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PubMedDate not supplied

In vitro and in vivo MR imaging of hyaline cartilage: zonal anatomy, imaging pitfalls, and pathologic conditions.

Hyaline cartilage plays an essential role in the maintenance of normal synovial joint function by reducing friction and distributing loads. Histologic analysis of hyaline cartilage reveals zonal variation in cellular morphology, proteoglycan concentration, and collagen fiber size and orientation. High-resolution magnetic resonance (MR) imaging reveals an analogous laminar anatomy that is often visible on clinical images obtained with proper attention to technique. In vitro and in vivo pulse sequences show three distinct laminae: a hypointense superficial lamina, a hyperintense intermediate lamina, and a heterogeneous deep lamina that consists of alternating hyperintense and hypointense bands perpendicular to the subchondral bone. Imaging pitfalls include magic angle effects, truncation artifact, partial volume effect, regional anatomic variation, chemical shift, and magnetic susceptibility effects. Pathologic conditions that affect articular cartilage include chondromalacia patellae, osteoarthritis, and localized traumatic lesions. Although detection of early cartilage disease remains elusive, MR imaging can demonstrate intermediate and advanced lesions.

Adult↗
PubMed1998

The lesion in multiple sclerosis: clinical, pathological, and magnetic resonance imaging considerations.

Despite the cause of multiple sclerosis remaining elusive, recent studies of the disease using magnetic resonance imaging (MRI) and detailed pathological analysis have provided new insights into the events involved in the evolution of the lesion in multiple sclerosis. Most evidence points to disruption of the blood-brain barrier as the initial event in development of the lesion in multiple sclerosis. It is thought that antigen specific T cells enter the nervous system, recognise antigen, and begin a cytokine cascade that mediates disruption of the blood-brain barrier seen on contrast enhanced MRI. Subsequently, the inflammatory response is amplified and the effector stage leading to myelin damage is initiated. The mechanism(s) causing myelin damage is uncertain. MRI and pathological studies now indicate that damage to the axon may occur earlier in lesion development than generally thought. Although T2 weighted MRI techniques lack pathological specificity, considerable attention is now focused on studying newer techniques that should provide greater insight into lesion development. These include studies of hypointensities on T1 weighted images, proton spectroscopy, magnetisation transfer imaging, and diffusion imaging. Hopefully, these new techniques will provide a better understanding of events involved in the multiple sclerosis lesion as well as an improved understanding of the relation between disease as measured on MRI and that seen clinically.

Atrophy↗
PubMed2005

Granular cell tumor of the extremity: magnetic resonance imaging characteristics with pathologic correlation.

OBJECTIVE: The purpose of this study is to delineate the magnetic resonance (MR) appearance of a granular cell tumor (GrCT) of the extremity and to correlate the imaging appearance with the microscopic findings. DESIGN AND PATIENTS: A retrospective review of five patients with a histopathologic diagnosis of GrCT and pre-operative MR imaging of the neoplasm was done. The images were reviewed by two musculoskeletal radiologists in a consensus fashion. Lesion location, size, shape, margination, and signal intensity characteristics were assessed. MR findings were correlated with histopathological examination. RESULTS: The benign subtype of GrCT is usually isointense or brighter than muscle on T1-weighted sequences, round or oval in shape, superficial in location, and 4 cm or less in size. On T2-weighted sequences, benign lesions may demonstrate a high peripheral signal, as well as a central signal intensity that is isointense to muscle or suppressed fat. A significant stromal component in the tumor and, hypothetically, a ribbon-like arrangement of tumor cells may influence the signal intensity demonstrated on the T1 and T2-weighted sequences. The malignant subtype may demonstrate signal intensity characteristics and invasion of adjacent structures often seen with other aggressive neoplasms; sizes larger than 4 cm and association with major nerve trunks can be seen. CONCLUSION: Benign GrCT has imaging characteristics which may distinguish this tumor from other soft tissue neoplasms, as well as the malignant type of this tumor.

Adolescent↗
PubMed2005

A critical appraisal of the performance, reporting, and interpretation of studies comparing carotid plaque imaging with histology.

BACKGROUND AND PURPOSE: Carotid plaque instability is an important determinant of stroke risk. There are now a number of different imaging techniques that provide information on carotid plaque morphology. However, it is unclear how they compare with one another or whether they can reliably assess plaque instability. Studies comparing imaging with pathology have shown highly variable results, even for similar imaging techniques. This may be because of variable pathology techniques rather than differences in imaging. METHODS: We performed a systematic review of studies that compared carotid imaging with histology of the excised plaque published between January 1995 and September 2004. We assessed the quality and comparability of these studies. In particular, we determined which histology methods were used and whether observer reproducibility of the histology assessment was reported. RESULTS: Among 73 eligible studies, histological methods were poorly reported and highly variable; 23% reported reproducibility data for imaging and only 12% reported reproducibility data for histology. Of 29 studies that reported quantitative results of blinded comparisons, there were methodological deficiencies and the results were highly variable. No study considered the extent to which the lack of reproducibility influenced the imaging-pathological correlations reported. CONCLUSIONS: Pathological correlation in studies of carotid plaque imaging cannot be reliably interpreted or compared because of incomparable and poorly reported histology methods. We make recommendations for the performance, reporting, and interpretation of imaging-pathological correlation studies and highlight the need for consensus guidelines.

Carotid Arteries↗
PubMed1999

Chondrosarcoma of the foot: imaging, surgical and pathological correlation of three new cases.

The foot is an uncommon location for chondrosarcoma. The presentation, diagnosis, pathological findings, surgical treatment and follow-up of three patients with chondrosarcoma in this rare location are presented. Though nonspecific, MR imaging findings were of aid in the diagnosis and treatment planning of these patients. If the diagnosis of this tumor is rapidly made, a tumor excision instead of limb amputation may be sufficient treatment at surgery.

Adult↗
PubMed2004

Parasellar solitary fibrous tumor of meninges: magnetic resonance imaging features with pathologic correlation.

Solitary fibrous tumor (SFT) is a benign mensenchymal neoplasm of spindle-cell origin. The authors report the case of a 50-year-old man with SFT arising from the meninges of the left parasellar region with cavernous sinus involvement. The tumor was demonstrated isointense on T1-weighted and heterogeneously hypointense on T2-weighted magnetic resonance imaging (MRI) with strong contrast enhancement. The preoperative MRI diagnosis was meningioma or hemangiopericytoma. Pathological study revealed an SFT that stained positive immunohistochemically for CD34 and vimentin.

Humans↗
PubMed1993

Small hepatocellular carcinomas and associated nodular lesions of the liver: pathology, pathogenesis, and imaging findings.

Hepatocellular carcinomas frequently occur in association with liver cirrhosis, as chronic liver disease is one of the most important factors in carcinogenesis. In addition to small hepatocellular carcinomas (less than 3 cm in diameter), recent reports of pathologic studies of resected specimens from cirrhotic liver describe associated small nodular lesions (i.e., regenerating nodule, adenomatous hyperplasia, and early hepatocellular carcinoma). In hepatocarcinogenesis of the cirrhotic liver, a regenerating nodule might be the first step in the development of hepatocellular carcinoma, going through phases of adenomatous hyperplasia and early hepatocellular carcinoma in a multistep fashion. We describe the pathologic characteristics of small hepatocellular carcinomas and associated nodular hepatic lesions and review the current concepts of the role of these associated lesions in carcinogenesis. We also discuss the imaging findings of these abnormalities, the efficacy of various imaging techniques for diagnosing them, and the importance of imaging in treatment planning.

Carcinoma, Hepatocellular↗
PubMed1992

An image analysis on pathological changes in pulmonary arteries in chronic obstructive pulmonary disease.

The changes in small pulmonary arteries of 15 patients with chronic obstructive pulmonary disease (COPD) were investigated by light and electron microscopy, image analysis etc. It was found that the structural changes in the pulmonary arteries of the patients with COPD were characterized by muscularization of non-muscular arterioles, media hypertrophy, longitudinal smooth muscle bundles in the intima and fibrosis in both the media and intima. In the course of time, these lesions resulted in thickening of the arterial wall and narrowing of the lumen. Clinically, the patients developed pulmonary hypertension causing cor pulmonale. Initial data on the structure of arterial wall at different segments were compared statistically. There was very significant difference between the COPD and control groups (P less than 0.001). By Fisher's auto-classification (automatic pattern recognition), the rate recognized was correct in more than 90% in the small arteries of less than 200 microns in diameter. It is suggested that these arteriolar changes are closely related to pulmonary hypertension. The image analysis showed that the ratios of MWA/MVA and MWT/MD were of great value in evaluating the degree of the changes in the arteries of the patients with COPD.

Female↗
PubMed1994

[Images of pancreatic pathology: advantages and limitations of magnetic resonance compared with computerized tomography and ultrasound].

We discuss the usefulness of MR examination in the diagnosis of pancreatic diseases, in addition to the other available imaging techniques. MR imaging yields important information in diagnosis and staging of pancreatic tumours, and in the characterization of pancreatic masses. MRI is also valuable for the study of chronic as well as acute pancreatitis, although there are some limits such as the poor detection of calcifications in the chronic, and the excessively long time required to complete the examination in the acute form.

Adenocarcinoma↗
PubMed2000

Osseous lesions of the distal ulna: atypical location--unusual diagnosis. Report of three cases with similar imaging and different pathologic diagnoses.

Three cases with destructive bone lesions of the distal end of the ulna caused by different pathologic entities (Ewing's sarcoma, osteosarcoma, rheumatoid pseudotumoral synovitis) are presented, all with similar clinical and comparable x-ray and magnetic resonance imaging features. Although the distal end of the ulna may be resected without significant functional impairment, careful evaluation of treatment strategies compatible with oncologic standards is warranted.

Adult↗
PubMedDate not supplied

Chronic, reactive conditions of the oral cavity simulating mucosal carcinomas: CT and MR imaging findings with pathologic correlation in five patients.

To investigate the radiologic and pathologic findings of chronic, inflammatory, reactive conditions of the oral cavity, which clinically and radiologically simulate mucosal malignancy, computed tomography (CT; n=4) and magnetic resonance (MR; n=2) images, as well as surgical specimens, obtained from five patients with surgically proved, chronic inflammatory mass of the oral cavity were retrospectively reviewed. All patients had a palpable mass or ulcerative lesion in the oral cavity. On CT and MR images, all three lesions in the oral tongue and one lesion in the retromolar trigone were seen as a superficial, ill-marginated, well-enhancing ellipsoid or focal soft tissue mass. Pathologic examinations revealed various depths and degrees of acute and chronic inflammation, granulation tissue, and fibrosis in the subepithelial stroma, accompanied by pseudoepitheliomatous hyperplasia in these four patients. In the remaining one patient with lesion in the hard palate, CT showed a relatively well-marginated, well-enhancing soft tissue mass, which histologically proved to be irritation fibroma. Neither clinical nor radiologic manifestations could afford clues to make the correct diagnosis, which therefore should rely on histology. Some forms of chronic, inflammatory, reactive conditions of the oral cavity are nearly indistinguishable from the malignant tumors both clinically and radiologically. Knowledge of this entity may obviate the unnecessary and somewhat disfiguring operation.

Adult↗
PubMed1986

A comparison of imaging, clinical, and pathologic aspects of space-occupying lesions within the brain in patients with acquired immune deficiency syndrome.

Patients with acquired immune deficiency syndrome (AIDS) often have central nervous system mass lesions. Since clinical signs, symptoms, and results of imaging techniques are generally nonspecific, brain biopsy has been considered to be the optimal method for establishing a definitive diagnosis. In an effort to define better the imaging characteristics of such lesions, we retrospectively analyzed 24 patients with AIDS who had intracerebral space-occupying lesions, with subsequent definitive histologic diagnosis and/or a diagnostic response to empiric therapy for toxoplasmosis. We employed computerized tomography (CT), double-dose-delay CT (DDD-CT), and nuclear magnetic resonance imaging (NMRI) of the brain. Sixteen patients had toxoplasmosis, seven had high-grade non-Hodgkins lymphoma, and one had progressive multifocal leukoencephalopathy that was due to herpes simplex virus II (HPML). Toxoplasmosis generally occurred as multiple, small (2 cm or smaller), hypodense or isodense lesions with variable enhancement. Malignant lymphomas appeared as single lesions, always larger than 3 cm, which were isodense or hyperdense, with internal enhancement. The combined radiologic criteria of size, multiplicity, and pre- and postcontrast appearance were useful in differentiating these two pathologic processes. The best single discriminant of toxoplasmosis versus lymphoma was the average lesion size of less than 3 cm. In our experience, diagnostic brain biopsy may be averted when lesions typical of toxoplasmosis are seen. DDD-CT and NMRI may be useful in identifying lesions that are not seen optimally on routine CT.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Omental infarction in children: imaging features with pathological correlation.

INTRODUCTION: Omental infarction is a rare occurrence in the paediatric population. It often presents as an acute abdomen that can mimic acute appendicitis and cholecystitis. METHODS: Six cases of omental infarction in children, proven on histopathology, were retrospectively reviewed for their clinical presentation and imaging findings on ultrasonography and computed tomography. RESULTS: These cases revealed clinical and imaging findings on computed tomography that were suggestive and helpful in the pre-operative diagnosis of omental infarction. Findings on ultrasonography were less specific. Histopathological specimens revealed findings of vasculitis in all cases. CONCLUSION: There are clinical and imaging features that will help in the pre-operative diagnosis of this uncommon condition. We also postulate vasculitis as a possible underlying pathology for omental infarction.

Child↗
PubMed1999

Hemorrhagic necrosis due to peliosis hepatis: imaging findings and pathological correlation.

Peliosis hepatis is an uncommon liver condition characterized by blood-filled cavities. We report the CT, angiographic and MR features of a case of peliosis hepatis with no obvious etiology and spontaneously regressing hemorrhagic necrosis. Helical CT showed multiple peripheral low-density regions with foci of spontaneous high density suggesting the presence of blood component. On MR imaging, the multiple peripheral lesions were hypointense on T1-weighted and hyperdense on T2-weighted images, with bright foci on all sequences suggesting subacute blood. Angiography showed no evidence of tumor or vascular malformation; multiple nodular vascular lesions filling in the parenchymal phase and persisting in the venous phase suggested blood-filled cavities. Pathological examination showed blood-filled spaces with no endothelial lining, characteristic of the parenchymal type of peliosis. Knowledge of the imaging features of hemorrhagic necrosis due to peliosis hepatis is important since it can be responsive to antibiotic therapy. Furthermore, differentiating hemorrhagic necrosis from hepatic abscess avoids dangerous and sometimes fatal percutaneous drainage.

Adult↗
PubMed1994

Persistent hyperplastic primary vitreous of the eye: imaging findings with pathologic correlation.

Persistent hyperplastic primary vitreous is a rare benign developmental disorder of the globe in which the embryonic hyaloid artery fails to regress normally, resulting in abnormal lenticular development and secondary changes of the retina and globe. This entity often presents a diagnostic challenge as it is the most common intraocular abnormality to be confused with retinoblastoma. Sonography, CT, and MR imaging have been used alone and in combination to diagnose this condition. This essay illustrates the imaging characteristics of persistent hyperplastic primary vitreous in two children with unilateral disease and in one child with bilateral disease as representative cases (Figs. 1-3). Available pathologic correlates also are presented.

Diagnosis, Differential↗
PubMed2002

Mature mediastinal teratoma: sonographic imaging patterns and pathologic correlation.

OBJECTIVE: To characterize the sonographic patterns of teratomas located within the mediastinum and to correlate them with pathologic findings, because there have been few reports concerning the application of sonography in the diagnosis of mediastinal teratoma. METHODS: Over a 9-year period, we carried out an image analysis of the sonographic findings of 28 mediastinal teratomas whose diagnoses were proved surgically. RESULTS: Sonography showed that 18 patients had a complex mass of heterogeneous echogenicity, including regional bright echoes (n = 12), acoustic shadows (n = 8), hyperechoic lines and dots (n = 7), soft tissue septa (n = 9), dermoid plugs (n = 6), and hypoechoic areas (n = 11). This type of mediastinal teratoma revealed, in pathologic findings, varying combinations of fat, sebaceous and mucinous materials, hair, mineralized elements, and multiple compartments. Eight patients had a homogeneous hyperechoic mass, and the 2 remaining patients had floating spherules within a cystic mass. Pathologically, the homogeneous mass mainly contained hair and sebaceous material. The floating spherules were also composed of sebaceous tissue and were above the fluid of the cyst. CONCLUSIONS: On the basis of the evaluation of the sonographic and pathologic findings, we described 3 major patterns of mediastinal teratoma: a complex mass of heterogeneous echogenicity, homogeneous high echogenicity within a solid mass, and floating spherules within a cystic mass. Thus, sonography can improve the diagnosis of mediastinal teratoma. However, additional prospective studies are needed to test the sensitivity and specificity of these sonographic patterns in the diagnosis of mediastinal teratoma.

Adult↗