RESUMEN
We report a case of arthritis of the temporomandibular joint (TMJ) associated with sclerosing osteomyelitis of the mandible and temporal bone, causing deafness. The presence of a palmoplantar pustulosis established the diagnosis of SAPHO syndrome. SAPHO (an acronym referring to synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis) syndrome is defined by the association of characteristic osteoarticular and dermatologic manifestations, with diffuse sclerosing osteomyelitis of the mandible being a part of this entity. We review the literature of SAPHO syndrome with mandibular manifestations and discuss the mechanisms of inflammatory spread from the TMJ to the cochlea. To our knowledge, this is the first description of skull base involvement in a patient with SAPHO syndrome leading to sudden deafness.
Asunto(s)
Síndrome de Hiperostosis Adquirido/diagnóstico , Pérdida Auditiva Súbita/etiología , Trastornos de la Articulación Temporomandibular/diagnóstico , Síndrome de Hiperostosis Adquirido/complicaciones , Humanos , Imagen por Resonancia Magnética , Masculino , Enfermedades Mandibulares/diagnóstico , Persona de Mediana Edad , Trastornos de la Articulación Temporomandibular/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: The purpose of this study was to compare breath-hold three-dimensional (3D) rapid gradient-echo (GRE) MR imaging obtained before and after gadolinium chelate injection with T2-weighted fast spin-echo and T2-weighted breath-hold fast spin-echo (BHFSE) MR imaging in the detection of focal hepatic masses. SUBJECTS AND METHODS: Fifty-three patients with 108 focal hepatic masses had, prospectively, MR of the liver at 1.5 T. T2-weighted fast spin-echo (6000/117 [TR/effective TE]; echo train length=16; acquisition time = 3 min 12 sec) images obtained with and without fat suppression, T2-weighted BHFSE (2700/105; echo train length = 20; acquisition time = 22 sec), and 3D rapid GRE images (10.1/1.9/30 degrees [TR/TE/alpha]) obtained during one breath-hold (12 scan locations in 21 sec or 20 scan locations in 32 sec) before and after injection of gadolinium chelate were blindly and independently analyzed in consensus by three readers. RESULTS: Gadolinium chelate-enhanced 3D rapid GRE images allowed depiction of more focal hepatic masses (90 of 108, sensitivity = 83%) than did T2-weighted fast spin-echo with fat suppression images (76 of 108, sensitivity = 70%), T2-weighted fast spin-echo without fat suppression images (74 of 108, sensitivity = 69%), T2-weighted BHFSE images (73 of 108, sensitivity = 68%), and unenhanced 3D rapid GRE images (54 of 108, sensitivity = 50%) (p < .01). No difference in sensitivity was found between the three T2-weighted sequences. CONCLUSION: Gadolinium chelate-enhanced 3D rapid GRE imaging is superior to T2-weighted fast spin-echo images obtained with or without fat suppression for the detection of focal hepatic masses. T2-weighted BHFSE is similar to T2-weighted fast spin-echo images in detecting focal hepatic lesions.
Asunto(s)
Medios de Contraste , Compuestos Heterocíclicos , Hepatopatías/diagnóstico , Hígado/patología , Imagen por Resonancia Magnética/métodos , Compuestos Organometálicos , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética/instrumentación , Imagen por Resonancia Magnética/normas , Imagen por Resonancia Magnética/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Respiración , Sensibilidad y Especificidad , Estadísticas no Paramétricas , Factores de TiempoRESUMEN
OBJECTIVE: The goal of our study was to compare a T2-weighted breath-hold fast spin-echo (BHSE) technique with T2-weighted non-breath-hold fast spin-echo techniques for imaging the liver. SUBJECTS AND METHODS: Thirty-three patients with hepatic lesions had T2-weighted BHSE images obtained in 22 sec and conventional T2-weighted non-breath-hold fast spin-echo images obtained in 3 min 12 sec with and without fat suppression. Images were analyzed quantitatively by measuring the lesion-liver contrast, spleen-liver contrast, and signal-to-noise ratios of lesions and qualitatively by evaluating the sharpness of hepatic contours, visibility of intrahepatic vessels and other segmental landmarks, and presence of artifacts. RESULTS: Quantitatively, lesion-liver contrast, spleen-liver contrast, and signal-to-noise ratios obtained with the BHSE technique were inferior to those obtained with fast spin-echo techniques with and without fat suppression (11.2 +/- 7.1 versus 15.4 +/- 10.6 and 14.5 +/- 9.8, p < .001; 5.3 +/- 3.7 versus 8.7 +/- 3.5 and 7.0 +/- 3.8, p < .001; 16.2 +/- 8.2 versus 20.1 +/- 10.9 and 19.7 +/- 9.5, p < .01, respectively; Student's t test). Qualitatively, image artifacts and intrahepatic vessel depiction on BHSE images were similar to those obtained with the fast spin-echo techniques. The BHSE technique was superior to fat-suppressed fast spin-echo technique for showing hepatic contours (p < .01; Wilcoxon signed-rank test). CONCLUSION: The BHSE technique is quantitatively inferior to non-breath-hold fast spin-echo techniques. However, further studies with a surgical standard of reference are needed to compare the three techniques in terms of sensitivity.