Silent brain infarction on magnetic resonance imaging and neurological abnormalities in community-dwelling older adults. The Cardiovascular Health Study. CHS Collaborative Research Group.

BACKGROUND AND PURPOSE: Infarctlike lesions are frequently detected in symptomatic and asymptomatic older persons undergoing cerebral MRI, but their significance in older adults has not been examined. We determined the prevalence of MRI infarcts in a population-based sample of men and women aged > or = 65 years and related these findings to demographic, cognitive, and neurological status. METHODS: MRI scanning was performed in 3660 Cardiovascular Health Study (CHS) participants after brief neurological examinations and tests of cognitive function. MRIs were read centrally for the presence of an infarct > or = 3 mm in diameter or smaller infarctlike lesions. RESULTS: MRI infarcts were detected in 1131 of 3647 participants with readable infarct information (31%) and in 961 of the subgroup of 3397 participants (28%) without known prior stroke ("silent" MRI infarcts). Smaller infarctlike lesions were found in 196 of 2516 participants who had no MRI infarcts > or = 3 mm. MRI infarcts were more common in participants who were older, had prior stroke, impaired cognition, visual field deficits, slowed repetitive finger tapping (all P < .0001), weakness on toe and heel walking, and history of memory loss, coma, or migraine headaches. Multivariate analysis in those without prior stroke showed strong associations of silent MRI infarcts with older age, history of migraines, lower digit symbol scores, and more abnormalities on neurological examination. CONCLUSIONS: MRI evidence of brain infarction is common in older men and women without a clinical history of stroke. Their strong associations with impaired cognition and neurological deficits suggest that they are neither silent nor innocuous.

Sulcal, ventricular, and white matter changes at MR imaging in the aging brain: data from the cardiovascular health study.

PURPOSE: To determine the distribution of changes in sulcal size, ventricular size, and white matter signal intensity depicted on cranial magnetic resonance (MR) images, with stratification according to age, race, and sex. MATERIALS AND METHODS: Ventricular size, sulcal size, and white matter signal intensity changes were graded on cranial MR images of 3,660 community-living, elderly participants in the Cardiovascular Health Study. A healthier subgroup was also defined. Summary statistics for both groups were generated for age, race, and sex. RESULTS: Regression models of the entire imaged cohort showed higher grades of all variables with increasing age, and higher ventricular and sulcal grades in men and in nonblack individuals. White matter grade was greater in women and in black individuals. Regression models of the healthier subgroup showed similar associations, except for a lack of association of sulcal and ventricular size with race. CONCLUSION: Sulcal width, ventricular size, and white matter signal intensity change with age, sex, and race. Knowledge of these changes is important in appropriate interpretation of MR images of the elderly.

Clinically serious abnormalities found incidentally at MR imaging of the brain: data from the Cardiovascular Health Study.

PURPOSE: To determine the prevalence of clinically serious findings unrelated to stroke on cranial magnetic resonance (MR) images in a population of community-dwelling elderly people. MATERIALS AND METHODS: Neuroradiologists reviewed MR images of 3,672 people aged 65 years and older who were enrolled in a longitudinal, population-based study of cardiovascular and cerebrovascular disease. The neuroradiologists alerted MR imaging field centers about potentially serious abnormalities. Clinical information was obtained from clinical examinations performed before MR imaging, hospital discharge summaries, and the field centers at which MR imaging was performed. RESULTS: On 3,672 image sets, 64 (1.74%) clinically serious abnormalities were found. Among the presumptive diagnoses were 19 meningiomas (0.52%), six pituitary adenomas (0.16%), five cavernous malformations (0.14%), eight vascular stenoses (0.22%), four aneurysms (0.11%), two intraventricular masses (0.05%), two subdural fluid collections (0.05%), and two other tumors (0.05%). Only nine participants with these abnormalities required surgery. All but one of the meningiomas were in women, and the prevalence of the tumor decreased with increasing age. CONCLUSION: Physicians should be alert to the possible presence of clinically serious conditions in otherwise asymptomatic elderly individuals.

Primary craniosynostosis: imaging features.

In 1851, Virchow introduced the term craniosynostosis to describe a variety of abnormalities in calvarial growth. These skull deformities are usually apparent in infancy. When an abnormal calvarial configuration is detected, a radiologic evaluation is necessary to characterize the deformity and to guide the corrective surgical procedure. Affected children are believed to have an improved outcome when diagnosis and surgical intervention occur at an early age. CT with three-dimensional reconstruction optimally evaluates the presence and degree of sutural involvement and assesses associated facial and intracranial abnormalities. This pictorial essay illustrates the imaging findings, nomenclature, and associated abnormalities of the various types of primary craniosynostosis.

The hourglass facial deformity as a consequence of orbital irradiation for bilateral retinoblastoma.

We report a case illustrating characteristic facial deformities following irradiation during infancy for bilateral retinoblastoma. CT and MR imaging revealed distinctive features of the resulting "hourglass facial deformity": hypotelorism, enophthalmos, depressed temporal bones, atrophy of the temporalis muscles, and a depressed nasion. This case also displayed premature metopic craniosynostosis and frontal sinus aplasia; these may be additional hallmarks of this deformity.

Increased signals seen in globus pallidus in T1-weighted magnetic resonance imaging in cirrhotics are not suggestive of chronic hepatic encephalopathy.

Increased, symmetrical signals of varying intensity in the globus pallidi on T1-weighted (T1W) images, without corresponding signals on T2-weighted (T2W) images, have been reported previously in chronic hepatic failure. It has been suggested that these signals are characteristic of chronic hepatic encephalopathy. To test this hypothesis, we evaluated the relationship of magnetic resonance imaging (MRI) abnormalities with ammonia, albumin, bilirubin, prothrombin time, ascites, clinical encephalopathy, and neuropsychological tests in 46 patients (16 with alcohol-induced cirrhosis and 30 with non-alcohol-induced cirrhosis). T1W signal and cortical atrophy were graded by a neuroradiologist in a blinded fashion. Eleven patients had no T1W signal, 18 had minimal T1W signal, and 17 had high T1W signal. Twenty-five patients had no cortical atrophy, 14 had mild atrophy, and 7 had moderate atrophy. Cortical atrophy was noted more commonly in patients with alcohol-induced liver disease. The neuropsychological tests correlated significantly with albumin, prothrombin time, Child-Pugh's score, clinical encephalopathy, and ammonia. T1W signal and cortical atrophy did not correlate with the neuropsychological tests, clinical encephalopathy, ascites, albumin, prothrombin time, ammonia, or Child-Pugh's score. Patients with high T1W signal showed significant correlation with bilirubin (P < .005). This study suggests that globus pallidus signal in T1W images observed in liver disease are not indicators of chronic hepatic encephalopathy as previously assumed.

Advances in brain tumor imaging.

Scientists have taken advantage of the powerful imaging capability of computed tomographic and magnetic resonance (MR) scanners to analyze brain tumor morphology in vivo. Recently, the development of functional MR imaging techniques have added the ability to noninvasively examine brain tumor function and physiology with near real-time temporal resolution, and spatial resolution approaching that of anatomic images. This advance allows the study of cerebral blood volume, cerebral blood flow, and stimulated cortical activity, which have traditionally been within the domain of positron emission tomography (PET) research. PET research on brain tumors continues mainly with research into glycolytic rates and comparison with proton MR spectroscopic lactate data. These comparisons are facilitated by the refinement of two-dimensional MR spectroscopic techniques, which provide comparable spatial resolution to that of PET. On a more clinical note, several prospective studies involving the MR contrast agent gadolinium have been carried out, specifically those optimizing the timing of contrast-enhanced postoperative MR scans after resection of glioblastomas, using triple-dose contrast to increase sensitivity to brain metastases, and using contrast-enhanced MR imaging to study the efficacy of embolization in meningiomas.

Cerebellopontine angle masses: radiologic-pathologic correlation.

The cerebellopontine angle cistern is a cerebrospinal fluid-filled space bound by the pons, cerebellum, and petrous temporal bone. Masses in this region are readily identified on cross-sectional images. Differential diagnosis of masses in this region can be simplified by using an algorithmic approach that combines morphologic and enhancement characteristics with established demographic data. Schwannomas are enhancing, round masses, most commonly arising from the vestibular nerve near the porus acusticus and associated with enlargement of the internal auditory canal. Meningiomas are enhancing, oval or hemispheric lesions with a broad attachment to the tentorium or petrous dura mater. Congenital epidermoid inclusion cysts are nonenhancing masses that have undulating margins, molding their shape to conform to the adjacent structures. Aneurysms without significant internal thrombus have prominent flow voids on magnetic resonance images.

Crohn disease: prone-angled compression view in radiographic evaluation.

A prone-angled compression radiographic view was compared with traditional radiographs in 17 patients with suspected Crohn disease. The angled view was clearly superior to the posteroanterior view in visualization of disease in the terminal ileum and small bowel and was superior to spot radiographs in six of 10 patients with disease in the small bowel. This view can be a valuable adjunct when small bowel loops overlap in the pelvic area.

Is preoperative angiography useful in patients with periampullary tumors?

Ninety patients with periampullary tumors, staged by CT scan and believed to be resectable, were staged further by visceral angiography. Most of these patients (78) had carcinoma of the head of the pancreas. Visceral angiography was normal in 62 patients. Major vessel encasement (17 patients) or occlusion (11 patients) was identified in 28 patients. There were no complications related to angiography. Among the 62 patients with normal angiograms, 48 underwent a pancreaticoduodenectomy, for a resectability rate of 77%. Among the 17 patients with vessel encasement, the resectability rate was 35%. For the 11 patients with vessel occlusion, the resectability rate was 0%. Combined with CT scan, visceral angiography is a useful adjunct in the staging of patients with periampullary tumors. Major vessel occlusion precludes resection, and major vessel encasement makes resection unlikely. If visceral angiography is normal, it is very likely that the tumor will be resectable.