Intracavitary aspergilloma: transthoracic percutaneous injection of amphotericin gelatin solution.
For aspergillomas in patients with fibrocavitary lung disease, surgery is often not recommended. Injection or lavage of the cavities with solutions of potassium iodide or antifungal agents has had varying success and requires repeated sessions because of nonretention of the therapeutic agent within the cavity. In three patients with four aspergillomas, the authors used fluoroscopic or computed tomographic (CT) guidance to inject amphotericin in gelatin as a liquid that solidifies within the cavity at body temperature. The patients were followed up with serial chest radiography or CT. The mixture was successfully instilled in every case. Three of the four aspergillomas completely resolved within 3 months or less, with no evidence of recurrence at follow-up of 6-18 months. The remaining aspergilloma decreased in size, but the patient needed pneumonectomy because of recurrent hemoptysis within 6 months of amphotericin injection. Transthoracic instillation of a liquid mixture of amphotericin and gelatin that solidifies rapidly at body temperature may be useful as a one-step treatment for aspergillomas.
Adult↗
Producing picture-perfect posters.
Scientific posters form an integral part of many radiology meetings. They provide the opportunity for interested parties to read the material at an individualized pace, to study the images in detail, and to return to the exhibit numerous times. Although the content of the poster is undoubtedly its most important component, the visual presentation of the material can enhance or detract from the clarity of the message. With the wide availability of sophisticated computer programs for desktop publishing (DTP), one can now create the poster on a computer monitor with full control of the form as well as the content. This process will result in a professional-appearing poster, yet still allow the author the opportunity to make innumerable revisions, as the poster is visualized in detail on the computer monitor before printing. Furthermore, this process is less expensive than the traditional method of typesetting individual sections separately and mounting them on cardboard for display. The purpose of this article is to present our approach to poster production using commercially available DTP computer programs.
Computer Graphics↗
Three-dimensional sonographic reconstruction: techniques and diagnostic applications.
In this review, we summarize the techniques of obtaining and reconstructing three-dimensional (3D) sonograms in a number of anatomic areas, catalog the clinical efforts at 3D sonography so far, and introduce more recent work in this area that takes advantage of the unique features of sonography. Although it is an active area of 3D imaging research, cardiac 3D imaging is not discussed because it has unique requirements stemming from the heart's anatomic inaccessibility and motion. Image analysis and display also are not covered, as no clear consensus has been reached about the usefulness of the large number of available methods.
Female↗
Sonography of ocular choroidal melanomas.
Ocular choroidal melanomas lend themselves particularly well to evaluation by sonography. This essay illustrates the different appearances of ocular melanoma as depicted with sonographic imaging, including conventional gray-scale sonography and duplex Doppler, color flow Doppler, and three-dimensional display.
Choroid↗
Lesions of cartilage and bone around the knee.
A variety of bone and cartilage abnormalities can be demonstrated on magnetic resonance imaging (MRI), which can play an important role in the diagnosis and management of these abnormalities. Ischemic bone lesions, including medullary bone infarction, primary osteonecrosis, and the osteochondroses, can be precisely evaluated as to their anatomic locations and relationship to overlying cartilage. Osteochondritis dissecans may also be diagnosed and staged. Presence of subchondral fractures and bone contusions, which are frequently associated with ligament and meniscal injuries, can also be diagnosed and followed; these conditions may play a role in the evolution of osteoarthritis. The changes of osteoarthritis, including cartilage abnormalities, cyst formation, and loose bodies, can be evaluated; this evaluation may be important in the assessment of therapies. Stress fractures often have characteristic appearances, and MR may be used in making this diagnosis, especially when symptoms and other imaging are unclear. Diffuse marrow disorders including hemoglobinopathies and neoplasia are also well demonstrated.
Bone Diseases↗
Magnetic resonance imaging of a giant nonfunctioning retroperitoneal paraganglioma.
The authors describe the magnetic resonance imaging (MRI), computed tomographic, ultrasonographic and angiographic appearance of a giant nonfunctioning retroperitoneal paraganglioma. To their knowledge, the MRI appearance of a nonfunctioning paraganglioma has not been previously described. The MRI characteristics of the nonfunctioning tumour were similar to those of a functioning paraganglioma and included hyperintensity in T2-weighted images and intense enhancement after intravenous administration of contrast agent.
Adolescent↗
Hepatic pseudomass observed with computed tomography after direct injection of contrast agent into the portal vein.
Hepatic pseudomasses have been described on both non-contrast and contrast-enhanced computed tomography (CT) scans, as well as on scans obtained by CT-arteriography and CT-portography. The authors describe a hepatic pseudomass that appeared in CT scans after direct injection of contrast material into the portal vein through an indwelling catheter.
Aged↗
Excimer-laser-assisted angioplasty in chronic femoropopliteal occlusion: the significance of an intimal flap in predicting reocclusion.
Angioplasty assisted by excimer laser was performed on 27 chronic femoropopliteal occlusions, ranging from 2 to 30 cm in length, in 26 patients. Twenty-one (78%) of the procedures were successful initially. Of these, 12 (57% [44% of the total]) remained patent at follow-up 3 months later. In seven of the nine cases of reocclusion observed after 3 months (78%) a large intimal flap resulting from the angioplasty-induced dissection could be identified in the postprocedure angiogram. The authors stress the possible importance of such an intimal flap in limiting the success of laser-assisted angioplasty of long femoropopliteal occlusions.
Adult↗
Leaking Baker's cyst detected by magnetic resonance imaging.
Popliteal or Baker's cysts, often found incidentally during examination of the knee, are common. The authors report the magnetic resonance imaging (MRI) manifestations of a leaking Baker's cyst that initially presented as thrombophlebitis in a patient who had undergone reconstruction of the anterior cruciate ligament 4 months before; no cyst was present at the time of the surgery. Marked inflammatory changes apparent in the surrounding muscle and subcutaneous tissues were best appreciated in T2-weighted and fat-suppressed inversion recovery images. Although the results of ultrasonography suggested the diagnosis, they were not conclusive; MRI was a useful noninvasive adjunct in making the definitive diagnosis.
Adult↗
Intravenous administration of gadolinium in the evaluation of rheumatoid arthritis of the shoulder.
The authors sought to determine the utility of intravenously administered gadolinium chelates in magnetic resonance imaging (MRI) of patients with rheumatoid arthritis of the shoulder. One shoulder was examined for each of 12 patients--6 men and 6 women, ranging in age from 48 to 71 (average 63) years--with well-established disease. The patients had had the disease for 1 to 25 (average 13) years. Static MRI was performed before and after infusion of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) (0.1 mmol/kg body weight); T1-weighted or proton-density images (repetition time [TR] 600 to 1000 ms, echo time [TE] 15 to 30 ms) were obtained. Images obtained after enhancement were particularly useful in the differentiation of pannus from fluid and also allowed improved delineation of tears of the supraspinatus tendon. In addition, contrast-enhanced dynamic gradient-echo spoiled GRASS sequences (TR 50 ms, TE 11 ms, flip angle 70 degrees) were obtained for all patients; for these sequences the same slice was imaged repeatedly at 20-second intervals. The rate of increase of signal intensity in abnormal synovium varied from 0.64 to 5.83 (average 2.30, standard deviation [SD] 1.67) units/second; the enhancement factor ranged from 1.55 to 4.64 (average 2.63, SD 0.98). The authors conclude that for imaging the shoulder enhancement with Gd-DTPA allows improved distinction between synovial thickening and joint effusion and may improve assessment of the rotator cuff. The wide range in the rate of signal increase and total enhancement during dynamic imaging probably reflected heterogeneity in the study population.
Acromioclavicular Joint↗
Soft tissue sarcomas: a plea for proper management.
Although soft tissue sarcomas are relatively uncommon, they often occur in young patients and if properly treated are often curable. Unfortunately, inappropriate approaches to biopsy before adequate staging may compromise a successful outcome. The roles of diagnostic imaging (particularly magnetic resonance imaging) in adequate preoperative evaluation and staging and the fundamental principles of surgical management are discussed.
Adolescent↗
Sonolucent peripancreatic masses: differential diagnosis and related imaging.
The most common cause of a sonolucent mass in the epigastrium is a pancreatic pseudocyst; however, several other conditions can simulate a pseudocyst on ultrasonography (US) scans. This pictorial essay illustrates the spectrum of conditions that may present in this fashion and demonstrates the use of other imaging modalities, such as colour-flow and pulsed Doppler US, computed tomography, magnetic resonance imaging and angiography, in their evaluation.
Abscess↗
Tears of the medial collateral ligament: magnetic resonance imaging findings and associated injuries.
For 23 patients with a surgically proven tear of the medial collateral ligament the findings from magnetic resonance imaging (MRI) of the knee were evaluated retrospectively. MRI revealed the tear in all cases, although when the injury was severe, distinguishing high-grade partial tears from complete tears was difficult. Physical examination had indicated a tear in 22 (96%) of the cases. A high prevalence of associated cruciate and meniscal injuries was seen (in 23 [100%] and 12 [52%] of the cases respectively). Tears of the fibular collateral ligament occurred in 13 (57%) of the patients and at least one bony infraction in 22 (96%); most of the infractions were in the lateral compartment. Infractions of the lateral femoral condyle were frequently geographic (in 14 [70%] of the 20 cases) or impacted (in 5 [25%]). The spectrum of injuries associated with tears of the medial collateral ligament was consistent with the findings of previous studies focusing on cruciate and meniscal abnormalities; the minor variations were likely due to the severity of valgus stress in this sample.
Adolescent↗
Case report 708: Metastasis of renal cell carcinoma to skeletal muscle (right trapezius).
A patient is described who presented with a painful soft-tissue mass in the region of the right shoulder 10 months following nephrectomy for carcinoma. This mass proved to be a metastasis to skeletal muscle. A full metastatic work-up demonstrated no other detectable lesions. Metastases to skeletal muscle are rare, regardless of the site of origin, and their true incidence is difficult to determine since they rarely present clinically and are not routinely searched for, even on autopsy.
Carcinoma, Renal Cell↗
High-grade chondrosarcoma of the sacrum--the crucial role of MR in surgical planning.
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Adult↗
Adenocarcinoma of the pancreatic ducts: comparative evaluation with CT and MR imaging at 1.5 T.
A prospective comparison of computed tomography (CT) and magnetic resonance (MR) imaging at 1.5 T was performed in 50 patients with the suspected diagnosis of pancreatic carcinoma. CT scans were obtained before and after administration of contrast material in 41 of 50 patients (82%); 34 of 41 postcontrast scans (83%) were obtained with dynamic CT. MR images were interpreted without knowledge of the results of CT, ultrasound, cholangiography, or endoscopic retrograde cholangiopancreatography in 48 patients (96%). Surgical correlation of findings at CT and MR imaging was performed in 24 patients (48%) at laparotomy and in two patients (4%) at autopsy. On T1-weighted MR images, relatively diminished signal intensity of tumor compared with that of the adjacent pancreas was a consistent finding. MR imaging proved superior to CT in identification of pancreatic carcinoma (particularly in smaller intrapancreatic tumors), peripancreatic extension, vascular and portal vein invasion, and duodenal invasion. These results suggest that MR imaging of the pancreas is superior in many instances to CT in preoperative evaluation of pancreatic carcinoma.
Adenocarcinoma↗