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Young Eun KIM ; Donghoon LEE ; Hokyeong HWANG ; Minji KIM

Investigative Magnetic Resonance Imaging.2016;20(3):200-205. doi:10.13104/imri.2016.20.3.200

In Korea, tuberculosis is still common disease. Central nervous system tuberculosis can manifest in a variety of forms, including tuberculous meningitis, tuberculous cerebritis, tuberculoma, tuberculous abscess, and miliary tuberculosis. Although intra-axial tuberculomas are the more common type of CNS tuberculosis, extra-axial lesions are rarely encountered. En plaque tuberculoma is an extremely rare presentation of intracranial tuberculosis with mimicking primary or secondary meningeal neoplasia. We describe a rare case of an en plaque tuberculoma accompanied by tuberculous meningitis and tuberculomas.
Abscess ; Korea ; Magnetic Resonance Imaging ; Tuberculoma* ; Tuberculosis ; Tuberculosis, Central Nervous System ; Tuberculosis, Meningeal ; Tuberculosis, Miliary

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A Rare Case of Viagra Induced Toxic Encephalopathy.

Soo Yeon JEONG ; Se Jeong JEON ; Youe Ree KIM ; See Sung CHOI ; Hyo Sung KWAK

Investigative Magnetic Resonance Imaging.2016;20(3):196-199. doi:10.13104/imri.2016.20.3.196

Viagra has been prescribed worldwide to treat men with erectile dysfunction. Clinical trials have shown that Viagra may cause various kinds of adverse effects include some central nervous system (CNS) adverse effects. Although extremely rare, toxic encephalopathy also can be one of those effects. This report presents a case of encephalopathy caused by Viagra in correlation with its radiologic findings. Its pharmacologic mechanism and potential effects on the biochemistry of the CNS are reviewed.
Biochemistry ; Brain Diseases ; Central Nervous System ; Erectile Dysfunction ; Humans ; Male ; Neurotoxicity Syndromes* ; Sildenafil Citrate*

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Displaced Double-Layered Lateral Meniscus That Mimicked the Bucket-Handle Tear: a Case Report.

Min Jee KWAK ; Sun Ki KIM ; Ki Jun KIM ; Bum Sik LEE ; Jun KANG

Investigative Magnetic Resonance Imaging.2016;20(3):191-195. doi:10.13104/imri.2016.20.3.191

Among the various types of congenital meniscal anomalies, the double-layered lateral meniscus is extremely rare. The double-layered meniscus consists of both the upper additional and the lower normal meniscus. As the upper additional meniscus is mobile, it can be easily displaced, while the lower lateral meniscus is usually normal in shape and volume. A 42-year-old woman suffering from pain and locking of her left knee underwent Magnetic resonance imaging (MRI) examination and an arthroscopic surgery. A rare meniscal abnormality was seen in her left knee, which presented as a double-layered lateral meniscus with displacement. It was remarkable that the upper additional meniscus was displaced over the intercondylar eminence of the tibia and it mimicked a bucket-handle tear. Even though it is rare, it is necessary to consider the possibility of displaced double-layered meniscus in the differential diagnosis of a bucket-handle tear. Here, we report the MRI and arthroscopic findings of a displaced double-layered lateral meniscus, which was similar to the bucket-handle tear.
Adult ; Arthroscopy ; Diagnosis, Differential ; Female ; Humans ; Knee ; Magnetic Resonance Imaging ; Menisci, Tibial* ; Tears* ; Tibia

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Xanthogranulomatous Pancreatitis Mimicking a Pancreatic Cancer on CT and MRI: a Case Report and Literature Review.

Jong Min PARK ; Seung Hyun CHO ; Han Ik BAE ; An Na SEO ; Hye Jung KIM ; So Mi LEE ; Jae Hyuck YI ; Jae Kwang LIM ; Chang Min CHO

Investigative Magnetic Resonance Imaging.2016;20(3):185-190. doi:10.13104/imri.2016.20.3.185

Xanthogranulomatous inflammation is a rare benign condition involving various organs. However, its pancreas involvement is very rare. To the best of our knowledge, only 17 cases have been described in the literature. Interestingly, all reported 17 cases due to various causes underwent surgical resection. Here, we present a case of xanthogranulomatous pancreatitis in a 63-year-old man. He presented with epigastric pain and solid mass mimicking ductal adenocarcinoma in the body and tail of pancreas on magnetic resonance imaging. The patient was diagnosed as xanthogranulomatous pancreatitis via endoscopic ultrasound-guided fine needle aspiration. After that, he was followed up and monitored without any surgical treatment. Here, we show imaging findings and serial image changes of xanthogranulomatous pancreatitis for this case.
Adenocarcinoma ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Humans ; Inflammation ; Magnetic Resonance Imaging* ; Middle Aged ; Pancreas ; Pancreatic Neoplasms* ; Pancreatitis* ; Tail

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A Potential Diagnostic Pitfall in the Differentiation of Hemorrhagic and Fatty Lesions Using Short Inversion Time Inversion Recovery: a Case Report.

Jee Hye KIM ; Woo Young KANG ; Bum Sang CHO ; Kyung Sik YI

Investigative Magnetic Resonance Imaging.2016;20(3):181-184. doi:10.13104/imri.2016.20.3.181

Short inversion time inversion recovery (STIR) is widely used for spinal magnetic resonance imaging (MRI) because the pulse sequence of STIR is insensitive to magnetic field inhomogeneity and can be used to scan a large field of view. In this case report, we present a case of spinal epidural hematoma with unexpected signal decrease on a STIR image. The MRI showed an epidural mass that appeared with high signal intensity on both T1- and T2-weighted images. However, a signal decrease was encountered on the STIR image. This nonspecific decrease of signal in tissue with a short T1 relaxation time that is similar to that of fat (i.e., hemorrhage) could lead to a diagnostic pitfall; one could falsely diagnose this decrease of signal as fat instead of hemorrhage. Awareness of the nonselective signal suppression achieved with STIR pulse sequences may avert an erroneous diagnosis in image interpretation.
Diagnosis ; Hematoma, Epidural, Spinal ; Hemorrhage ; Magnetic Fields ; Magnetic Resonance Imaging ; Relaxation ; Spine

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Motor and Sensory Peripheral Neuropathy in a Patient Came after Acute Carbon Monoxide Intoxication: a Case Report with Magnetic Resonance Image.

Seungmin LEE ; Sang Yoon KIM ; Jee Young LEE ; Min Jeong CHOI

Investigative Magnetic Resonance Imaging.2016;20(3):175-180. doi:10.13104/imri.2016.20.3.175

Carbon monoxide (CO) intoxication is a leading cause of the variable neuropsychiatric impairment. Despite of widely known central nerve system complications after CO intoxication, peripheral neuropathy due to CO poisoning is rare and has been under-recognized. We report interesting case of a 29-year-old male who suffered from motor weakness and sensory abnormalities in his lower extremity following acute CO intoxication. The patient revealed direct and indirect signs of peripheral neuropathy of the left inferior gluteal and sciatic nerve on magnetic resonance imaging.
Adult ; Carbon Monoxide* ; Carbon* ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Peripheral Nervous System Diseases* ; Poisoning ; Sciatic Nerve ; Sciatic Neuropathy

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Enhancement of Optic Nerve in Leukemic Patients: Leukemic Infiltration of Optic Nerve versus Optic Neuritis.

Yo Han RA ; Sun Young PARK ; Soo Ah IM ; Jee Young KIM ; Nak Gyun CHUNG ; Bin CHO

Investigative Magnetic Resonance Imaging.2016;20(3):167-174. doi:10.13104/imri.2016.20.3.167

PURPOSE: To identify magnetic resonance imaging (MRI) findings of leukemic infiltration of optic nerve and optic neuritis in leukemic patients with emphasis of clinical findings as reference standard to differentiate them. MATERIALS AND METHODS: MRI and clinical findings of 7 patients diagnosed as leukemic infiltration of optic nerve (n = 5) and optic neuritis (n = 2) in our institution between July 2006 and August 2015were reviewed retrospectively. In particular, MR imaging findings involved perineural enhancement and thickening of optic nerve and its degree, signal intensity, laterality (unilateral/bilateral), intraconal fat infiltration and its degree, and associated central nervous system abnormalities. RESULTS: Of 5 cases of leukemic infiltration of optic nerve, 4 cases showed positive cerebrospinal fluid (CSF) study for leukemia relapse and 1 case was positive on bone marrow (BM) biopsy only. Moreover, of 5 leukemic infiltration of optic nerve, 2 cases showed the most specific MR findings for leukemic central nervous system involvement including 1 prominent leptomeningeal enhancement and 1 chloroma. However, other MR imaging findings of the patients with leukemic infiltration or optic neuritis such as thickening and perineural enhancement of optic nerves are overlapped. CONCLUSION: Enhancement and thickening of optic nerve were overlapped MR findings in leukemic infiltration of optic nerve and optic neuritis. Our findings suggest that enhancing optic nerve thickening with associated central nervous system MR abnormality favors the diagnosis of leukemic infiltration of optic nerve, especially in patients with history of acute lymphoblastic leukemia. However, CSF and BM study were required for differentiation between leukemic infiltration of optic nerve and optic neuritis.
Biopsy ; Bone Marrow ; Central Nervous System ; Cerebrospinal Fluid ; Diagnosis ; Humans ; Leukemia ; Leukemic Infiltration* ; Magnetic Resonance Imaging ; Optic Nerve Diseases ; Optic Nerve* ; Optic Neuritis* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Recurrence ; Retrospective Studies ; Sarcoma, Myeloid

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The Importance of Interface Irregularity between the Tumor and Brain Parenchyma in Differentiating between Typical and Atypical Meningiomas: Correlation with Pathology.

Jeongmin LEE ; Yeon Soo LEE ; Kook Jin AHN ; Song LEE ; Jinhee JANG ; Hyun Seok CHOI ; So Lyung JUNG ; Bum Soo KIM ; Sinsoo JEUN ; Yongkil HONG

Investigative Magnetic Resonance Imaging.2016;20(3):158-166. doi:10.13104/imri.2016.20.3.158

PURPOSE: To understand clinical significance of irregular interface between meningioma and adjacent brain parenchyma in predicting histological grading of tumor, focusing on brain parenchymal invasion. MATERIALS AND METHODS: Pathologically confirmed 79 cases with meningiomas with pathological reports about the presence of parenchymal invasion were included. We defined the presence of interface irregularity as either spiculations or fuzzy margins between the tumor and brain parenchyma. We counted number of spiculations and measured ratio of fuzzy margin length to whole length of mass with consensus of two neuroradiologists. We classified the patients into Present group and Absent group, and the two groups were compared by using the Mann-Whitney U test. Statistical correlations between the presence of an interface irregularity and brain parenchymal invasion by the tumor as well as meningioma histological grade were tested with chi-square test. The optimal cutoff values of spiculation numbers and the ratio of fuzzy margins were determined. The sensitivity and specificity of number of spiculations, ratio of fuzzy margin and the presence of irregular interface as combined parameters for predicting the parenchymal invasion were calculated using ROC curve analysis. RESULTS: Statistically significant differences were noted between the Present and Absent groups for number of spiculations and ratio of fuzzy margin (P = 0.038 and P = 0.028, respectively). The optimal cutoff value for number of spiculations (> 4.5 with 61.1% sensitivity and 68.9% specificity) and the ratio of fuzzy margin (> 0.24 with 66.7% sensitivity and 65.6% specificity) were determined. The sensitivity and specificity of interface irregularity as the combined parameters were 72% and 59%, respectively. The interface irregularity between tumor and brain parenchyma significantly correlated with not only brain parenchymal invasion (P = 0.001) and but also histological grade (P < 0.001). CONCLUSION: The interface irregularity between tumor and brain parenchyma in MRI can be a strong predictive factor for brain parenchymal invasion and high grade meningioma.
Brain* ; Consensus ; Humans ; Magnetic Resonance Imaging ; Meningioma* ; Pathology* ; ROC Curve ; Sensitivity and Specificity

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Safety Management for MR-Guided Interventions.

Mikhail CHERKASHIN ; Natalia BEREZINA ; Alexey SEROV ; Artem FEDOROV ; Georgy ANDREEV ; Vladymir KUPLEVATSKY

Investigative Magnetic Resonance Imaging.2016;20(3):152-157. doi:10.13104/imri.2016.20.3.152

PURPOSE: Operating room management is the serious and complex task for hospital managers and the common approach is to develop relevant standard operational procedures. From patient and staff safety perspective, operating room management should be well-studied and hospital should identify and address any potential risks. Simultaneous usage of different imaging and less-invasive treatment technologies demands strong management control. MATERIALS AND METHODS: We have formed the multidisciplinary expert panel (surgeons, anesthesiologists, radiologists, healthcare managers etc.) for hybrid theater management standard operational procedure development. On the first stage the general concept of hybrid room design and patient routing was developed. The second stage included the technical details discussion. For patient safety improvement we modified the Surgical Safety Check-list in accordance with potential MRI-related safety challenges and concerns. RESULTS: WHO Surgical Safety Checklist is a simple and easy-to use tool which includes three blocks of question (grouped by the surgery process). We have developed two additional blocks of questions for the intraoperative magnetic resonance investigation. It is very important to have a special detailed routing with a strong control of ferromagnetic devices and anesthesiology care. CONCLUSION: High-energy MRI (1.5-3.0T) is characterized by potential influence on patient and staff safety in case of hybrid surgery. It is obvious to have a strong managerial control of ferromagnetic devices and anesthesiology care. Surgical Safety Checklist is the validated tool for improving patient safety. Modification and customization of this check-list potentially provides the opportunity for surgery processes improving.
Anesthesiology ; Checklist ; Delivery of Health Care ; Humans ; Magnetic Resonance Imaging ; Magnets ; Operating Rooms ; Patient Safety ; Safety Management*

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Review of Recent Advancement of Ultra High Field Magnetic Resonance Imaging: from Anatomy to Tractography.

Zang Hee CHO

Investigative Magnetic Resonance Imaging.2016;20(3):141-151. doi:10.13104/imri.2016.20.3.141

PURPOSE: Advances of magnetic resonance imaging (MRI), especially that of the Ultra-High Field (UHF) MRI will be reviewed. MATERIALS AND METHODS: Diffusion MRI data was obtained from a healthy adult young male of age 30 using a 7.0T research MRI scanner (Magnetom, Siemens) with 40 mT/m maximum gradient field. The specific imaging parameters used for the data acquisition were a single shot DW echo planar imaging. RESULTS: Three areas of the imaging experiments are focused on for the study, namely the anatomy, angiography, and tractography. CONCLUSION: It is envisioned that, in near future, there will be more 7.0T MRIs for brain research and explosive clinical application research will also be developed, for example in the area of connectomics in neuroscience and clinical neurology and neurosurgery.
Adult ; Angiography ; Brain ; Connectome ; Diffusion Magnetic Resonance Imaging ; Echo-Planar Imaging ; Humans ; Magnetic Resonance Imaging* ; Male ; Neurology ; Neurosciences ; Neurosurgery

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