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Hepatic Lymphoma Representing Iso-Signal Intensity on Hepatobiliary Phase, in Gd-EOB-DTPA-Enhanced MRI: Case Report.

Tae Ran AHN ; Yeo Eun KIM ; Chul Hi PARK ; Eun Ah JUNG

Investigative Magnetic Resonance Imaging.2015;19(3):200-204. doi:10.13104/imri.2015.19.3.200

Image findings of hepatic lymphoma have been reported as variable, ranging from single or multiple small nodules to diffuse infiltrative patterns. On MRI, most hepatic lymphomas show T1 low signal intensity, T2 high signal intensity. Dynamic imaging reveals a hypointense appearance in the arterial phase, followed by delayed enhancement in the portal venous and transitional phase. In the hepatobiliary phase using a hepatocyte-specific contrast agent (which have recently aided in increasing the access to the focal liver lesions), hepatic lymphoma is known to exhibit low signal intensity. We report a case of hepatic lymphoma, which shows iso-signal intensity on hepatobiliary phase, using gadoxetic acid (Gd-EOB-DTPA).
Liver ; Lymphoma* ; Magnetic Resonance Imaging*

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MRI Findings of Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA syndrome) with a Blind Megaureter: Case Report.

Yun Hee CHO ; Deuk Jae SUNG ; Na Yeon HAN ; Beom Jin PARK ; Min Ju KIM ; Ki Choon SIM ; Sung Bum CHO

Investigative Magnetic Resonance Imaging.2015;19(3):196-199. doi:10.13104/imri.2015.19.3.196

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is an uncommon congenital abnormality of the female urogenital tract characterized by the triad of uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. A 13-year-old female presented with acute lower abdominal pain. Magnetic resonance imaging (MRI) revealed uterine didelphys, hematometrocolpos, obstructed hemivagina, and right ipsilateral agenesis, consistent with OHVIRA syndrome. Also, a well-defined mass with fluid signal intensity, mimicking adnexal neoplasm was seen in the right lower pelvic cavity adjacent to the posterior wall of the bladder. Vaginal septotomy and drainage of hematometrocolpos were done initially, but unilateral hysterectomy was later performed to relieve the patient's symptoms. The cystic mass in the right lower pelvic cavity was also excised and confirmed as a blind megaureter.
Abdominal Pain ; Adolescent ; Congenital Abnormalities ; Drainage ; Female ; Humans ; Hysterectomy ; Magnetic Resonance Imaging* ; Urinary Bladder

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Chest Wall Lipogranuloma after Hydrogel Implant Rupture: Case Report.

So Yoon PARK ; Boo Kyung HAN ; Eun Yoon CHO ; Sa Ik BANG

Investigative Magnetic Resonance Imaging.2015;19(3):191-195. doi:10.13104/imri.2015.19.3.191

We present a 53-year-old woman with a large chest wall mass in the interpectoral space, which was eventually confirmed as a lipogranuloma resulting from hydrogel implant rupture. Ultrasonography (US) showed reduced implant volume with surrounding peri-implant fluid collection, suggesting the possibility of implant rupture. A heterogeneously hypoechoic mass was found between the pectoralis major and minor muscles adjacent to the ruptured implant. On magnetic resonance imaging (MRI), there was a large mass in the left interpectoral space of the upper inner chest wall. The mass showed slightly high signal intensity (SI) on pre-contrast T1-weighted image (WI) with mixed iso and high SI on T2-WI. The signal of the mass was suppressed using the water suppression technique but not with the fat suppression technique on T2-WI. The mass showed diffuse enhancement upon contrast enhancement. The enhancing kinetics showed persistent enhancement pattern. US-guided core needle biopsy revealed a lipogranuloma and removal confirmed a ruptured PIP hydrogel implant.
Biopsy, Large-Core Needle ; Breast ; Female ; Humans ; Hydrogel* ; Kinetics ; Magnetic Resonance Imaging ; Middle Aged ; Muscles ; Rupture* ; Thoracic Wall* ; Thorax* ; Ultrasonography ; Water

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Acute Disseminated Encephalomyelitis Presenting as Rhombencephalitis: An Atypical Case Presentation.

Joonseok HWANG ; A Leum LEE ; Kee Hyun CHANG ; Hyun Sook HONG

Investigative Magnetic Resonance Imaging.2015;19(3):186-190. doi:10.13104/imri.2015.19.3.186

Acute disseminated encephalomyelitis (ADEM) is a demyelinating and inflammatory condition of the central nervous system, occurring predominantly in white matter. ADEM involving the rhombencephalon without affecting the white matter is very rare. Here, we present an unusual case of ADEM involving only the rhombencephalon in a 4-year-old Asian girl. The patient complained of pain in the right lower extremities, general weakness, ataxia, and dysarthria. The initial brain CT showed subtle ill-defined low-density lesions in the pons and medulla. On brain MRI, T2 high signal intensity (T2-HSI) lesions with mild swelling were present in the pons, both middle cerebellar peduncles, and the anterior medulla. The initial diagnosis was viral encephalitis involving the rhombencephalon. Curiously, a cerebrospinal fluid (CSF) study revealed no cellularity, and negative viral marker findings. Three weeks later, follow up brain MRI showed that the extent of the T2-HSI lesions in the brain stem had decreased. After reinvestigation, it was found that she had a prior history of upper respiratory infection. In this case, we report the very rare case of a patient showing isolated involvement of the rhombencephalon in ADEM, mimicking viral rhombencephalitis on CT and MR imaging. ADEM can involve unusual sites such as the rhombencephalon in isolation, without involvement of the white matter or deep gray matter and, therefore, should be considered even when it appears in unusual anatomical areas. Thorough history taking is important for making a correct diagnosis.
Asian Continental Ancestry Group ; Ataxia ; Biomarkers ; Brain ; Brain Stem ; Central Nervous System ; Cerebrospinal Fluid ; Child, Preschool ; Diagnosis ; Dysarthria ; Encephalitis, Viral ; Encephalomyelitis ; Encephalomyelitis, Acute Disseminated* ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Pons ; Rhombencephalon

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Assessment of Posterior Globe Flattening: Two-Dimensional versus Three-Dimensional T2-Weighted Imaging.

Jun Hyung ANN ; Eung Yeop KIM

Investigative Magnetic Resonance Imaging.2015;19(3):178-185. doi:10.13104/imri.2015.19.3.178

PURPOSE: To compare the frequency of posterior globe flattening between two-dimensional T2-weighted imaging (2D T2WI) and three-dimensional (3D T2WI). MATERIALS AND METHODS: Sixty-nine patients (31 female; mean age, 44.4 years) who had undergone both 5-mm axial T2WI and sagittal 3D 1-mm isovoxel T2WI of the whole brain for evaluation of various diseases (headache [n = 30], large hemorrhage [n = 19], large tumor or leptomeningeal tumor spread [n = 15], large infarct [n = 3], and bacterial meningitis [n = 2]) were used in this study. Two radiologists independently reviewed both sets of images at separate sessions. Axial T2WI and multi-planar imaging of 3D T2WI were visually assessed for the presence of globe flattening. The optic nerve sheath diameter (ONSD) was measured at a location 4 mm posterior to each globe on oblique coronal imaging reformatted from 3D T2WI. RESULTS: There were significantly more globes showing posterior flattening on 3D T2WI (105/138 [76.1%]) than on 2D T2WI (27/138 [19.6%], P = 0.001). Inter-observer agreement was excellent for both 2D T2WI and 3D T2WI (Cohen's kappa = 0.928 and 0.962, respectively). Intra-class correlation coefficient for the ONSD was almost perfect (Cohen's kappa = 0.839). The globes with posterior flattening had significantly larger ONSD than those without on both 2D and 3D T2WI (P < 0.001; 6.14 mm +/- 0.44 vs. 5.74 mm +/- 0.44 on 2D T2WI; 5.90 mm +/- 0.47 vs. 5.56 mm +/- 0.34 on 3D T2WI). Optic nerve protrusion was significantly more frequent on reformatted 1-mm 3D T2WI than on 5-mm 2D T2WI (8 out of 138 globes on 3D T2WI versus one on 2D T2WI; P = 0.018). CONCLUSION: Posterior globe flattening is more frequently observed on 3D T2WI than on 2D T2WI in patients suspected of having increased intracranial pressure. The globes with posterior flattening have significantly larger ONSD than those without.
Brain ; Female ; Hemorrhage ; Humans ; Intracranial Pressure ; Meningitis, Bacterial ; Optic Nerve

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Intra-Rater and Inter-Rater Reliability of Brain Surface Intensity Model (BSIM)-Based Cortical Thickness Analysis Using 3T MRI.

Ji Young JEON ; Won Jin MOON ; Yeon Sil MOON ; Seol Heui HAN

Investigative Magnetic Resonance Imaging.2015;19(3):168-177. doi:10.13104/imri.2015.19.3.168

PURPOSE: Brain surface intensity model (BSIM)-based cortical thickness analysis does not require complicated 3D segmentation of brain gray/white matters. Instead, this technique uses the local intensity profile to compute cortical thickness. The aim of the present study was to evaluate intra-rater and inter-rater reliability of BSIM-based cortical thickness analysis using images from elderly participants. MATERIALS AND METHODS: Fifteen healthy elderly participants (ages, 55-84 years) were included in this study. High-resolution 3D T1-spoiled gradient recalled-echo (SPGR) images were obtained using 3T MRI. BSIM-based processing steps included an inhomogeneity correction, intensity normalization, skull stripping, atlas registration, extraction of intensity profiles, and calculation of cortical thickness. Processing steps were automatic, with the exception of semiautomatic skull stripping. Individual cortical thicknesses were compared to a database indicating mean cortical thickness of healthy adults, in order to produce Z-score thinning maps. Intra-class correlation coefficients (ICCs) were calculated in order to evaluate inter-rater and intra-rater reliabilities. RESULTS: ICCs for intra-rater reliability were excellent, ranging from 0.751-0.940 in brain regions except the right occipital, left anterior cingulate, and left and right cerebellum (ICCs = 0.65-0.741). Although ICCs for inter-rater reliability were fair to excellent in most regions, poor inter-rater correlations were observed for the cingulate and occipital regions. Processing time, including manual skull stripping, was 17.07 +/- 3.43 min. Z-score maps for all participants indicated that cortical thicknesses were not significantly different from those in the comparison databases of healthy adults. CONCLUSION: BSIM-based cortical thickness measurements provide acceptable intra-rater and inter-rater reliability. We therefore suggest BSIM-based cortical thickness analysis as an adjunct clinical tool to detect cortical atrophy.
Adult ; Aged ; Atrophy ; Brain* ; Cerebellum ; Humans ; Magnetic Resonance Imaging* ; Skull

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Quantitative Analysis of the Facial Nerve Using Contrast-Enhanced Three Dimensional FLAIR-VISTA Imaging in Pediatric Bell's Palsy.

Jin Hee SEO ; Sun Kyoung YOU ; In Ho LEE ; Jeong Eun LEE ; So Mi LEE ; Hyun Hae CHO

Investigative Magnetic Resonance Imaging.2015;19(3):162-167. doi:10.13104/imri.2015.19.3.162

PURPOSE: To evaluate the usefulness of quantitative analysis of the facial nerve using contrast-enhanced three-dimensional (CE 3D) fluid-attenuated inversion recovery-volume isotopic turbo spin echo acquisition (FLAIR-VISTA) for the diagnosis of Bell's palsy in pediatric patients. MATERIALS AND METHODS: Twelve patients (24 nerves) with unilateral acute facial nerve palsy underwent MRI from March 2014 through March 2015. The unaffected sides were included as a control group. First, for quantitative analysis, the signal intensity (SI) and relative SI (RSI) for canalicular, labyrinthine, geniculate ganglion, tympanic, and mastoid segments of the facial nerve on CE 3D FLAIR images were measured using regions of interest (ROI). Second, CE 3D FLAIR and CE T1-SE images were analyzed to compare their diagnostic performance by visual assessment (VA). The sensitivity, specificity, and accuracy of RSI measurement and VA were compared. RESULTS: The absolute SI of canalicular and mastoid segments and the sum of the five mean SI (total SI) were higher in the palsy group than in the control group, but with no significant differences. The RSI of the canalicular segment and the total SI were significantly correlated with the symptomatic side (P = 0.028 and 0.015). In 11/12 (91.6%) patients, the RSI of total SI resulted in accurate detection of the affected side. The sensitivity, specificity, and accuracy for detecting Bell's palsy were higher with RSI measurement than with VA of CE 3D FLAIR images, while those with VA of CE T1-SE images were higher than those with VA of CE 3D FLAIR images. CONCLUSION: Quantitative analysis of the facial nerve using CE 3D FLAIR imaging can be useful for increasing the diagnostic performance in children with Bell's palsy when difficult to diagnose using VA alone. With regard to VA, the diagnostic performance of CE T1-SE imaging is superior to that of CE 3D FLAIR imaging in children. Further studies including larger populations are necessary.
Bell Palsy* ; Child ; Diagnosis ; Facial Nerve* ; Geniculate Ganglion ; Humans ; Magnetic Resonance Imaging ; Mastoid ; Paralysis ; Sensitivity and Specificity

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Useful MRI Features for Distinguishing Benign Peripheral Nerve Sheath Tumors and Myxoid Tumors in the Musculoskeletal System.

Eunchae LEE ; Guen Young LEE ; Whan Sung CHO ; Joon Woo LEE ; Joong Mo AHN ; Eugene LEE ; Heung Sik KANG

Investigative Magnetic Resonance Imaging.2015;19(3):153-161. doi:10.13104/imri.2015.19.3.153

PURPOSE: To identify the differential MRI findings between myxoid tumors and benign peripheral nerve sheath tumors (BPNSTs) in the musculoskeletal system. MATERIALS AND METHODS: The study participants included a total of 35 consecutive patients who underwent MRI between September 2011 and December 2013. The patients were pathologically diagnosed with myxoid tumors (22 patients) or BPNSTs (13 patients). Evaluation was done by two radiologists, based on the following characteristics: size, margin, degree of signal intensity (SI) on T2-weighted images (T2WI), homogeneity of SI on T2WI, enhancement pattern, enhancement homogeneity, presence of cystic portion, internal fat component, presence of fat split sign, presence of target sign, presence of continuation with adjacent neurovascular bundle, and presence of surrounding halo. RESULTS: Large size, high SI on T2WI, heterogeneous enhancement, and internal fat component were commonly observed in myxoid tumors, while homogenous enhancement, fat split sign, target sign were common in BPNSTs. The differences were statistically significant (P < 0.05). Other findings, such as margin, homogeneity of SI on T2WI, enhancement pattern (peripheral or solid), internal cystic portion, continuation with neurovascular bundle, and surrounding halo, did not show significant difference between myxoid tumors and BPNSTs (P > 0.05). CONCLUSION: In the differential diagnosis of myxoid tumors and BPNSTs involving the musculoskeletal system, several MRI findings such as degree of SI on T2WI, enhancement homogeneity, internal fat component, fat split sign, and target sign, may be helpful in establishing the diagnosis.
Diagnosis ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging* ; Musculoskeletal System* ; Nerve Sheath Neoplasms* ; Peripheral Nerves*

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Associated Brain Parenchymal Abnormalities in Developmental Venous Anomalies: Evaluation with Susceptibility-weighted MR Imaging.

Hyeon Gyu RYU ; Dae Seob CHOI ; Soo Bueum CHO ; Hwa Seon SHIN ; Ho Cheol CHOI ; Boseul JEONG ; Hyemin SEO ; Jae Min CHO

Investigative Magnetic Resonance Imaging.2015;19(3):146-152. doi:10.13104/imri.2015.19.3.146

PURPOSE: The purpose of this study was to evaluate the associated brain parenchymal abnormalities of developmental venous anomalies (DVA) with susceptibility-weighted image (SWI). MATERIALS AND METHODS: Between January 2012 and June 2013, 2356 patients underwent brain MR examinations with contrast enhancement. We retrospectively reviewed their MR examinations and data were collected as per the following criteria: incidence, locations, and associated parenchymal signal abnormalities of DVAs on T2-weighted image, fluid-attenuated inversion recovery (FLAIR), and SWI. Contrast enhanced T1-weighted image was used to diagnose DVA. RESULTS: Of the 2356 patients examined, 57 DVAs were detected in 57 patients (2.4%); 47 (82.4%) were in either lobe of the supratentorial brain, 9 (15.7%) were in the cerebellum, and 1 (1.7%) was in the pons. Of the 57 DVAs identified, 20 (35.1%) had associated parenchymal abnormalities in the drainage area. Among the 20 DVAs which had associated parenchymal abnormalities, 13 showed hemorrhagic foci on SWI, and 7 demonstrated only increased parenchymal signal abnormalities on T2-weighted and FLAIR images. In 5 of the 13 patients (38.5%) who had hemorrhagic foci, the hemorrhagic lesions were demonstrated only on SWI. CONCLUSION: The overall incidence of DVAs was 2.4%. Parenchymal abnormalities were associated with DVAs in 35.1% of the cases. On SWI, hemorrhage was detected in 22.8% of DVAs. Thus, we conclude that SWI might give a potential for understanding of the pathophysiology of parenchymal abnormalities in DVAs.
Brain* ; Cerebellum ; Drainage ; Hemorrhage ; Humans ; Incidence ; Magnetic Resonance Imaging* ; Pons ; Retrospective Studies

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Invasive Lobular Carcinoma: MRI Features and Clinicohistological Characteristics According to the ER, PR, and HER2 Statuses.

Eun Young YOO ; Sang Yu NAM ; Hye Young CHOI ; Hyun Yee CHO

Investigative Magnetic Resonance Imaging.2015;19(3):137-145. doi:10.13104/imri.2015.19.3.137

PURPOSE: To investigate correlations of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor type 2 (HER2) statuses with magnetic resonance imaging (MRI) features and clinicohistological characteristics in patients with invasive lobular carcinoma (ILC). MATERIALS AND METHODS: Data from 64 histologically confirmed ILCs were analyzed retrospectively. Preoperative breast MRI was reviewed for morphology and dynamic contrast-enhanced kinetics of the tumor. Pathologic reports were reviewed for ER, PR, and HER2 positivity, tumor size, lymph node metastasis, and the number of metastatic lymph nodes. Furthermore, there was an investigation of the MRI features and clinicohistologic characteristics, according to the ER, PR, and HER2 statuses. RESULTS: A significant difference in MRI features and clinicohistological tumor characteristics were observed only in relation to PR status. Of the 64 ILCs, 10 (15.6%) were PR negative. PR negative cancers, compared with PR positive cancers, were more likely to present as non-mass enhancement (P = 0.027); have a significantly larger mean tumor size (5.00 +/- 1.05 cm vs. 2.57 +/- 0.21 cm, P = 0.021); and have significantly more metastatic lymph nodes (P = 0.010). CONCLUSIONS: PR negative ILC presented more frequently as non-mass enhancement on MRI, with larger tumors and increased numbers of metastatic lymph nodes. Therefore, the PR status plays an important role in determining MRI features and clinicohistological characteristics of ILC.
Breast ; Carcinoma, Lobular* ; Estrogens ; Humans ; Kinetics ; Lymph Nodes ; Magnetic Resonance Imaging* ; Neoplasm Metastasis ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Retrospective Studies

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