Temporal bone MRI with 3D-FIESTA in the evaluation of facial and audiovestibular dysfunction.

PURPOSE: To evaluate the clinical usefulness of magnetic resonance imaging (MRI) of the temporal bone using three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) sequences in patients with facial and audiovestibular dysfunction. METHODS: We retrospectively reviewed the MR images of 1263 patients who presented with hearing loss (n=429), peripheral facial palsy (n=96), tinnitus (n=341) or vertigo (n=397). There were 605 men and 658 women, with a mean age of 46.97±16.95 (SD) years (range: 2-83 years). Positive MRI findings that were responsible for clinical manifestations in individual patients were categorized according to the anatomic sites and etiologies of the lesions. RESULTS: Positive MRI findings possibly responsible for clinical manifestations were found in 232/1263 (18.37%) patients, including 86/429 (20.05%) patients with hearing loss, 21/96 (21.88%) patients with facial palsy, 62/341 (18.18%) patients with tinnitus, and 63/397 (15.87%) patients with vertigo. CONCLUSION: Although the use of MRI of the temporal bone using 3D-FIESTA shows positive findings in only 18.37% of patients, it provides important information in those with facial and audiovestibular dysfunction. However, for patients with normal MRI of the temporal bone, other etiological factors should be investigated in order to clarify or elucidate the cause of clinical manifestations.

A GIANT RETROPERITONEAL LIPOMA PRESENTING AS A SCIATIC HERNIA: MRI FINDINGS.

Sciatic hernia is a rare condition and its clinical diagnosis is uneasy. Herniation of pelvic organs as well as of retroperitoneal neoplasm has been reported in the literature. Sciatica occurs as a result of compression of the sciatic nerve by the herniated sac. We present a case of retroperitoneal lipoma in a patient who had lower leg complaint and describe the imaging findings.

Petrous apex cephalocoele: contribution of coexisting intracranial pathologies to the aetiopathogenesis.

OBJECTIVE: The aim of this study was to show the MRI findings of petrous apex cephalocoele (PAC) and the other intracranial pathologies that coexist with PAC, and to discuss the contribution of the co-existing pathologies to aetiopathogenesis. METHODS: A retrospective analysis of our imaging archive for the period from January 2012 to October 2013 revealed 13 patients with PAC (12 females and 1 male; age range, 26-69 years). 11 patients underwent MRI examination of the cranium, and 2 patients underwent MRI examination of the sellar region. We evaluated the lesions for content, signal intensity, enhancement, relation to petrous apex and Meckel's cave. Images were also evaluated for coexisting pathologies. RESULTS: The presenting symptoms included headache, vertigo, cerebrospinal fluid (CSF) leak and trigeminal neuropathy. All patients had PAC. All lesions were located posterolateral to the Meckel's cave and were isointense with CSF signal on all pulse sequences. All lesions were continuous with Meckel's cave. Coexisting pathologies included intracranial aneurysmal dilatation, empty sella, mass in hypophysis, arachnoid cyst, inferior herniation of parahippocampal gyrus and optic nerve sheath CSF distension. CONCLUSION: Coexistence with other intracranial pathologies supports the possibility of CSF imbalance and/or intracranial hypertension in the aetiopathogenesis of PAC. ADVANCES IN KNOWLEDGE: This study examined the contribution of the co-existing intracranial pathologies to the aetiopathogenesis of PAC.

Intramedullary lipoma of the cervico-thoracic spinal cord.

Most of the spinal cord lipomas reported in the literature are intradural extramedullary, and true intramedullary lipomas are very rare. We present a case of intramedullary spinal cord lipoma of the cervico-thoracic region with extensions over many spinal segments. Magnetic resonance (MR) examination showed an intramedullary lipoma of the cervico-thoracic spinal cord of both high T1 and T2-weighted signal intensity and suppression on fat saturation sequence. MR imaging assessment is critical in the detection of intramedullary lipomas which may present without any neurological deficit at an early stage. Early diagnosis may lead to prevention of the irreversible deterioration of neurological functions.