Paravertebral leiomyosarcoma mimicking a chronic ongoing inflammatory process.

Leiomyosarcomas usually present with symptoms associated with the tumor site or as painless soft tissue masses. We report the case of a young woman with spiking fever and elevated acute reaction proteins for months, in the context of a paravertebral high grade leiomyosarcoma.

MR imaging of tuberculous vertebral osteomyelitis: pictorial review.

Vertebral osteomyelitis is one of the most common manifestations of tuberculosis. Magnetic resonance imaging is considered the main imaging modality for the diagnosis, the demonstration of the extent of the disease, and follow-up studies. Vertebral destruction involving two consecutive levels with sparing of the intervertebral disc, disc herniation into the vertebral body, epidural involvement, and paraspinal abscess are the most common MRI findings suggestive of tuberculous vertebral osteomyelitis.

Focal nodular hyperplasia: imaging findings.

Focal nodular hyperplasia is an uncommon benign hepatic tumor that continues to pose diagnostic dilemmas. Imaging techniques are of great value in diagnosis of this tumor. In this article we present the US, CT, MR imaging, scintigraphy, and angiography findings. The demonstration of a central vascular scar is very helpful. Although the radiologic features may be diagnostic, many atypical cases must be differentiated from other benign or malignant hepatic tumors. In these cases excisional biopsy and histopathologic examination are necessary to determine a definite diagnosis.

Imaging of a supernumerary kidney.

A 33-year-old female patient was investigated for a right lower quadrant pain. The investigation, which included an excretory urography and a computed tomography examination, revealed a normal kidney on the right side and another two normal sized, complete kidneys on the left side, which appeared to have a small parenchymal bridge. The patient was treated surgically for a cyst of the right ovary.

A benign-looking subcutaneous metastasis from squamous cell cervical carcinoma: A case report and review of the literature.

A 30-year-old woman with a stage IIIB grade 3 squamous cell cervical carcinoma and pelvic lymph node metastases was treated with external beam radiotherapy and intracavitary brachytherapy. One month after the completion of the treatment, a rubbery, movable, and painless mass appeared in the lower third and outer aspect of her right thigh. The overlying epidermis was intact. The whole clinical picture and CT scan image indicated a benign tumor. Biopsy revealed a nonkeratinizing, grade 2-3, squamous cell carcinoma similar to the primary cervical tumor. She then received six cycles of chemotherapy (cis-platinum and 5-fluorouracil) with transient partial response. The patient died one year after the diagnosis of the disease. This is the 29th case of cutaneous metastasis from a cervical carcinoma, the seventh localized on the leg, but the first solitary one with a benign-looking appearance reported since 1855. The possible mechanism of this rare metastasis is debated and the literature is reviewed.

MRI in the investigation of patients with myelopathy thought to be due to multiple sclerosis.

The role of cerebral and spinal cord MRI was investigated in 65 patients with myelopathy suspected of having demyelinating disease. Cerebral MRI demonstrated lesions compatible with demyelination in 80% and spinal cord MRI in 68.6%. In 28.5% of our patients brain lesions were present with normal spinal cord images, but in 17% spinal cord lesions were depicted with a normal brain MRI. The combination of the two examinations demonstrated lesions in 97% of the patients. The frequency of coexistent cerebral lesions in patients with spinal cord lesions was over 85% in patients with chronic disease but only 28.5% in patients with acute myelitis.

Gadopentetate dimeglumine-enhanced MR in the diagnosis of the Tolosa-Hunt syndrome.

A 54-year-old man first was admitted with a right oculomotor nerve palsy that ameliorated spontaneously. Two months later, he was readmitted with right proptosis, ophthalmoplegia, and optic nerve involvement. MR showed an enlarged right cavernous sinus. There was dramatic improvement after high doses of steroids. MR findings 10 months later were normal. Thus, the diagnosis of the Tolosa-Hunt syndrome was established.

Correlation between spinal cord MRI and clinical features in patients with demyelinating disease.

Localisation of spinal cord lesions by MRI was correlated with neurological symptoms and signs in 16 patients with clinical and laboratory evidence of multiple sclerosis. There was good correspondence between spinal cord lesions and motor tract signs. On the other hand, superficial or deep sensory disturbances correlated with spinal cord lesions in only about a quarter of the patients. MRI of the spinal cord appeared to explain the myelopathy in 11 patients, while in 3 there was strong clinical evidence of more extensive demyelinating lesions. In 7 of the 16 patients MRI of the brain was normal.

CT and MR of pineal region tumors.

Magnetic Resonance (MR) imaging features of pineal region tumors were analyzed in 14 oncologic cases. The tumors were classified as germ-cell tumors, glial tumors, pineal parenchymal tumors, meningiomas, and cysts. They demonstrated different MR signal characteristics on precontrast scans and nodular or ring type enhancement with occasional central lucencies, except for benign cysts, which have not shown enhancement. MR images were useful in defining the relationship of the tumor to the posterior third ventricle, sylvian aqueduct, vein of Galen, and tentorium. Although CT can demonstrate in more evident fashion displacement of the original pineal calcification as well as tumor calcifications, MR imaging demonstrates different signal characteristics in germinomas and pineoblastomas which can be a useful adjunct in the evaluation and differential diagnosis of these tumors.

Retrocrural masses of extramedullary hemopoiesis in beta-thalassemia.

A case of extramedullary hemopoiesis in an 18-yr-old girl suffering from beta-thalassemia is reported. Extramedullary hemopoietic masses were localized apart from the paraspinal region in the retrocrural areas as well as the presacral region associated with massive destruction of the sacrum. The importance of recognition of hemopoietic masses in these regions in conditions other than hereditary hemolytic anaemias is briefly discussed.

Differential diagnosis of space-occupying lesions of the liver with MR imaging.

In a retrospective study of 84 patients who underwent MRI examination of the liver the qualitative parameters margin, shape, internal structure, signal intensity and the presence of a capsule were evaluated in 152 lesions comprising 48 hemangiomas, 54 secondary deposits, 23 hepatomas, 8 simple cysts, 17 hydatid cysts, 1 abscess and 1 focal fatty infiltration. Our main objective was to differentiate hemangiomas from secondary deposits and hepatomas. In hemangiomas the combination of smooth margin (98%) round or oval shape (90%) homogeneity (96%) very high signal intensity on T2-weighted sequence (94%), and the complete absence of capsule helped to distinguish them from secondary deposits and hepatomas in the majority of cases. It is concluded that with MR imaging we can establish the diagnosis of focal lesions of the liver in about 95% of cases.

CT and MRI of symptomatic spinal involvement by extramedullary haemopoiesis.

Five cases of tumour-like extramedullary haemopoiesis (EH) causing spinal cord compression or back pain are reported. Three patients were suffering from thalassaemia major, one from sickle cell anaemia and one from thalassaemia intermedia. CT findings included soft tissue masses in the epidural space of the spinal canal, spinal cord displacement and involvement of the underlying bone. MRI studies showed masses compressing the spinal cord. On T1-weighted images there was a signal of slightly higher intensity compared to that of the adjacent marrow. CT suggested the diagnosis in four cases (in the fifth it was not performed), while MRI was positive in all five. There was good correlation between the MRI findings and the CT appearance of the EH masses. Our results suggest that MRI may eliminate the need for other diagnostic examinations in the investigation of patients with EH.

Comparative study between ultrasound, computed tomography, intra-arterial digital subtraction angiography, and magnetic resonance imaging in the differentiation of tumors of the liver.

Forty-one patients with liver tumor have been evaluated with ultrasound (US), computed tomography (CT), intra-arterial digital subtraction angiography (IA-DSA), and magnetic resonance imaging (MRI) in order to establish the accuracy of each technique. In group A (24 patients), in which all four imaging modalities were performed, our results show that MRI detected all hemangiomas (25/25) compared to 22/25, 21/25, and 20/25 with US, CT, and IA-DSA, respectively. No difference between the various methods was seen in the case of hepatoma. Finally, in the patients with metastases, all four techniques had the same sensitivity (100%) but the specificity of MRI was also 100%, compared to 33% for IA-DSA and 66% for US and CT.

Magnetic resonance imaging of marrow heterotopia in haemoglobinopathy.

The MRI findings of masses of MH in three patients suffering from thalassaemia major, sickle-cell anaemia and thalassaemia intermedia, respectively, are presented. There was good correlation between the MRI findings and the conventional radiology or CT appearance of the masses. The masses produced a low intensity signal, similar to that of the adjacent marrow of the thoracic spine, while they were surrounded by a high-intensity signal rim attributed to a layer of fat surrounding the masses. The latter MRI finding is thought to be characteristic of MH masses.