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Clear Cell Sarcoma of the Wrist: MRI Findings with Diffusion-Weighted Image and Histopathologic Correlation.

Bo Yong CHUNG ; Seun Ah LEE ; Jung Ah CHOI ; Jung Weon SHIM

Investigative Magnetic Resonance Imaging.2016;20(2):136-139. doi:10.13104/imri.2016.20.2.136

Clear cell sarcoma is rare and difficult to diagnose. Herein, we present a case of clear cell sarcoma in the dorsum of the wrist with MRI findings, including diffusion-weighted imaging, and histopathologic correlation, which was initially diagnosed as giant cell tumor of tendon sheath.
Diffusion Magnetic Resonance Imaging ; Giant Cell Tumors ; Magnetic Resonance Imaging* ; Sarcoma, Clear Cell* ; Tendons ; Wrist*

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Paradoxical Response of Giant Left Atrial Appendage Aneurysm after Catheter Ablation of Atrial Fibrillation.

Jee Won CHUNG ; Jaemin SHIM ; Wan Joo SHIM ; Young Hoon KIM ; Sung Ho HWANG

Investigative Magnetic Resonance Imaging.2016;20(2):132-135. doi:10.13104/imri.2016.20.2.132

We report the case of a 43-year-old male with both giant left atrial appendage (LAA) aneurysm and drug-refractory atrial fibrillation (AF). The patient was treated with percutaneous electrical isolation of cardiac arrhythmogenic substrate, and has been free of AF symptom over one year. Although the surgical resection of giant LAA aneurysm is mostly used to prevent systemic thromboembolism, we have performed follow-up of the giant LAA aneurysm using cardiac magnetic resonance (CMR) imaging and transesophageal echocardiography (TEE) after the successful catheter ablation of refractory AF. At one-year follow-up CMR, the giant LAA aneurysm showed remarkable enlargement as well as decreased contractility. Additionally, one-year follow-up TEE showed spontaneous echo contrast as an indicator of blood stasis in the giant LAA aneurysm. Those findings of giant LAA aneurysm suggest that the risk of thromboembolism may be high despite termination of AF.
Adult ; Aneurysm* ; Atrial Appendage* ; Atrial Fibrillation* ; Catheter Ablation* ; Catheters* ; Echocardiography ; Echocardiography, Transesophageal ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Thromboembolism

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Tenosynovial Giant Cell Tumor Showing Severe Bone Erosion in the Finger: Case Report and Review of the Imaging Findings and Their Significance.

Kyung Ryeol LEE ; Chang Lim HYUN

Investigative Magnetic Resonance Imaging.2016;20(2):127-131. doi:10.13104/imri.2016.20.2.127

We report a case of tenosynovial giant cell tumor with severe bone erosion in the right fifth finger of a 46-year-old man. Throughout this case review, we describe the imaging findings of tenosynovial giant cell tumor with severe bone erosion and review the literatures regarding osseous lesions caused by tenosynovial giant cell tumor and their significance related to the differential diagnosis and patient treatment.
Diagnosis, Differential ; Fingers* ; Giant Cell Tumors* ; Giant Cells* ; Hand ; Humans ; Magnetic Resonance Imaging ; Middle Aged

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The MRI Findings of Flexor Digitorum Accessorius Longus Muscle: a Case Report.

Jae Hwan SHIN ; Jae Chan SHIM ; Kyoung Eun LEE ; Ho Kyun KIM ; Ghi Jai LEE ; Jung Ho SUH

Investigative Magnetic Resonance Imaging.2016;20(2):123-126. doi:10.13104/imri.2016.20.2.123

The flexor digitorum accessorius longus (FDAL) is the most common accessory muscle found in the posterior compartment of the ankle area. The accessory muscle in this area such as the FDAL may be incidentally identified on magnetic resonance images (MRI). There are some case reports about the FDAL in cadaver researches. However, the MRI findings about the FDAL have been reported in a few cases. In this paper, we report a case of the FDAL incidentally identified on MRI with review of the literature about the FDAL.
Ankle ; Cadaver ; Magnetic Resonance Imaging*

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Nontraumatic Intracystic Hemorrhage of Arachnoid Cyst: CT and MR Findings.

Seung Jin KIM ; Hye Jin BAEK ; Jin Il MOON ; Soo Buem CHO ; Bo Hwa CHOI ; Kyungsoo BAE ; Kyung Nyeo JEON ; Dae Seob CHOI

Investigative Magnetic Resonance Imaging.2016;20(2):120-122. doi:10.13104/imri.2016.20.2.120

Arachnoid cysts (AC) are intraarachnoidal cerebrospinal fluid collections, and account for 1% of all intracranial space-occupying lesions. Intracystic hemorrhage of the AC can occur spontaneously, but this is an extremely rare event. Herein, we present a case of hemorrhagic AC in a nontraumatic patient in the left middle cranial fossa. We also performed relevant literature review on this disease.
Arachnoid Cysts ; Arachnoid* ; Cerebrospinal Fluid ; Cranial Fossa, Middle ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Rupture

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Diagnosis of Right Ventricular Vegetation on Late Gadolinium-Enhanced MR Imaging in a Pediatric Patient after Repair of a Ventricular Septal Defect.

Jewon JEONG ; Hae Jin KIM ; Sung Mok KIM ; June HUH ; Ji Hyuk YANG ; Yeon Hyeon CHOE

Investigative Magnetic Resonance Imaging.2016;20(2):114-119. doi:10.13104/imri.2016.20.2.114

We report a case of vegetation in a 4-year-old female with infective endocarditis, diagnosed by late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) imaging. The patient had a history of primary closure for ventricular septal defect and presented with mild febrile sensation. No remarkable clinical symptoms or laboratory findings were noted; however, transthoracic echocardiography demonstrated a 14 mm highly mobile homogeneous mass in the right ventricle. On LGE CMR imaging, the mass showed marginal rim enhancement, which suggested the diagnosis of vegetation rather than thrombus. The extracellular volume fraction (≥ 42%) of the lesion was higher than that of normal myocardium. Based on the patient's clinical history of congenital heart disease and pathologic confirmation of the lesion, a diagnosis of infective endocarditis with vegetation was made.
Child, Preschool ; Diagnosis* ; Echocardiography ; Endocarditis ; Female ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular* ; Heart Ventricles ; Humans ; Magnetic Resonance Imaging* ; Myocardium ; Sensation ; Thrombosis

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Susceptibility Vessel Sign for the Detection of Hyperacute MCA Occlusion: Evaluation with Susceptibility-weighted MR Imaging.

Sangmin LEE ; Soo Bueum CHO ; Dae Seob CHOI ; Sung Eun PARK ; Hwa Seon SHIN ; Hye Jin BAEK ; Ho Cheol CHOI ; Ji Eun KIM ; Hye Young CHOI ; Mi Jung PARK

Investigative Magnetic Resonance Imaging.2016;20(2):105-113. doi:10.13104/imri.2016.20.2.105

PURPOSE: Susceptibility vessel sign (SVS) on gradient echo image, which is caused by MR signal loss due to arterial thrombosis, has been reported in acute middle cerebral artery (MCA) infarction. However, the reported sensitivity and diagnostic accuracy of SVS have been variable. Susceptibility-weighted imaging (SWI) is a newly developed MR sequence. Recent studies have found that SWI may be useful in the field of cerebrovascular diseases, especially for detecting the presence of prominent veins, microbleeds and the SVS. The purpose of this study was to evaluate the diagnostic values of SWI for the detection of hyperacute MCA occlusion. MATERIALS AND METHODS: Sixty-nine patients (37 males, 32 females; 46-89 years old [mean, 69.1]) with acute stroke involving the MCA territory underwent MR imaging within 6 hours after the symptom onset. MR examination included T2, FLAIR (fluid-attenuated inversion recovery), DWI, SWI, PWI (perfusion-weighted imaging), contrast-enhanced MR angiography (MRA) and contrast-enhanced T1. Of these patients, 28 patients also underwent digital subtraction angiography (DSA) within 2 hours after MR examination. Presence or absence of SVS on SWI was assessed without knowledge of clinical, DSA and other MR imaging findings. RESULTS: On MRA or DSA, 34 patients (49.3%) showed MCA occlusion. Of these patients, SVS was detected in 30 (88.2%) on SWI. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of SWI were 88.2%, 97.1%, 96.8%, 89.5% and 92.8%, respectively. CONCLUSION: SWI was sensitive, specific and accurate for the detection of hyperacute MCA occlusion.
Angiography ; Angiography, Digital Subtraction ; Cerebrovascular Disorders ; Female ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Male ; Middle Cerebral Artery ; Sensitivity and Specificity ; Stroke ; Thrombosis ; Veins

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Evaluation of Knee Joint after Double-Bundle ACL Reconstruction with Three-Dimensional Isotropic MRI.

Min Ju JUNG ; Yu Mi JEONG ; Beom Goo LEE ; Jae Ang SIM ; Hye Young CHOI ; Jeong Ho KIM ; Sheen Woo LEE

Investigative Magnetic Resonance Imaging.2016;20(2):95-104. doi:10.13104/imri.2016.20.2.95

PURPOSE: To evaluate the knee joint after double-bundle anterior cruciate ligament (ACL) reconstruction with three-dimensional (3D) isotropic magnetic resonance (MR) image, and to directly compare the ACL graft findings on 3D MR with the clinical results. MATERIALS AND METHODS: From January 2009 to December 2014, we retrospectively reviewed MRIs of 39 patients who had reconstructed ACL with double bundle technique. The subjects were examined using 3D isotropic proton-density sequence and routine two-dimensional (2D) sequence on 3.0T scanner. The MR images were qualitatively evaluated for the intraarticular curvature, graft tear, bony impingement, intraosseous tunnel cyst, and synovitis of anteromedial and posterolateral bundles (AMB, PLB). In addition anterior tibial translation, PCL angle, PCL ratio were quantitatively measured. KT arthrometric values were reviewed for anterior tibial translation as positive or negative. The second look arthroscopy results including tear and laxity were reviewed. RESULTS: Significant correlations were found between an AMB tear on 3D-isotropic proton density MR images and arthroscopic proven AMB tear or laxity (P < 0.05). Also, a significant correlation was observed between increased PCL ratio on 3D isotropic MRI and the arthroscopic findings such as tear, laxities of grafts (P < 0.05). KT arthrometric results were found to be significantly correlated with AMB tears (P < 0.05) and tibial tunnel cysts (P < 0.05). CONCLUSION: An AMB tear on 3D-isotropic MRI was correlated with arthroscopic results qualitatively and quantitatively. 3D isotropic MRI findings can aid the evaluation of ACL grafts after double bundle reconstruction.
Anterior Cruciate Ligament ; Arthroscopy ; Humans ; Knee Joint* ; Knee* ; Magnetic Resonance Imaging* ; Protons ; Retrospective Studies ; Synovitis ; Tears ; Transplants

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Assessment of Diffusion-Weighted Imaging-FLAIR Mismatch: Comparison between Conventional FLAIR versus Shorter-Repetition-Time FLAIR at 3T.

Byeong Ho GOH ; Eung Yeop KIM

Investigative Magnetic Resonance Imaging.2016;20(2):88-94. doi:10.13104/imri.2016.20.2.88

PURPOSE: Fluid-attenuated inversion recovery (FLAIR) imaging can be obtained faster with shorter repletion time (TR), but it gets noisier. We hypothesized that shorter-TR FLAIR obtained at 3 tesla (3T) with a 32-channel coil may be comparable to conventional FLAIR. The aim of this study was to compare the diagnostic value between conventional FLAIR (TR = 9000 ms, FLAIR9000) and shorter-TR FLAIR (TR = 6000 ms, FLAIR6000) at 3T in terms of diffusion-weighted imaging-FLAIR mismatch. MATERIALS AND METHODS: We recruited 184 patients with acute ischemic stroke (28 patients < 4.5 hours) who had undergone 5-mm diffusion-weighted imaging (DWI) and two successive 5-mm FLAIR images (no gap; in-plane resolution, 0.9 × 0.9 mm) at 3T with a 32-channel coil. The acquisition times for FLAIR9000 and FLAIR6000 were 108 seconds (generalized autocalibrating partially parallel acquisitions [GRAPPA] = 2) and 60 seconds (GRAPPA = 3), respectively. Two radiologists independently assessed the paired imaging sets (DWI-FLAIR9000 and DWI-FLAIR6000) for the presence of matched hyperintense lesions on each FLAIR imaging. The signal intensity ratios (area of DWI lesion to contralateral normal-appearing region) on both FLAIR imaging sets were compared. RESULTS: DWI-FLAIR9000 mismatch was present in 39 of 184 (21.2%) patients, which was perfectly the same on FLAIR6000. Three of 145 patients (2%) with DWI-matched lesions on FLAIR9000 had discrepancy on FLAIR6000, showing no significant difference (P > 0.05). Interobserver agreement was excellent for both DWI-FLAIR9000 and DWI-FLAIR6000 (k = 0.904 and 0.883, respectively). Between the two FLAIR imaging sets, there was no significant difference of signal intensity ratio (mean, standard deviation; 1.25 ± 0.20; 1.24 ± 0.20, respectively) (P > 0.05). CONCLUSION: For the determination of mismatch or match between DWI and FLAIR imaging, there is no significant difference between FLAIR9000 and FLAIR6000 at 3T with a 32-channel coil.
Humans ; Magnetic Resonance Imaging ; Stroke

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Detecting Peripheral Nerves in the Elbow using Three-Dimensional Diffusion-Weighted PSIF Sequences: a Feasibility Pilot Study.

Domin NA ; Jaeil RYU ; Suk Joo HONG ; Sun Hwa HONG ; Min A YOON ; Kyung Sik AHN ; Chang Ho KANG ; Baek Hyun KIM

Investigative Magnetic Resonance Imaging.2016;20(2):81-87. doi:10.13104/imri.2016.20.2.81

PURPOSE: To analyze the feasibility of three-dimensional (3D) diffusion-weighted (DW) PSIF (reversed FISP [fast imaging with steady-state free precession]) sequence in order to evaluate peripheral nerves in the elbow. MATERIALS AND METHODS: Ten normal, asymptomatic volunteers were enrolled (6 men, 4 women, mean age 27.9 years). The following sequences of magnetic resonance images (MRI) of the elbow were obtained using a 3.0-T machine: 3D DW PSIF, 3D T2 SPACE (sampling perfection with application optimized contrasts using different flip angle evolution) with SPAIR (spectral adiabatic inversion recovery) and 2D T2 TSE (turbo spin echo) with modified Dixon (m-Dixon) sequence. Two observers used a 5-point grading system to analyze the image quality of the ulnar, median, and radial nerves. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of each nerve were measured. We compared 3D DW PSIF images with other sequences using the Wilcoxon-signed rank test and Friedman test. Inter-observer agreement was measured using intraclass correlation coefficient (ICC) analysis. RESULTS: The mean 5-point scores of radial, median, and ulnar nerves in 3D DW PSIF (3.9/4.2/4.5, respectively) were higher than those in 3D T2 SPACE SPAIR (1.9/2.8/2.8) and 2D T2 TSE m-Dixon (1.7/2.8/2.9) sequences (P < 0.05). The mean SNR in 3D DW PSIF was lower than 3D T2 SPACE SPAIR, but there was no difference between 3D DW PSIF and 2D T2 TSE m-Dixon in all of the three nerves. The mean CNR in 3D DW PSIF was lower than 3D T2 SPACE SPAIR and 2D T2 TSE m-Dixon in the median and ulnar nerves, but no difference among the three sequences in the radial nerve. CONCLUSION: The three-dimensional DW PSIF sequence may be feasible to evaluate the peripheral nerves around the elbow in MR imaging. However, further optimization of the image quality (SNR, CNR) is required.
Elbow Joint ; Elbow* ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Peripheral Nerves* ; Pilot Projects* ; Radial Nerve ; Signal-To-Noise Ratio ; Ulnar Nerve ; Volunteers

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