Objectives: The aim of this study was to evaluate the diagnostic accuracy of chemical shift imaging in vertebral compression. Patients and Methods: Forty-nine patients with vertebral compression with suspected malignancy or history of trauma were included in this study. MR imaging of the spine with standard conventional MR sequences and additional chemical shift imaging was done with 1.5 Tesla MR Unit. Regions of interest (ROI) were placed on the abnormal marrow of compressed vertebrae both on the opposed phase and on the matching in phase images and signal intensity (SI) ratio values (SI out-phase/SI-in phase) were calculated. Results: Forty-nine patients had 68 spine lesions, consisting of 49 benign and 19 malignant fractures. Student t test, receiver operating characteristic (ROC) analysis and interclass correlation test were used statistically. Mean SI ratio of benign vertebral compression (0. 68 ± 0.29, range 0.13 - 1.53) was significantly lower than malignant SI ratio values (1.06 ± 0.10, range 0.96 - 1.35). With student t-test, there was significant difference between benign compressions compared to malignant compressions (P < 0.001). Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut off value in malignant and benign lesion definition. The optimal SI ratio cut off value was found to be 0.96 for separating benign and malignant vertebral compression. The area under the curve (AUC) value was observed as 0.92 (95% confidence interval [CI] = 0.86 - 0.99). According to that cutoff value, sensitivity was 100% (95% CI = 82.35% - 100%) and the specificity was 86% (95% CI = 72.76% - 94.06%). Interobserver reliability was studied with intraclass correlation and results were statistically significant with intraclass correlation coefficient (ICC) as 0.85 (P < 0.05). Conclusions: There is significant difference in signal values between benign and malignant compression fractures in chemical shift MR imaging. Chemical shift MR imaging has much additive data to conventional MRI in vertebral compression.
Some of the lung cancers are diagnosed at metastatic stage and symptomatic ocular metastasis is very rare. Therefore, eye examination and orbital imaging are not routinely performed in lung cancer staging. Retinal detachment was detected in our patient who had visual loss in the left eye. In the imaging, choroidal metastasis was seen and the diagnosis of underlying lung adenocarcinoma was thought to be related. It is a rare presentation in the presence of eye-related symptoms that provides dramatic improvement in quality of life with early diagnosis and therefore should be kept in mind.
Background An inverted papilloma (IP) is a benign sinonasal tumor of ectodermal origin, which is locally aggressive and destructive, tends to recur if incompletely removed, and has significant malignant potential. On CT scan, the appearance of an IP is variable and nonspecific but most commonly it appears to have soft tissue density. The association of IPs and new bone formation is extremely rare; to the best of our knowledge, only one case has been reported in the literature to date. Methods We report three cases with existence of bony mass surrounded by polypoid soft tissue diagnosed as IP histopathologically. Results The nature, shape, and location of the bony mass were not in concordance with trapped bone, with tumoral calcifications, or with osteoma. Conclusion We propose that with regard to the three cases presented here, new bone formation may be associated with IP pathologically. We also believe that additional investigations are required to characterize the pathophysiological mechanisms involved in neoplasm-induced osteogenesis.
Summary A 29‐year‐old woman with swelling, multiple nodules and discharging sinuses of her right foot is presented. A single nodule on the sole was excised 15 years ago and since then she has had recurrent attacks of swelling and discharging sinuses that improved partially with antibiotics. Magnetic resonance images (MRI) revealed an ill‐defined mass predominantly with low signal intensity on T2W images. Within the granulomata, multiple unenhancing foci, with low T1W and T2W signal most likely representing the fungal balls or grains were detected. Histopathological examination revealed large clusters of microorganisms resembling fungal hyphae and bacteria, which were surrounded by mixed inflammatory infiltrate cells and stained positively by PAS and Gomori's methenamine silver stain. As minimal regression was seen on MRI with 4 months’ itraconazole (200 mg day −1 ) treatment, co‐trimoxazole (160 TMP/800 SMX b.i.d.) was added to treatment. Complete remission was established by MRI examination after 10 months with this combination therapy.
This case report demonstrates the importance of the CISS sequence, a fast imaging technique in MRI, in case of suspected nerve root avulsion. We present a case of traumatic pseudomeningoceles at T1-T2 root levels with right T2 ventral root avulsion without associated skeletal fracture diagnosed by MRI using the three dimensional CISS technique. A 28-year-old man presented to the Emergency Department following a motorcycle accident. Clinical examination revealed paresis in intrinsic muscles of the right hand. Traumatic pseudomeningoceles at T1-T2 root levels bilaterally with right T2 ventral root avulsion without associated skeletal fracture were diagnosed by three dimensional cervicothoracic MRI with CISS technique.
Complex neonatal cystic masses with fluid-debris level, multiple septa, internal echoes, and solid component in ultrasound (US) examination are fairly specific for ovarian torsion in female newborns (2). Foci of dystrophic calcifications secondary to hemorrhage have been a well-known histopathological finding of ovarian torsion (2). There is a recent case report in the literature which presents US and CT findings of an amputated ovarian torsion cyst with punctate wall calcification in an 11 month old female infant (3).