Evaluation of the inferior alveolar canal for cysts and tumors of the mandible-comparison of multidetector computed tomography and 3-dimensional volume interpolated breath-hold examination magnetic resonance sequence with curved multiplanar reformatted reconstructions.

OBJECTIVE: To evaluate the mandibular canal using volume interpolated breath-hold examination (VIBE) sequencing in patients with cysts and tumors of the mandible. MATERIALS AND METHODS: Twenty-five patients with mandibular cysts and tumors were recruited for a study in the authors' institution to compare the role of multidetector row computed tomography with magnetic resonance imaging (MRI) in jaw lesions. Of these 25 patients, VIBE was performed in 12 patients (age range, 16 to 52 yrs; 11 male and 1 female patients) and formed the study group. The status (normal/destroyed/attenuated) and position of the inferior alveolar canal (normal/displaced) on panoramic reconstructed computed tomographic (CT) images and curved multiplanar reformatted (MPR) images reconstructed from VIBE images were analyzed. The contralateral normal mandibular canal was used as the control in these patients. RESULTS: In all 12 patients, the inferior alveolar canal on the normal side was visualized as a hyperintense structure in relation to the hypointense bone on the curved MPR VIBE images. In 9 patients, the inferior alveolar canal was equally well visualized on panoramic CT and curved MPR VIBE images. In 2 patients, the inferior alveolar canal was better visualized on curved MPR VIBE images; in 1 patient, the course of the mandibular canal was better seen on panoramic CT images. CONCLUSIONS: MR reconstructions with VIBE sequencing as source images provide images comparable to CT reconstructed images for evaluation of the mandibular canal. Three-dimensional (3D) VIBE sequencing can be added to the MR protocol to visualize the inferior alveolar neurovascular bundle. 3D VIBE sequencing increases the diagnostic capabilities of MRI when used to image mandibular cysts and tumors.

Antenatal ultrasound and MRI findings of Pena-Shokeir syndrome.

INTRODUCTION: Pena-Shokeir syndrome is an autosomal recessive disorder characterized by arthrogryposis, facial anomalies (micrognathia), camptodactyly, polyhydramnios and lung hypoplasia. CASE REPORT: We report prenatal ultrasonographic, antenatal MR and postnatal examination findings of a fetus with Pena-Shokeir syndrome. CONCLUSION: Pena-Shokeir syndrome is a potentially lethal condition and most cases are diagnosed prenatally by ultrasound. Fetal MR can be performed to look associated neurological malformation.

Magnetic resonance sialography using CISS and HASTE sequences in inflammatory salivary gland diseases: comparison with digital sialography.

BACKGROUND: Inflammatory conditions are the most common pathology affecting the salivary glands. Magnetic resonance (MR) sialography has emerged as an alternative to conventional sialography for evaluation of inflammatory salivary gland diseases. PURPOSE: To prospectively evaluate the role and diagnostic accuracy of MR sialography in the diagnosis of inflammatory salivary gland disease. MATERIAL AND METHODS: Thirty-seven glands in 28 patients (19 males and nine females; mean age 31 years, range 3-65 years) presenting with inflammatory salivary gland disorders underwent MR sialography. Conventional sialography was used as the gold standard and was performed in 26 patients (34 glands). Thus, comparative evaluation was done in 26 patients (34 glands). Axial T1-weighted (T1W) and fat-suppressed T2W sequences, a constructive interference in steady state (CISS) sequence in the axial plane with maximum intensity projection (MIP)/multiplanar reformation (MPR) done in the axial and sagittal oblique planes, and a half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequence in the sagittal oblique direction were performed. RESULTS: Main salivary gland duct was visualized in 32 glands (94.1%) with MR sialography, and in all 34 (100%) glands with conventional sialography. Calculus and strictures were well demonstrated by MR sialography. MR sialography was superior for demonstration of the ductal system proximal to calculus/strictures. Sensitivity and specificity for diagnosis of specific pathology were 87% and 100% with CISS sequence and 90% and 75% with HASTE sequence, respectively. On using a combination of CISS and HASTE sequences, the sensitivity, specificity, and positive and negative predictive values in the diagnosis of specific pathology were 93%, 100%, 100%, and 64%, respectively. CONCLUSION: MR sialography using CISS and HASTE sequences is a promising technique and has the potential to replace conventional sialography in patients with inflammatory salivary gland disorders.

MRI and MR sialography of juvenile recurrent parotitis.

BACKGROUND: Juvenile recurrent parotitis (JRP) is the second most common inflammatory salivary gland disease of childhood, after mumps. Diagnosis of JRP is usually based on clinical history of recurrent unilateral or bilateral parotid swelling and demonstration of sialectasis. Conventional sialography, digital sialography, US, MRI and sialoendoscopy have been used as investigative tools for the diagnosis of JRP. MR sialography is increasingly recognized as a useful supplement to sialography in salivary duct disorders. OBJECTIVE: To describe the MRI and MR sialographic findings in children with JRP. MATERIALS AND METHODS: MR Sialography was performed using T2-weighted three-dimensional constructive interference in steady-state (CISS) and half fourier acquisition single-shot turbo spin-echo (HASTE) sequences in 62 children with inflammatory salivary gland disease. Out of these 62 children, 6 had JRP. Axial T1- and T2-W images were also performed. RESULTS: The main parotid duct was normal in all six children with JRP. High signal intensity focal lesions suggestive of sialectasis were seen involving both parotid glands in all six children. CISS sequence demonstrated the intraglandular ducts and sialectasis better than HASTE images. CONCLUSION: MRI and MR sialography can non-invasively delineate the parenchymal and ductal system abnormalities of the parotid glands in children with JRP. Although MR and MR sialography cannot substitute US, they can accurately depict findings such as sialectasis and signal intensity changes in the parotid gland depending upon the phase of the disease (acute vs. chronic inflammation). The radiologist should be familiar with MR findings of JRP.

Role of MRI in fetal abdominal cystic masses detected on prenatal sonography.

OBJECTIVE: Our aim was to determine the role of fetal MRI in sonographically detected abdominal cystic masses. MATERIALS AND METHODS: Fifty-six fetuses in 56 women with fetal malformation underwent sonography and MRI. Out of the 56 fetuses, 6 had intra-abdominal cystic masses and formed our study group. MRI findings were compared with ultrasonographic findings regarding detection, anatomical localization and tissue characterization. MR findings were considered to have affected management if subsequent treatment was influenced by the MR findings and diagnosis. RESULTS: Final individual diagnoses were: meconium pseudocyst (n = 2), mesenteric cyst, hydrometrocolpos, chylous ascitis, and gross hydronephrosis with pelvic-ureteric junction obstruction (n = 1 each). MRI was superior to sonography and had supplemental value because of better anatomical localization in five cases. MRI better characterized the nature of cystic masses in two fetuses (Chylous ascitis, and hydrometrocolpos). In two patients with meconium pseudocyst, tissue characterization was inferior with MRI. Overall, addition of MRI changed the diagnosis and management in four cases. CONCLUSION: Our preliminary results suggest that because of its excellent anatomical localization and contrast resolution, MRI has a supplemental value to antenatal sonography in delineation and characterization of abdominal cystic masses.

Middle interhemispheric variant of holoprosencephaly: A rare midline malformation.

Middle interhemispheric variant (MIH) of holoprosencephaly (HPE) or syntelencephaly is a rare variant of HPE characterized by abnormal midline union of the posterior frontal and parietal lobes with variable fusion of thalami. It varies from classic HPE in embryopathogenesis, severity of fusion of brain structures, associated craniofacial anomalies and clinical presentation. We report a case of MIH in a 5-year-old girl, who presented with severe developmental delay and discuss the features differentiating it from other more common forms of HPE.

Unilateral parotid agenesis associated with pleomorphic adenoma of ipsilateral accessory parotid gland.

Congenital agenesis of the parotid gland is rare, and its association with accessory parotid tissue is even rarer. We report an unusual case of unilateral agenesis of the left parotid gland associated with pleomorphic adenoma of the left accessory parotid gland. To best of our knowledge, this is only the second such published case in the literature.

Unusual presentation of Sjögren syndrome: multiple parotid cysts.

Sjögren syndrome is a chronic autoimmune exocrinopathy that destroys salivary and lacrimal gland tissue. We report an unusual case of this disease in a 40-year-old woman who presented with bilateral parotid cystic masses. As this case illustrates, Sjögren syndrome should be included in the differential diagnosis of bilateral cystic parotid lesions.

Spontaneous rupture of benign mediastinal teratoma: A report of two cases.

Benign mediastinal teratomas are commonly asymptomatic and seldom cause complications. Spontaneous rupture into the pleura is rare and cross-sectional imaging is crucial in its early detection and planning a proper surgical approach. We report two cases of spontaneous pulmonary and pleural rupture of benign mediastinal teratoma and discuss the imaging appearances.

Disseminated zygomycosis with renal involvement simulating malignancy in a diabetic patient.

Zygomycosis or mucormycosis refers to a group of uncommon but frequently fatal mycoses caused by fungi of the class Zygomycetes. The disease is usually an opportunistic infection in patients with diabetes, immunosuppression, trauma, burn wounds and other chronic debilitating diseases. Isolated renal involvement is rare although involvement of kidneys in disseminated mucormycosis is not uncommon. Clinical awareness and thorough appropriate investigations are required for an early diagnosis and successful treatment. We herein report a case of disseminated zygomycosis presenting as renal mass with pulmonary lesions, which was initially suspected to be disseminated renal cell carcinoma before a tissue diagnosis was obtained.

Spectrum of synovial pathologies: a pictorial assay.

The synovium, a specialized vascular tissue, lines the diarthrodial joints, bursae, and tendon sheaths of the body. It helps in nourishment of articular structures. The synovium is affected by a variety of disorders that can be either localized or systemic. Although normal synovium is barely perceptible on magnetic resonance imaging, it provides an excellent imaging modality for the evaluation of pathologic processes involving the synovium. The pathologic processes affecting the synovium include 1 of the following etiologies: inflammatory, infectious, degenerative, traumatic, or neoplastic and tumor-like conditions. In this article, we discuss the magnetic resonance imaging technique and the sequences used in the evaluation of synovial pathologies and review the characteristic imaging findings of specific conditions thus narrowing the differential diagnoses.

Bladder hernia: Multidetector computed tomography findings.

Herniation of bladder in inguinal hernia is rare, with most cases diagnosed intraoperatively. Preoperative diagnosis is even rarer. We report a case of bladder as content of inguinal hernia diagnosed using multidetector computed tomography.