RESUMEN
Radiological anatomy education is an important aspect of the medical curriculum. The purpose of this study was to establish and demonstrate the use of plastinated anatomical specimens, specifically human hearts, for use in radiological anatomy education. Four human hearts were processed with routine plastination procedures at room temperature. Specimens were subjected to cone beam computed tomography and a graphics program (ER3D) was applied to generate 3D cardiac models. A comparison was conducted between plastinated hearts and their corresponding computer models based on a list of morphological cardiac features commonly studied in the gross anatomy laboratory. Results showed significant correspondence between plastinations and CBCT-generated 3D models (98 %; p < .01) for external structures and 100 % for internal cardiac features, while 85 % correspondence was achieved between plastinations and 2D CBCT slices. Complete correspondence (100 %) was achieved between key observations on the plastinations and internal radiological findings typically required of medical student. All pathologic features seen on the plastinated hearts were also visualized internally with the CBCT-generated models and 2D slices. These results suggest that CBCT-derived slices and models can be successfully generated from plastinated material and provide accurate representations for radiological anatomy education.
Asunto(s)
Anatomía/educación , Tomografía Computarizada de Haz Cónico , Corazón/diagnóstico por imagen , Radiología/educación , Fijación del Tejido/métodos , Corazón/anatomía & histología , HumanosRESUMEN
OBJECTIVE: To determine whether a structured and quantitative assessment of differential olfactory performance-recognized between a blast-injured traumatic brain injury (TBI) group and a demographically comparable blast-injured control group-can serve as a reliable antecedent marker for preclinical detection of intracranial neurotrauma. METHODS: We prospectively and consecutively enrolled 231 polytrauma inpatients, acutely injured from explosions during combat operations in either Afghanistan or Iraq and requiring immediate stateside evacuation and sequential admission to our tertiary care medical center over a 2½-year period. This study correlates olfactometric scores with both contemporaneous neuroimaging findings as well as the clinical diagnosis of TBI, tabulates population-specific incidence data, and investigates return of olfactory function. RESULTS: Olfactometric score predicted abnormal neuroimaging significantly better than chance alone (area under the curve = 0.78, 95% confidence interval [CI] 0.70-0.87). Normosmia was present in all troops with mild TBI (i.e., concussion) and all control subjects. Troops with radiographic evidence of frontal lobe injuries were 3 times more likely to have olfactory impairment than troops with injuries to other brain regions (relative risk 3.0, 95% CI 0.98-9.14). Normalization of scores occurred in all anosmic troops available for follow-up testing. CONCLUSION: Quantitative identification olfactometry has limited sensitivity but high specificity as a marker for detecting acute structural neuropathology from trauma. When considering whether to order advanced neuroimaging, a functional disturbance with central olfactory impairment should be regarded as an important tool to inform the decision process. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that central olfactory dysfunction identifies patients with TBI who have intracranial radiographic abnormalities with a sensitivity of 35% (95% CI 20.6%-51.7%) and specificity of 100% (95% CI 97.7%-100.0%).
Asunto(s)
Traumatismos por Explosión/diagnóstico , Lesiones Encefálicas/diagnóstico , Lóbulo Frontal/lesiones , Personal Militar/estadística & datos numéricos , Trastornos del Olfato/diagnóstico , Olfatometría/normas , Adulto , Campaña Afgana 2001- , Biomarcadores , Traumatismos por Explosión/complicaciones , Traumatismos por Explosión/epidemiología , Conmoción Encefálica/complicaciones , Conmoción Encefálica/diagnóstico , Conmoción Encefálica/epidemiología , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/epidemiología , Estudios de Cohortes , Femenino , Humanos , Guerra de Irak 2003-2011 , Masculino , Trastornos del Olfato/epidemiología , Trastornos del Olfato/etiología , Sensibilidad y Especificidad , Estados Unidos/epidemiología , Adulto JovenRESUMEN
A 25-year-old female presented with a well-defined, painless mass of 1 year's duration in the right parotid gland. MR imaging revealed a relatively well-circumscribed lesion involving the deep and superficial lobes of the right parotid gland. Histologic examination of the resection resulted in a diagnosis of sclerosing polycystic adenosis, a rare benign salivary gland entity of presumed non-neoplastic origin. The clinical, radiographic, and morphologic features of sclerosing polycystic adenosis are discussed.
Asunto(s)
Quistes/patología , Enfermedades de las Parótidas/patología , Glándula Parótida/patología , Adulto , Femenino , Humanos , Esclerosis/patologíaRESUMEN
A 20-year-old male with a prior history of germinoma presented 8 years after the initial diagnosis with progressive lower back pain. The preoperative diagnosis was schwannoma based on the appearances of a tumor in the lumbosacral region on MRI; however, histologically, a germinoma "drop" metastasis was seen. This report emphasizes the need for long-term follow-up in patients with germinoma. In addition, this patient is unusual in that the preoperative assessment favored schwannoma.
Asunto(s)
Germinoma/patología , Neurilemoma/fisiopatología , Pinealoma/patología , Neoplasias de la Médula Espinal/secundario , Gonadotropina Coriónica Humana de Subunidad beta/líquido cefalorraquídeo , Germinoma/líquido cefalorraquídeo , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Pinealoma/líquido cefalorraquídeo , Neoplasias de la Médula Espinal/líquido cefalorraquídeo , Adulto Joven , alfa-Fetoproteínas/líquido cefalorraquídeoRESUMEN
OBJECTIVE: The purpose of this study was to present the neuroimaging findings and differential diagnosis of bilateral thalamic lesions. CONCLUSION: The limited differential diagnosis of bilateral thalamic lesions can be further narrowed with knowledge of the specific imaging characteristics of the lesions in combination with the patient history.
Asunto(s)
Encefalopatías/diagnóstico , Imagen por Resonancia Magnética/métodos , Tálamo/patología , Encefalopatías/patología , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patología , Medios de Contraste , Diagnóstico Diferencial , HumanosRESUMEN
Diseases of the central nervous system (CNS) in patients infected with the human immunodeficiency virus (HIV) result directly from HIV itself or from a variety of opportunistic agents. These infections include progressive multifocal leukoencephalopathy, toxoplasmosis, and cryptococcosis. A resurgence of tuberculosis and neurosyphilis has also been documented. Mass lesions, meningoencephalitis, demyelination, atrophy, and vascular lesions are the commonly encountered imaging findings. The introduction of highly active antiretroviral therapy (HAART) has improved both the clinical and radiologic findings in HIV-infected patients and reduced the number of opportunistic infections. In countries that use HAART, AIDS (acquired immunodeficiency syndrome) dementia complex is becoming the most common neurologic complication of HIV infection, whereas opportunistic infections are still the major cause of neurologic complications in patients from countries that do not commonly use HAART. Immune reconstitution inflammatory syndrome, which occurs in some patients in the weeks to months after the institution of HAART, may alter the typical imaging appearance of infectious diseases involving the CNS. Knowledge of the spectrum of imaging findings of these infectious diseases, as well as the effect that treatment has on imaging appearances, is important in the evaluation of HIV-infected patients.
Asunto(s)
Encefalitis Viral/diagnóstico , Infecciones por VIH/diagnóstico , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , HumanosRESUMEN
Immune reconstitution inflammatory syndrome represents a spectrum of clinicopathologic entities encountered in human immunodeficiency virus-infected patients who have received highly active anti-retroviral therapy. The diagnosis is often challenging, treatment options are limited, and the prognosis is variable. To increase awareness and define the clinicopathologic features, we present our experience with 6 probable cases involving the brain, including 1 autopsy. Clinicopathologic review was supplemented by immunohistochemical analysis. There were 5 men and 1 woman, ranging in age from 34 to 47 (mean, 41; SD, 5.39) years. All patients experienced neurologic deterioration (focal deficits in 5/6) after highly active anti-retroviral therapy. All specimens showed a predominance of CD8+ lymphocytic inflammation. Concurrent CNS infections included human immunodeficiency virus encephalitis, progressive multifocal leukoencephalopathy, cryptococcal meningitis, and syphilis. One patient died, 1 was lost to follow-up, 2 improved, and 2 showed no substantial clinical changes. Subtle and overlapping features may preclude a definitive diagnosis. To capture all suspected cases, it is important to consider the possibility of this entity. In this study, the degree of CD8+ inflammation was more pronounced in the single fatal example, and mast cells were not identified in the infiltrates. Although nonspecific, imaging findings may offer clues to early diagnosis.
Asunto(s)
Terapia Antirretroviral Altamente Activa/métodos , Encéfalo/patología , Enfermedades del Sistema Nervioso Central/patología , Enfermedades del Sistema Nervioso Central/terapia , Inflamación/patología , Inflamación/terapia , Adulto , Antígenos CD/metabolismo , Encéfalo/diagnóstico por imagen , Encéfalo/virología , Enfermedades del Sistema Nervioso Central/etiología , Enfermedades del Sistema Nervioso Central/virología , Femenino , Humanos , Inflamación/etiología , Imagen por Resonancia Magnética , Masculino , Mastocitos/inmunología , Mastocitos/patología , Persona de Mediana Edad , Radiografía , Estudios RetrospectivosRESUMEN
PURPOSE: To retrospectively quantify the effect of systematic use of tube current modulation for neuroradiology computed tomographic (CT) protocols on patient dose and image quality. MATERIALS AND METHODS: This HIPAA-compliant study had institutional review board approval, with waiver of informed consent. The authors evaluated the effect of dose modulation on four types of neuroradiologic CT studies: brain CT performed without contrast material (unenhanced CT) in adult patients, unenhanced brain CT in pediatric patients, adult cervical spine CT, and adult cervical and intracranial CT angiography. For each type of CT study, three series of 100 consecutive studies were reviewed: 100 studies performed without dose modulation, 100 studies performed with z-axis dose modulation, and 100 studies performed with x-y-z-axis dose modulation. For each examination, the weighted volume CT dose index (CTDI(vol)) and dose-length product (DLP) were recorded and noise was measured. Each study was also reviewed for image quality. Continuous variables (CTDI(vol), DLP, noise) were compared by using t tests, and categorical variables (image quality) were compared by using Wilcoxon rank-sum tests. RESULTS: For unenhanced CT of adult brains, the CTDI(vol) and DLP, respectively, were reduced by 60.9% and 60.3%, respectively, by using z-axis dose modulation and by 50.4% and 22.4% by using x-y-z-axis dose modulation. Significant dose reductions (P < .001) were also observed for pediatric unenhanced brain CT, cervical spine CT, and adult cervical and intracranial CT angiography performed with each dose modulation technique. Image quality and noise were unaffected by the use of either dose modulation technique (P > .05). CONCLUSION: Use of dose-modulation techniques for neuroradiology CT examinations affords significant dose reduction while image quality is maintained.
Asunto(s)
Dosis de Radiación , Tomografía Computarizada por Rayos X/métodos , Adulto , Encéfalo/diagnóstico por imagen , Vértebras Cervicales/diagnóstico por imagen , Niño , Humanos , Radiometría/métodos , Estudios Retrospectivos , Estadísticas no Paramétricas , Tomografía Computarizada por Rayos X/instrumentaciónRESUMEN
BACKGROUND: Magnetic resonance neurography (MRN) enables visualization of peripheral nerves. Clinical examination and electrodiagnostic studies have been used in the evaluation of birth-related brachial plexus injury. These are limited in their demonstration of anatomic detail and severity of injury. OBJECTIVE: We investigated the utility of MRN in evaluating birth-related brachial plexus injury in pediatric patients, and assessed the degree of correlation between MRN findings and physical examination and electromyographic (EMG) findings. MATERIALS AND METHODS: The MRN findings in 11 infants (age 2 months to 20 months) with birth-related brachial plexus injury were evaluated. A neuroradiologist blinded to the EMG and clinical examination findings reviewed the images. Clinical history, examination, EMG and operative findings were obtained. RESULTS: All infants had abnormal imaging findings on the affected side: seven pseudomeningoceles, six neuromas, seven abnormal nerve T2 signal, four nerve root enlargement, and two denervation changes. There was greater degree of correlation between MRN and physical examination findings (kappa 0.6715, coefficient of correlation 0.7110, P < 0.001) than between EMG and physical examination findings (kappa 0.5748, coefficient of correlation 0.5883, P = 0.0012). CONCLUSION: MRN in brachial plexus trauma enables localization of injured nerves and characterization of associated pathology. MRN findings demonstrated a statistically significant correlation with physical examination and EMG findings, and might be a useful adjunct in treatment planning.
Asunto(s)
Traumatismos del Nacimiento/diagnóstico , Neuropatías del Plexo Braquial/diagnóstico , Plexo Braquial/lesiones , Imagen por Resonancia Magnética/métodos , Traumatismos del Nacimiento/cirugía , Plexo Braquial/cirugía , Neuropatías del Plexo Braquial/cirugía , Distribución de Chi-Cuadrado , Electromiografía , Femenino , Humanos , Lactante , Masculino , Estudios RetrospectivosRESUMEN
We report a case of Chiari III malformation diagnosed by fetal MRI. Ultrasound (US) performed at a gestational age of 18 weeks demonstrated a posterior skull base cyst. Repeat US at 19 weeks demonstrated neural tissue in the cyst, consistent with an encephalocele. MR imaging at 23 weeks confirmed the presence of an occipital encephalocele, demonstrated additional bony defect in the upper cervical spine, and identified abnormal morphology and position of the brainstem consistent with the diagnosis of Chiari III. Postnatal MRI and CT confirmed the fetal MRI findings and demonstrate the utility of fetal MRI in the early evaluation of songraphically detected posterior fossa abnormalities.
Asunto(s)
Malformación de Arnold-Chiari/diagnóstico , Feto/diagnóstico por imagen , Feto/patología , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Recién Nacido , Embarazo , Segundo Trimestre del Embarazo , Estadística como AsuntoRESUMEN
Atypical teratoid/rhabdoid tumors (ATRT) of infancy are highly malignant neoplasms that are most common in the first 2 years of life. We present the case of a 3-month-old girl who presented with the acute onset of generalized seizures and was found to have a large spontaneous intraventricular hemorrhage. The blood masked an underlying ATRT of the velum interpositum in the midline of the lateral ventricles and roof of the third ventricle, the first reported case in this location. Serial imaging studies and two ventriculoscopic biopsies were required to establish the diagnosis of the tumor in this unique location and in the midst of an evolving hematoma. After surgical resection, the patient received adjuvant chemotherapy. At 4-year follow-up, the child is neurologically intact, meeting normal developmental milestones, and imaging studies show no evidence of tumor. ATRT were previously associated with an extremely poor prognosis, but more recent evidence with complete surgical resection and adjuvant chemotherapy shows extended survival in some cases, supporting an aggressive and comprehensive approach to give these patients the best chance for a good outcome. Spontaneous brain hemorrhage in a full-term infant requires a diligent and persistent search to rule out an underlying neoplasm.
Asunto(s)
Neoplasias Encefálicas/cirugía , Hemorragia Cerebral/etiología , Neoplasias del Ventrículo Cerebral/cirugía , Tumor Rabdoide/cirugía , Sobrevivientes , Teratoma/cirugía , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/tratamiento farmacológico , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/cirugía , Neoplasias del Ventrículo Cerebral/diagnóstico , Neoplasias del Ventrículo Cerebral/tratamiento farmacológico , Quimioterapia Adyuvante , Craneotomía , Diagnóstico Diferencial , Epilepsia Generalizada/diagnóstico , Epilepsia Generalizada/etiología , Epilepsia Generalizada/cirugía , Epilepsia Tónico-Clónica/diagnóstico , Epilepsia Tónico-Clónica/etiología , Epilepsia Tónico-Clónica/cirugía , Femenino , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/cirugía , Lactante , Ventrículos Laterales/patología , Ventrículos Laterales/cirugía , Imagen por Resonancia Magnética , Microscopía Electrónica , Reoperación , Tumor Rabdoide/diagnóstico , Tumor Rabdoide/tratamiento farmacológico , Teratoma/diagnóstico , Teratoma/tratamiento farmacológico , Tercer Ventrículo/patología , Tercer Ventrículo/cirugía , Tomografía Computarizada por Rayos X , Derivación Ventriculoperitoneal , VentriculostomíaRESUMEN
We report a case of thoracic spine diskitis of unknown cause that had aggressive and destructive features on MR images. Results of two biopsies were unremarkable. The process began after sneezing, also produced extensive paraspinous enhancement, and resolved without antibiotic therapy both clinically and radiologically after four months. A discussion of case similarities to Reflex Sympathetic Dystrophy (RSD) in the extremities render this possibly the first reported imaging evidence of RSD in the axial skeleton.