Solución del caso 15. Síndrome de Mayer-Rokitansky-Küster-Hauser atípico (tipo B) / No disponible

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Effect of copolymer-1 on serial gadolinium-enhanced MRI in relapsing remitting multiple sclerosis.

We examined the effect of Copolymer-1 (Cop1) on magnetic resonance (MR) imaging changes in 10 patients with relapsing-remitting multiple sclerosis (RRMS). Monthly gadolinium (Gd)-enhanced MR imaging was performed for 9 to 27 months in the pretreatment period followed by 10 to 14 additional months during Cop1 treatment. MR images were evaluated by two radiologists (F.S. and R.C.P.) masked to the scan date. We found a 57% decrease in the frequency of new Gd-enhancing lesions and in the mean area/month of new Gd-enhancing lesions in the Cop1 treatment period compared with the pretreatment period (0.92 versus 2.20 lesions per month and 22 mm2 versus 43 mm2 area/month; p = 0.1, Wilcoxon signed rank test). Percentage change in lesion load area on T2-weighted images showed a decrease in the accumulation of lesion area during treatment, which was significant for the patient group with a longer pretreatment period (p = 0.05, Friedman test). These results demonstrate a reduction in the number of new Gd-enhancing lesions and in the lesion load during Cop1 treatment compared with the preceding period without therapy and are suggestive of an effect of Cop1 on MR abnormalities observed in multiple sclerosis.

Magnetic resonance imaging of the breast in characterizing positive or uncertain mammographic findings.

A total of 38 suspected primary (26) or recurrent (12) breast tumors underwent enhanced magnetic resonance imaging (MRI) of the breast after positive (19) or uncertain (19) mammography. Spin echo T1-weighted images before and after intravenous administration of 0.15 mmol/kg Gd-DTPA, the latter ones at 1, 3, and 5 min, were obtained to characterize the mammographic findings. When contrast enhancement was absent, the same images were also obtained at 10 min. Evident and early focal enhancement was considered as an MRI sign of malignancy. All the lesions were submitted to histological examination (seven by core-biopsy only). Mammography results were 23 true positives and 15 false positives. MRI results were 22 true positives, 13 true negatives, 2 false positives, and 1 false negative. Twelve uncertain-mammography cases became true negatives at MRI; 1 uncertain-mammography case was the only MRI false negative; 1 positive-mammography cases became true negative at MRI. Resting on this limited series of patients, MRI is confirmed as a useful imaging technique after uncertain mammography.

Right ventricular dysplasia as a generalized cardiomyopathy? findings on magnetic resonance imaging.

The aim of our study was to define cardiac morphological and functional abnormalities of right ventricular dysplasia by magnetic resonance imaging. Twenty-two healthy volunteers (age, 37.7 +/- 14.2 years) free of cardiac or respiratory diseases (group I) and 12 patients (age, 41.9 +/- 15.8 years) with clinical, electrophysiological and cineangiographic diagnosis of right ventricular dysplasia (group II) underwent magnetic resonance imaging at 0.2 Tesla. End-diastolic diameter, trabecular disarray and segmental wall motion abnormalities were evaluated for the right ventricle as were adipose replacement and fractional shortening for both ventricles. The right ventricular end-diastolic diameter was significantly enlarged in group II (P = 0.0023). Right ventricular trabecular disarray was mild in two group I subjects, and moderate in seven and massive in five group II patients. Right ventricular systolic bulges were found in seven group II patients, aneurysms in five. Excellent agreement was found between magnetic resonance imaging and cineangiography for bulges, aneurysms and tricuspid regurgitation (P < 0.0001). On spin-echo images, signal hyperintensities, due to adipose replacement, were found in 44 cardiac regions in group II: right ventricular outflow tract (12), sub-tricuspid posterobasal region (8), right ventricular apex (9), right ventricular anterior wall (6), interventricular septum (4), left ventricular lateral wall (4), left ventricular apex (1). Significant signal-to-noise ratio differences were found between group II abnormal areas and group I myocardial tissue for the right (P < 0.0001) and left ventricles (P = 0.0006). Fractional shortening in the right and left ventricles were significantly reduced in group II (P = 0.0002 and P = 0.00016, respectively). Magnetic resonance imaging can be considered a very useful diagnostic tool for the detection of features typical of right ventricular dysplesia, such as adipose replacement, trabecular disarray, bulges and aneurysms and provides useful information about cardiac function and regional wall motion. It indicates that left ventricular involvement occurs in a significant fraction of patients, and suggests that right ventricular dysplasia may be a generalized cardiomyopathy.

[Magnetic resonance mammography in suspected tumor recurrences]. / La mammografia con Risonanza Magnetica nelle sospette recidive tumorali.

Twenty patients with clinically suspected breast cancer recurrence underwent MRI before and after paramagnetic contrast agent administration (MR mammography, MRM), after negative (4/20), questionable (11/20) or positive (5/20) X-ray mammography (XM). Spin-echo T1-weighted images before and after the i.v. administration of Gd-DTPA (0.15 mmol/kg) were acquired at 1, 3, 5, 7 and 10 minutes. Tissue behavior was studied directly on the images (qualitative analysis) and with dynamic curves of the signal-to-noise ratio and of enhancement rate (quantitative analysis). The histologic examination was performed in all cases--18 of them by surgical excision and in two by needle biopsy only. Seven of seven recurrences exhibited early (at 1 and 3 minutes) and focal qualitative enhancement, exceeding 100% at the quantitative analysis. Twelve of thirteen non-recurrences exhibited no significant qualitative enhancement, less than 40% at the quantitative analysis, while the extant lesion exhibited multifocal delayed (at 5-10 minutes) qualitative enhancement, about 60% at the quantitative analysis, and slight bilateral diffuse enhancement (proliferative dysplasia). MRM had 100% sensitivity, 92.3% specificity, 87.5% positive predictive value and 100% negative predictive value. XM had 100%, 30.8%, 43.7% and 100%, respectively (if we consider as positive all the questionable XM cases). To conclude, MRM is confirmed as a useful imaging technique in suspected breast cancer recurrences, especially after questionable XM exams.

Cranial MRI in ataxia-telangiectasia.

We examined five males with laboratory-confirmed ataxia-telangiectasia (AT), aged 9-28 years, several times by MRI (9 examinations: 5 at 0.15 T, 3 at 0.5 T, 1 at 1.5 T). Intermediate, T1-, T2- and T2*-weighted spin-echo and gradient-echo sequences were performed. All patients showed vermian atrophy, enlarged fourth ventricle and cisterna magna; four showed cerebellar hemisphere atrophy; two enlarged infracerebellar subarachnoid spaces and four patients had sinusitis. No focal areas of abnormal signal were seen in the brain, diffuse high signal was found in the central cerebral white matter of the oldest patient. AT is an important human model of inherited cancer susceptibility and multisystem ageing; as in xeroderma pigmentosum and other "breakage syndromes", ionising radiation should be avoided. When imaging is necessary, MRI should be preferred to CT in patients known or suspected to have AT and those with undefined paediatric ataxias of nontraumatic origin. If atrophy of only the cerebellum, especially the vermis, is noted, laboratory research should be performed to confirm the diagnosis of AT.

[Heart involvement in thymic neoformations: the role of magnetic resonance tomography. Experience in 3 cases]. / Interessamento cardiaco da neoformazioni timiche: il ruolo della tomografia a risonanza magnetica. Esperienza su 3 casi.

Three paracardiac masses (1 thymic cyst, 2 thymomas) were studied by magnetic resonance imaging (MRI) using spin-echo, multi-echo, and gradient-echo sequences (cine-MR). MRI showed: a pedunculate cystic lesion, typical for thymic origin, in Case 1; cardiac and pulmonary infiltration, and 3 intracardiac metastases, in Case 2; cardiovascular compression but not infiltration, in Case 3. In 3/3 cases MRI was superior to transthoracic echocardiography (TTE), and in 2/2 MRI was superior to computed tomography (CT), not performed in Case 2 (allergy to contrast agents). MRI may be considered the most important technique to evaluate cardiovascular involvement by thymic neoplasms. MRI should be performed after TTE and makes CT unnecessary.

MRI in hypertrophic cardiomyopathy: a morphofunctional study.

OBJECTIVE: We compared MRI with two-dimensional echocardiography (2dE) and Doppler echocardiography to determine the diagnostic role of MRI in hypertrophic cardiomyopathy (HCM). MATERIALS AND METHODS: Twenty-three patients with 2dE diagnosis of HCM were examined with MRI; 12 of 23 patients were also studied by color (cDE) and continuous wave (cwDE) Doppler echocardiography. Morphologic information and diastolic heart wall thickness were obtained by SE sequences; functional study was performed by gradient echo sequences (cine MR). RESULTS: The correlation between MR, SE sequences and 2dE was better for septal (r = 0.930, p < 0.01) than for posterolateral (r = 0.739, p < 0.01) wall thickness. The assessment of the distribution of the hypertrophy was changed by MR in five cases. Cine MR functional study showed a systolic subaortic signal void (dynamic obstruction) in 12 of 22 patients and a systolic left atrial signal void (mitral regurgitation) in 17 of 22. Systolic wall thickening was studied by cine MR and 2dE in 11 patients: A good correlation was found for septum (0.01 < p < 0.05) and a poor one for posterolateral wall (p > 0.05). The cine MR and cDE turbulence duration in the left ventricle and atrium showed excellent correlation (p < 0.01). Good agreement was found between the duration of subaortic turbulence (cine MR or cDE) and the pressure gradient (cwDE) (p < 0.01 and 0.01 < p < 0.05, respectively) and between cine MR and cDE semiquantitative estimate of the mitral regurgitation (p < 0.01). In all patients with subaortic MR signal void studied with cwDE, a pressure gradient was present. CONCLUSION: Magnetic resonance imaging can play an important role in the diagnosis of HCM after 2dE-DE.

[Magnetic resonance tomography compared to computed tomography in the intracardiac spread of hepatocarcinoma]. / Tomografia a risonanza magnetica a confronto con tomografia computerizzata nell'estensione intracardiaca di un epatocarcinoma.

A cirrhotic patient with inferior cava and right atrium-ventricular invasion by hepatic tumor was studied with transthoracic echocardiography (TTE), computerized tomography (CT) before and after contrast agent bolus iv, ECG-gated magnetic resonance imaging (MRI). Obesity obstacled abdominal echotomographic study; esophageal varices were relative contraindication to transesophageal echocardiography (TEE). The resolutive diagnosis was possible thanks to MRI which documented the spatial continuity among hepatic tumor, intracaval neoplastic thrombus and intracardiac mass. TTE can be considered the first step in case of suspected cardiac masses, but it is sometimes limited by the thorax conformation and not always discriminant. TEE is semi-invasive with important contraindications. CT is limited by the only axial or para-axial scans with low quality reconstructions, worsened in these cases by respiratory and cardiac movements. MRI can be considered the second step in the imaging of cardiac masses, immediately and directly after the echocardiographic techniques.