Ulku Kerimoglu

Visualization of the biliary tract using gadobenate dimeglumine: preliminary findings.

Objective: To compare contrast-enhanced magnetic resonance (MR) cholangiography (CE-MRC) performed with gadobenate dimeglumine with T2-weighted MRC (T2-MRC) for visualization of the bile ducts in nondilated biliary systems. Materials and Methods: Twenty consecutive patients who underwent MR imaging (MRI) of the liver and pancreas with nondilated intrahepatic ducts were included in this retrospective study. T2-weighted MRC was performed using a multislice, high-resolution fat-suppressed half-Fourier acquisition turbo spin-echo sequence. Contrast-enhanced MR cholangiography was performed using a fat-suppressed 3-dimensional fast low-angle shot sequence acquired 1 to 1.5 hour after intravenous administration of gadobenate dimeglumine. For image interpretation, the biliary system was divided into 8 segments. Two readers graded visualization of each segment on T2-MRC and CE-MRC using a 5-point scale (0, nonvisualization; 4, excellent visualization). Final opinion for each sequence was rendered by consensus. Superiority of visualization was assessed using the McNemar test and comparing adequately (visualization scores 3 and 4) and inadequately (visualization scores 0, 1, and 2) visualized segments of the ducts on both sequences. Interobserver variability was assessed with &kgr; statistics. Results: Overall and segment-based evaluation revealed superior visualization of biliary segments with CE-MRC compared with T2-MRC. We also found a statistically significant difference between the 2 sequences for overall and for right hepatic duct and cystic channel visualization (P < 0.05). A high concordance between readers 1 and 2 both for T2-MRC and CE-MRC was achieved (85.8% and 89.4%, respectively). Conclusions: Gadobenate dimeglumine can be used as an alternative intrabiliary contrast agent for contrast-enhanced MR cholangiography in nondilated biliary systems in patients with normal excretory liver function tests.

Magnetic Resonance Imaging of the Rotator Interval in Patients on Long-term Hemodialysis : Correlation With the Range of Shoulder Motions

Objective: To assess the rotator interval of patients on long-term hemodialysis with magnetic resonance imaging (MRI) for the presence of adhesive capsulitis and to correlate these findings with shoulder motions. Methods: Seventeen shoulders in 16 patients (mean age, 53.8 years) on hemodialysis (range of duration, 4-28 years) who had pain and limited range of shoulder motion underwent MRI. Rotator interval was inspected in 3 regions (subcoracoid area, above the subscapularis muscle, and around the biceps tendon) on sagittal magnetic resonance images with regard to increased nonfatty soft tissue intensity as none, mild, moderate, and marked. Magnetic resonance images were evaluated by 2 musculoskeletal radiologists with consensus. Ranges of motion for external and internal rotation and abduction and forward flexion were assessed either normal or mildly, moderately, and severely limited. Results: Increased nonfatty soft tissue intensity within the rotator interval fat was observed in 11 shoulders (65%). Very strong positive correlation was found between the limitation of external rotation and the presence of nonfatty soft tissue infiltrating all 3 areas of the rotator interval fat (rs, between 0.81 and 0.96; P < 0.001). Strong positive correlation was found between the hemodialysis duration and the presence of nonfatty soft tissue infiltrating all 3 areas of the rotator interval fat (rs, between 0.68 and 0.71; P ≤ 0.002). Conclusions: Long-term hemodialysis results in adhesive capsulitis-like MRI findings in the shoulder joint with nonfatty soft tissue infiltration in the rotator interval that is related to hemodialysis duration. The degree of MRI obliteration of the rotator interval fat strongly correlates with the range limitation of some shoulder motions.

Intraneural hemangioma of digital nerve diagnosed with MR imaging

Hemangioma may occur at any location. Although the imaging findings of hemangioma are well known, it may be difficult to differentiate this entity from other soft-tissue tumors. Intraneural hemangiomas are extremely rare. We present a girl with a painful swelling in the fourth web space of her right hand. Since it was painful, the referring clinician considered the possibility of a glomus tumor. However, demonstration of dilated feeding or draining vessels suggested the diagnosis of hemangioma. At surgery a hemangioma of the ulnar digital nerve of the ring finger was resected marginally.

A complete supra-patellar plica with an unusual presentation

A suprapatellar plica is a persistent remnant of the embryologic synovial membrane between the suprapatellar pouch and the knee joint. Pathologic synovial plica is not a common entity, however, when present, it can mimic a variety of clinical situations. We describe here a case of pathologic suprapatellar plica that has a check-valve mechanism, which results in a clinical presentation as knee joint swelling.

Spontaneously Thrombosed Polar Renal Artery Aneurysm: Multidetector Computed Tomography Findings

CLINICAL PRESENTATION A 64-year-old white man had high blood pressure for 10 years which was controlled with medication. He presented with right upper quadrant pain and underwent ultrasound imaging, which revealed a solid exophytic lesion in the upper pole of the right kidney. Multidetector computed tomography (MDCT) was planned to exclude renal cell cancer. MDCT demonstrated an exophytic lesion that had rim calcification in noncontrast images (Figure 1). The lesion demonstrated no enhancement after administration of contrast material but was associated with a vascular structure. The main renal artery produced a branch (polar artery) near the hilum and the polar renal artery demonstrated a thrombosed aneurysm. The polar renal artery was larger than the main renal artery in addition to showing irregularity in contour (Figure 2). A renal artery aneurysm (RAA) is a rare abnormality with an incidence of less than 1% (ranging from 0.01% to 1%) and it is usually single and unilateral. RAA is asymptomatic and is found incidentally by diagnostic imaging. To the best of our knowledge, spontaneous thrombosis of a polar RAA has not been previously reported. As in our case, a thrombosed RAA may be misdiagnosed as a solid lesion such as renal cell cancer, and MDCT by dynamic examination demonstrates the vascular origin of the lesion. REFERENCES

Tendon abnormalities mimicking metastatic disease in patients with prostate cancer.

We present plain x-ray examination, bone scintigraphy, computed tomography, and magnetic resonance imaging of 2 patients diagnosed with prostate cancer who complained of hip pain. Bone scintigraphy was suggestive for metastases. Further radiologic investigation revealed benign etiologies for the hip pain; calcific tendinitis of the vastus lateralis and tendonosis of the gluteus medius tendon were visualized.

Application of first-pass contrast bolus tracking sequence for the assessment of morphology and flow dynamics in cardiac MRI.

PURPOSE There are two well-known indications for first-pass perfusion in the literature. First is the evaluation of myocardial ischemia, and the other is the evaluation of tumor vascularity. Our aim was to assess the value of a first-pass contrast bolus tracking sequence (FPCBTS) for cases unrelated to these pathologies. MATERIALS AND METHODS A total of 35 patients (age range, 1 day to 66 years; mean age, 10.4±19.2 years; median age, 4.5 months) with suspected congenital (n=31) and acquired (n=4) heart and great vessel disease were included in the study. All the patients underwent cardiac magnetic resonance imaging (MRI) and FPCBTS, and 20 patients underwent contrast enhanced magnetic resonance angiography (CE-MRA). We used cardiac MRI and CEMRA for anatomic evaluation and FPCBTS for dynamic flow evaluation. RESULTS Truncus arteriosus, double outlet right ventricle, tetralogy of Fallot, corrected transposition of great arteries, atrial and ventricular septal defect, aortic rupture, cardiac hydatid cyst, tricuspid atresia, anomalous pulmonary venous return, and interrupted aorta were detected using the technique described here. Septal defects in six patients and atrial aneurysm in two patients were excluded. The shunt gap and flow direction of the septal defects, a ruptured wall in a dissected aorta, a hydatid cyst, and the atrial relationship in two cases with paracardiac masses were diagnosed easily using this dynamic evaluation technique. CONCLUSION FPCBTS can be performed in addition to cardiac MRI and CEMRA to reveal flow dynamics and morphology.