Is There Long-term Signal Intensity Increase in the Central Nervous System on T1-weighted Images after MR Imaging with the Hepatospecific Contrast Agent Gadoxetic Acid? A Cross-sectional Study in 91 Patients.

Purpose To evaluate whether there is T1-weighted signal intensity (SI) increase in the dentate nucleus (DN) and globus pallidus (GP) in relation to the middle cerebellar peduncle (MCP), pons, and thalamus after repeated administration of the liver-specific contrast agent gadoxetic acid. Materials and Methods This was an institutional review board-approved, prospectively conducted (written informed consent acquired), cross-sectional study performed in a consecutively selected patient group (n = 91; patients received one to 37 doses of gadoxetic acid) and a control group (n = 52; subjects had never received injections of gadolinium-based contrast agent) examined with a standard T1-weighted two-dimensional spin-echo pulse sequence of the brain at 1.5 T. DN/MCP, DN-to-pons, GP-to thalamus, and GP-to-cerebrospinal fluid ratios were measured and compared by using the nonparametric Kruskal-Wallis test, corresponding pairwise tests, and Spearman correlation. Results DN/MCP (ρ = 0.51, P < .0001) and DN-to-pons (ρ = 0.41, P = .0001) ratios correlated positively with the number of previous administrations of gadoxetic acid. DN/MCP and DN-to-pons ratios were significantly different between control subjects (medians of 1.016 and 1.034, respectively) and patients with more than 10 gadoxetic acid administrations (1.038 [P < .0001] and 1.053 [P = .0100], respectively), whereas no significant difference was found in the groups with five to 10 (1.029 [P = .053] and 1.044 [P = .072], respectively) and fewer than five (1.014 [P = .420] and 1.030 [P = .595], respectively) gadoxetic acid administrations. GP-to-thalamus ratios differed significantly between the study and control groups (P < .0001), whereas no significant correlation was found for GP-to-thalamus ratios and number of gadoxetic acid administrations (ρ = 0.13, P = .2304). Conclusion Results show a significant correlation between the number of gadoxetic acid administrations and the increase of SI in the DN, which is likely due to gadolinium retention. © RSNA, 2017.

A Novel Diagnostic and Treatment Algorithm for Acute Mastoiditis in Children Based on 109 Cases.

BACKGROUND: Acute mastoiditis (AM) is a potentially life-threatening condition primarily affecting children. To date, there are no consistent criteria or valid guidelines for the diagnosis and treatment of pediatric AM. Therefore, this study evaluates the clinical course of AM in terms of clinical signs and treatment. In addition, a novel classification scheme for the disease and a treatment algorithm is being proposed. METHODS: Patient records over a 12-year period from a single center were reviewed to identify confirmed cases of AM in children. Data collected included clinical signs, body temperature, and infection parameters during the disease, as well as radiological imaging, antibiotics, and surgical as well as conservative treatment. In addition, a classification of the AM stages was established in accordance with the findings described and practical experience, consisting of four stages (1, mastoidal irritation; 2, mild AM; 3, advanced AM; 4, advanced AM and additional complications) with corresponding treatment recommendations. In the retrospective cohort, those AM cases that were treated alongside the classification were compared with the rest concerning clinical course and outcome. RESULTS: A total of 109 patients (mean age, 3.8 ± 3.8 years) were included. The main symptoms at hospital admission were auricular protrusion (n = 73; 67.0%), fever (n = 56; 51.4%) with a mean temperature of 38.3 ± 1.1°C, and otalgia (n = 28; 25.7%). The mean laboratory-tested levels of leukocytes and C-reactive protein at the time of hospital admission were 15.96 ± 8.7/nl and 59.6 ± 54.0 mg/L, respectively. During winter, there was a higher prevalence of AM, with peak hospital admissions in April (n = 22). The most common pathogen was Streptococcus pyogenes (32 cases). Treatment was purely conservative in four cases, whereas the remaining cases underwent surgery (41× grommet insertion, 64× plus mastoidectomy). The outcome was generally good, but in eight patients a second surgical procedure had to be performed as they showed signs of clinical deterioration. A total of 101 patients were treated according to the proposed algorithm, and all of which had a good outcome without the need for further interventions. CONCLUSION: Based on clinical experience in a large cohort of pediatric AM patients, a novel diagnostic and treatment algorithm has been developed and successfully tested in a retrospective cohort for AM in children to prevent further complications and to ease its management by pediatricians and otorhinolaryngologists in the emergency setting.

Traumatic basilar artery entrapment with patency of pontine perforators and absence of significant brainstem infarction: report of an unusual case.

We report a rare case of entrapment of the basilar artery into the sphenoid bone caused by a longitudinal fracture of the clivus. Using high resolution three-dimensional flat panel angiography, we show preservation of the basilar artery perforators in spite of severe stenosis of the entrapped segment of the basilar artery. There were no obvious signs and symptoms of posterior fossa stroke clinically or radiographically as far as could be assessed under given clinical circumstances.

Traumatic basilar artery entrapment with patency of pontine perforators and absence of significant brainstem infarction: report of an unusual case.

We report a rare case of entrapment of the basilar artery into the sphenoid bone caused by a longitudinal fracture of the clivus. Using high resolution three-dimensional flat panel angiography, we show preservation of the basilar artery perforators in spite of severe stenosis of the entrapped segment of the basilar artery. There were no obvious signs and symptoms of posterior fossa stroke clinically or radiographically as far as could be assessed under given clinical circumstances.

Correlation of olfactory dysfunction of different etiologies in MRI and comparison with subjective and objective olfactometry.

BACKGROUND: The clinical diagnosis of olfactory dysfunction of different etiologies has been standardized by the German Working Group of Olfactology and Gustology, but there is no agreement about the most suitable imaging modality for diagnosing this disorder. MATERIAL AND METHODS: A total of 24 patients (13 women, 11 men; mean age 52 years) with different types of olfactory dysfunction (anosmia, hyposmia) were examined by objective and subjective olfactometry and magnetic resonance imaging (MRI) of the olfactory bulb. RESULTS: There was a positive correlation between objective olfactometry and volumetry of the olfactory bulb but no correlation between subjective olfactometry and MRI. CONCLUSION: MRI allows an evaluation of the olfactory bulb and appears to be superior to other modalities such as computed tomography (CT). Objective olfactometry remains the gold standard for reliable diagnosis of olfactory dysfunction.