Jaume Llauger

Comparison of Morphologic Assessment of Hypertrophic Cardiomyopathy by Magnetic Resonance Versus Echocardiographic Imaging

To compare the value of echocardiography and magnetic resonance imaging (MRI) in the assessment of the amount and extent of hypertrophy in hypertrophic cardiomyopathy (HC) and, second, to correlate the degree of hypertrophy, as assessed by MRI, with clinical and electrocardiographic parameters, 30 consecutive patients (16 men and 14 women, aged 20 to 74 years) with HC were studied. Measurements of left ventricular wall thickness were performed at 11 predetermined segments (5 basal, 5 midventricular, and 1 apical) by 2-dimensional echocardiography and MRI. Two parameters derived from MRI studies were considered as indicators of the degree and extent of hypertrophy: (1) mean of the measured wall thickness at the 11 segments, and (2) the number of segments with thickness > 15 mm. Results showed that, from a total of 330 myocardial segments, thickness could be measured by echocardiography in 221 (67%), whereas MRI allowed measurement of 320 segments (97%). When compared with clinical and electrocardiographic data, no correlation was found regarding mean wall thickness and number of hypertrophied segments by MRI except for the presence of an abnormal electrocardiographic repolarization pattern. It is concluded that MRI allows a better assessment of the degree and extension of left ventricular hypertrophy than echocardiography in HC. Despite the precise information on hypertrophy provided by MRI, the amount and degree of hypertrophy bears no correlation with most of the clinical data in these patients.

Synovial hemangioma of the knee : MRI findings in two cases

The findings in two patients with histologically proven synovial hemangioma of the knee are described. Both cases emphasize the typical appearance of this unusual tumor on magnetic resonance imaging. Additional radiologic findings, such as adjacent osseous involvement, are discussed.

Computed tomographic findings in bowel ischemia

Computed tomography (CT) has been used in the evaluation of 11 patients with ischemic bowel lesions before confirmation of the disease with surgery or autopsy. The CT abnormalities were thickened bowel wall (10 patients) with post-contrast enhancement (9 patients), dilated fluid-filled bowel (9 patients), intramural low attenuation zones (5 patients), intramural gas (8 patients), and focal or diffuse free intraperitoneal fluid (5 patients). The diagnosis of bowel ischemia should be considered when performing CT in patients with abdominal pain of unknown etiology.

Hemangioma of the rectum: CT appearance.

An 18-year-old man who had severe recurrent rectal bleeding and hematuria was found to have a diffuse cavernous hemangioma of the rectosigmoid. A computed tomographic (CT) study was indicated to evaluate tumor extension and therapeutic possibilities. CT scanning revealed a large mass with phleboliths throughout the true pelvis and nodular indentations in the rectosigmoid wall involving the dome and posterior wall of the bladder. A nonhomogeneous and subtle enhancement of the lesion was noticed after injection of contrast medium.

Aggressive angiomyxoma of pelvic soft tissue: CT appearance

A case of aggressive angiomyxoma of pelvic tissue is described. The characteristic clinical presenting symptoms together with radiographic findings can be suggestive of this disease. Computed tomography (CT) clearly depicted a solid mass in the pelvis without invasion of visceral structures and reaching caudally into the perineal region.

Computed tomography as the method of choice in the diagnosis of emphysematous cholecystitis

Computed tomographic (CT) findings in 4 cases of acute emphysematous cholecystitis are described. The use of CT in the diagnosis of this condition is discussed in relation to the use of sonography and plain radiography.

Case 170: Pericardial Fat Necrosis

Pericardial fat necrosis is an uncommon condition that can be diagnosed on the basis of its characteristic CT findings.

Focal myositis of the thigh: unusual MR pattern

Focal myositis is a commonly referenced, infrequently reported and poorly documented benign inflammatory pseudotumor which may be misdiagnosed clinically as a malignant tumor. We report the clinicopathologic features and magnetic resonance imaging findings in a case of focal myositis in the thigh of a 55-year-old woman. A different radiologic presentation of this disorder is described. The gross appearance of the lesion, previously undescribed, appears to be rather specific for such a pseudoneoplastic disorder, and correlates very well with the magnetic resonance imaging features.

The growing teratoma syndrome: radiologic findings in four cases

Radiologic findings in four patients with metastatic mixed germ-cell tumors of the testis are presented. In all cases metastases had increased in size following chemotherapy in spite of normal biomarker levels, and histological study of the residual masses showed mature teratoma with an absence of malignant cells, thus confirming the diagnosis of growing teratoma syndrome. At present CT appears to be the best technique both for diagnosis and follow-up in these patients. In one case, the growing teratoma syndrome presented as cavitation of a pulmonary nodular lesion, a finding rarely described in the literature, and with CT demonstration not reported.

Muscle imaging in muscle dystrophies produced by mutations in the EMD and LMNA genes.

Identifying the mutated gene that produces a particular muscle dystrophy is difficult because different genotypes may share a phenotype and vice versa. Muscle MRI is a useful tool to recognize patterns of muscle involvement in patients with muscle dystrophies and to guide the diagnosis process. The radiologic pattern of muscle involvement in patients with mutations in the EMD and LMNA genes has not been completely established. Our objective is to describe the pattern of muscle fatty infiltration in patients with mutations in the EMD and in the LMNA genes and to search for differences between the two genotypes that could be helpful to guide the genetic tests. We conducted a national multicenter study in 42 patients, 10 with mutations in the EMD gene and 32 with mutations in the LMNA gene. MRI or CT was used to study the muscles from trunk to legs. Patients had a similar pattern of fatty infiltration regardless of whether they had the mutation in the EMD or LMNA gene. The main muscles involved were the paravertebral, glutei, quadriceps, biceps, semitendinosus, semimembranosus, adductor major, soleus, and gastrocnemius. Involvement of peroneus muscle, which was more frequently affected in patients with mutations in the EMD gene, was useful to differentiate between the two genotypes. Muscle MRI/CT identifies a similar pattern of muscle fatty infiltration in patients with mutations in the EMD or the LMNA genes. The involvement of peroneus muscles could be useful to conduct genetic analysis in patients with an EDMD phenotype.Identifying the mutated gene that produces a particular muscle dystrophy is difficult because different genotypes may share a phenotype and vice versa. Muscle MRI is a useful tool to recognize patterns of muscle involvement in patients with muscle dystrophies and to guide the diagnosis process. The radiologic pattern of muscle involvement in patients with mutations in the EMD and LMNA genes has not been completely established. Our objective is to describe the pattern of muscle fatty infiltration in patients with mutations in the EMD and in the LMNA genes and to search for differences between the two genotypes that could be helpful to guide the genetic tests. We conducted a national multicenter study in 42 patients, 10 with mutations in the EMD gene and 32 with mutations in the LMNA gene. MRI or CT was used to study the muscles from trunk to legs. Patients had a similar pattern of fatty infiltration regardless of whether they had the mutation in the EMD or LMNA gene. The main muscles involved were the paravertebral, glutei, quadriceps, biceps, semitendinosus, semimembranosus, adductor major, soleus, and gastrocnemius. Involvement of peroneus muscle, which was more frequently affected in patients with mutations in the EMD gene, was useful to differentiate between the two genotypes. Muscle MRI/CT identifies a similar pattern of muscle fatty infiltration in patients with mutations in the EMD or the LMNA genes. The involvement of peroneus muscles could be useful to conduct genetic analysis in patients with an EDMD phenotype.