Non-traumatic complications of a solitary rib osteochondroma; an unusual cause of hemoptysis and pneumothorax.

Osteochondromas are a very common and usually asymptomatic entity which may originate anywhere in the appendicular and axial skeleton. However, the ribs are a rare site of origin and here they may prove symptomatic for mechanical reasons. In this case report, we describe an unusual case of a symptomatic osteochondroma of the rib secondary to its location and unique shape, ultimately requiring surgical intervention.

MRI Vessel Wall Imaging after Intra-Arterial Treatment for Acute Ischemic Stroke.

BACKGROUND AND PURPOSE: Vessel wall imaging is increasingly performed in the diagnostic work-up of patients with ischemic stroke. The aim of this study was to compare vessel wall enhancement after intra-arterial thrombosuction with that in patients not treated with thrombosuction. MATERIALS AND METHODS: From 2009 to 2017, forty-nine patients with an ischemic stroke underwent 7T MR imaging within 3 months after symptom onset as part of a prospective intracranial vessel wall imaging study. Fourteen of these patients underwent intra-arterial treatment using thrombosuction (intra-arterial treatment group). In the intra-arterial treatment group, vessel walls were evaluated for major vessel wall changes. All patients underwent pre- and postcontrast vessel wall imaging to assess enhancing foci of the vessel wall using coregistered subtraction images. A Wilcoxon signed rank test was performed to test for differences. RESULTS: In the intra-arterial treatment group, 11 of 14 patients (79%) showed vessel wall enhancement compared with 17 of 35 patients without intra-arterial treatment (49%). In the intra-arterial treatment group, more enhancing foci were detected on the ipsilateral side (n = 18.5) compared with the contralateral side (n = 3, P = .005). Enhancement was more often concentric on the ipsilateral side (n = 8) compared with contralateral side (n = 0, P = .01). No differences were found in the group without intra-arterial treatment between the number and configuration of ipsilateral and contralateral enhancing foci. CONCLUSIONS: Patients with intra-arterial treatment by means of thrombosuction showed more (concentric) enhancing foci of the vessel wall ipsilateral compared with contralateral to the treated artery than the patients without intra-arterial treatment, suggesting reactive changes of the vessel wall. This finding should be taken into account when assessing vessel wall MR images in patients with stroke.

Comparison of 3T Intracranial Vessel Wall MRI Sequences.

BACKGROUND AND PURPOSE: Intracranial vessel wall MR imaging plays an increasing role in diagnosing intracranial vascular diseases. For a complete assessment, pre- and postcontrast sequences are required, and including other sequences, these result in a long scan duration. Ideally, the scan time of the vessel wall sequence should be reduced. The purpose of this study was to evaluate different intracranial vessel wall sequence variants to reduce scan duration, provided an acceptable image quality can be maintained. MATERIALS AND METHODS: Starting from the vessel wall sequence that we use clinically (6:42 minutes), 6 scan variants were tested (scan duration ranging between 4:39 and 8:24 minutes), creating various trade-offs among spatial resolution, SNR, and contrast-to-noise ratio. In total, 15 subjects were scanned on a 3T MR imaging scanner: In 5 subjects, all 7 variants were performed precontrast-only, and in 10 other subjects, the fastest variant (4:39 minutes) and our clinically used variant (6:42 minutes) were performed pre- and postcontrast. RESULTS: The fastest variant (4:39 minutes) had higher or comparable SNRs/contrast-to-noise ratios of the intracranial vessel walls compared with the reference sequence (6:42 minutes). Qualitative assessment showed that the contrast-to-noise ratio was most suppressed in the fastest variant of 4:39 minutes and the variant of 6:42 minutes pre- and postcontrast. SNRs/contrast-to-noise ratios of the fastest variant were all, except one, higher compared with the variant of 6:42 minutes (P < .008). Furthermore, the fastest variant (4:39 minutes) detected all vessel wall lesions identified on the 6:42-minute variant. CONCLUSIONS: A 30% faster vessel wall sequence was developed with high SNRs/contrast-to-noise ratios that resulted in good visibility of the intracranial vessel wall.