Glenn A. Tung

MRI and neuropsychological differences in early- and late-life-onset geriatric depression

We sought to determine whether geriatric patients with late-life-onset major depression have more subcortical hyperintensities on MRI and greater cognitive impairment than age-matched geriatric patients with early-life-onset major depression, suggesting that subcortical disease may be etiologic in late-life depression. Most negative studies of the clinical significance of subcortical hyperintensities on MRI in geriatric patients have sampled from a restricted range of subjects, have employed limited batteries of neuropsychological tests, or have not quantified MRI changes; the present study attempted to address these limitations. Thirty subjects from a geriatric psychiatry inpatient service who were over 60 years of age and presented with major depression were divided into groups with onset of first depression after age 60 (mean = 72.4 years, 15 women, 0 men), and onset of first depression before age 60 (mean = 35.8 years, 12 women, 3 men). Quantitative analysis of MRI yielded the volume of: periventricular hyperintensities (PVH) and deep white-matter hyperintensities (DWMH). Subjects were administered a neuropsychological battery and measures of depression by raters blind to age of onset. The late-onset group had significantly more PVH and DWMH. They were also more impaired on executive and verbal and nonverbal memory tasks. Discriminant function analysis using the severity of subcortical signal hyperintensities on MRI, cognitive index, and depression scores correctly predicted late versus early onset of depression in 87% of the early-onset group and 80% of the late-onset group. These findings suggest that late-life-onset depression may be associated with an increased severity of subcortical vascular disease and greater impairment of cognitive performance. NEUROLOGY 1996;46: 1567-1574

Diffusion-Weighted MRI of Peripheral Zone Prostate Cancer: Comparison of Tumor Apparent Diffusion Coefficient With Gleason Score and Percentage of Tumor on Core Biopsy

OBJECTIVE The objective of our study was to determine the relationship between the apparent diffusion coefficient (ADC) value on diffusion-weighted imaging (DWI) and Gleason score of prostate cancer and percentage of tumor involvement on prostate core biopsy. MATERIALS AND METHODS We performed a retrospective study of 57 patients with biopsy-proven prostate cancer who underwent endorectal MRI with DWI between July 2007 and March 2008. Regions of interest (ROIs) were drawn on ADC maps at sites of visible tumor on DW images and ADC maps. A hierarchic mixed linear model was used to compare the ADC value of prostate cancer with the Gleason score and the percentage of tumor on core biopsy. RESULTS Eighty-one sites of biopsy-proven prostate cancer were visible on DW images and ADC maps. The least-squares mean ADC for disease with a Gleason score of 6 was 0.860 x 10(-3) mm(2)/s (standard error of the mean [SEM], 0.036); Gleason score of 7, 0.702 x 10(-3) mm(2)/s (SEM, 0.030); Gleason score of 8, 0.672 x 10(-3) mm(2)/s (SEM, 0.057); and Gleason score of 9, 0.686 x 10(-3) mm(2)/s (SEM, 0.067). Differences between the mean ADC values for a prostate tumor with a Gleason score of 6 and one with a Gleason score of 7 (p = 0.0096) and for a prostate tumor with a Gleason score of 6 and one with a Gleason score of 8 (p = 0.0460) were significant. Comparison between the ADC and percentage of tumor on core biopsy showed a mean ADC decrease of 0.006 (range, 0.004-0.008 x 10(-3) mm(2)/s) for every 1% increase in tumor in the core biopsy specimen. CONCLUSION DWI may help differentiate between low-risk (Gleason score, 6) and intermediate-risk (Gleason score, 7) prostate cancer and between low-risk (Gleason score, 6) and high-risk (Gleason score > 7) prostate cancer. There is an inverse relationship between the ADC and the percentage of tumor involvement on prostate core biopsies.

Comparison of Accidental and Nonaccidental Traumatic Head Injury in Children on Noncontrast Computed Tomography

OBJECTIVE. Mixed-density convexity subdural hematoma and interhemispheric subdural hematoma suggest nonaccidental head injury. The purpose of this retrospective observational study is to investigate subdural hematoma on noncontrast computed tomography in infants with nonaccidental head injury and to compare these findings in infants with accidental head trauma for whom the date of injury was known. PATIENTS AND METHODS. Two blinded, independent observers retrospectively reviewed computed tomography scans with subdural hematoma performed on the day of presentation on 9 infant victims of nonaccidental head injury (mean age: 6.8 months; range: 1–25 months) and on 38 infants (mean age: 4.8 months; range: newborn to 34 months) with accidental head trauma (birth-related: 19; short fall: 17; motor vehicle accident: 2). RESULTS. Homogeneous hyperdense subdural hematoma was significantly more common in children with accidental head trauma (28 of 38 [74%]; nonaccidental head trauma: 3 of 9 [33%]), whereas mixed-density subdural hematoma was significantly more common in cases of nonaccidental head injury (6 of 9 [67%]; accidental head trauma: 7 of 38 [18%]). Twenty-two (79%) subdural hematomas were homogeneously hyperdense on noncontrast computed tomography performed within two days of accidental head trauma, one (4%) was homogeneous and isodense compared to brain tissue, one (4%) was homogeneous and hypodense, and four (14%) were mixed-density. There was no statistically significant difference in the proportion of interhemispheric subdural hematoma, epidural hematoma, calvarial fracture, brain contusion, or subarachnoid hemorrhage. CONCLUSIONS. Homogeneous hyperdense subdural hematoma is more frequent in cases of accidental head trauma; mixed-density subdural hematoma is more frequent in cases of nonaccidental head injury but may be observed within 48 hours of accidental head trauma. Interhemispheric subdural hematoma is not specific for inflicted head injury.

Subscapularis tendon tear : Primary and associated signs on MRI

Purpose The purpose of this work was to investigate signs of subscapularis tendon tear on MRI. Method Preoperative written interpretations of high field (n = 9) and low field (n = 7) MRI of 16 patients with tears confirmed at surgery or arthroscopy were reviewed, followed by retrospective review of these studies. Results A preoperative diagnosis of subscapularis tear was made in five (31%) cases. On retrospective review, primary signs of tear were present in 15 (94%) cases and in two-thirds were limited to the cranial third of the tendon. Supraspinatus tears were present in 69% of cases. Associated findings included medial dislocation (n = 4) or subluxation (n = 3) of biceps tendon, biceps tendinopathy (n = 2), superior labral tear (n = 5), and effusions of superior subscapularis recess (n = 6), subcoracoid bursa (n = 2), or both (n = 5). One or more associated signs were present in 94% of cases. Conclusion Subscapularis tear is frequently missed on MRI. Recognizing that primary signs of tear may be limited to the cranial third of the subscapularis tendon and identifying associated signs should facilitate diagnosis.

Voice Recognition Dictation: Radiologist as Transcriptionist

Continuous voice recognition dictation systems for radiology reporting provide a viable alternative to conventional transcription services with the promise of shorter report turnaround times and increased cost savings. While these benefits may be realized in academic institutions, it is unclear how voice recognition dictation impacts the private practice radiologist who is now faced with the additional task of transcription. In this article, we compare conventional transcription services with a commercially available voice recognition system with the following results: 1) Reports dictated with voice recognition took 50% longer to dictate despite being 24% shorter than those conventionally transcribed, 2) There were 5.1 errors per case, and 90% of all voice recognition dictations contained errors prior to report signoff while 10% of transcribed reports contained errors. 3). After signoff, 35% of VR reports still had errors. Additionally, cost savings using voice recognition systems in non-academic settings may not be realized. Based on average radiologist and transcription salaries, the additional time spent dictating with voice recognition costs an additional

Perfusion abnormalities in subchondral bone associated with marrow edema, osteoarthritis, and avascular necrosis

6.10 per case or

MRI of Cerebral Microhemorrhages

76,250.00 yearly. The opportunity costs may be higher. Informally surveyed, all radiologists expressed dissatisfaction with voice recognition with feelings of frustration, and increased fatigue. In summary, in non-academic settings, utilizing radiologists as transcriptionists results in more error ridden radiology reports and increased costs compared with conventional transcription services.

The meniscal roots: gross anatomic correlation with 3-T MRI findings.

Abstract:  Bone marrow edema is seen in osteoarthritis, avascular necrosis, and other clinical conditions including the bone marrow edema syndrome. Bone marrow edema is associated with bone pain and may be related to the pathophysiology of osteoarthritis. Our hypothesis is that bone marrow edema is associated with a reduction in perfusion in subchondral bone, which contributes to focal and segmental bone necrosis and cartilage breakdown. We further hypothesize that altered fluid dynamics in subchondral bone comprise part of the physicochemical environment to which osteocytes are highly sensitive and alter their cytokine expression profile in response to changes in fluid flow, pressure, and oxygen gradients. We have used contrast‐enhanced magnetic resonance imaging with Gd‐DTPA to characterize changes in subchondral bone perfusion in two relevant and related models—the Dunkin–Hartley guinea pig model of osteoarthritis and human bone marrow edema associated with osteoarthritis and avascular necrosis. Pharmacokinetic modeling was used to extract dynamic parameters of perfusion. Representative time‐intensity curves are derived, which characterize normal bone and bone with marrow edema. Dynamic contrast‐enhanced magnetic resonance imaging may be a useful tool for the early diagnosis of bone perfusion abnormalities and may be used to characterize marrow edema associated with a number of clinical conditions. This technique may also shed light on the pathophysiology of subchondral perfusion in osteoarthritis and avascular necrosis.

Spermatic Cord Sarcomas: Sonographic and CT Features

OBJECTIVE The purpose of this pictorial essay is to discuss the differential diagnosis of cerebral microhemorrhages on T2*-weighted gradient-echo MRI. CONCLUSION Cerebral amyloid angiopathy and chronic systemic hypertension are the two most common causes of cerebral microhemorrhages. Less common causes include diffuse axonal injury, cerebral embolism, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, multiple cavernous malformations, vasculitis, hemorrhagic micrometastasis, radiation vasculopathy, and Parry-Romberg syndrome.

Spinal epidural abscess: correlation between MRI findings and outcome.

OBJECTIVE The purpose of this article is to highlight the normal anatomic features of the meniscal roots on photographs of dissected cadaveric knee specimens and 3-T MR images. CONCLUSION The meniscal roots, which are critical attachment sites of the medial and lateral menisci to the central tibial plateau, are well-visualized on intermediate-weighted, turbo spin-echo 3-T MRI and can be identified in proximity to the tibial insertions of the anterior and posterior cruciate ligaments.