ALT/WDL and lipoma have overlapping MR imaging characteristics. The most reliable imaging discriminators of ALT/WDL were size of lesion and lipomatous content, but due to the overlap in the MRI appearances of lipoma and ALT/WDL, discrimination should be based on molecular pathology rather than imaging.
Femoroacetabular impingement is a relatively recently appreciated "idiopathic" cause of hip pain and degenerative change. Two types of impingement have been described. The first, cam impingement, is the result of an abnormal morphology of the proximal femur, typically at the femoral head-neck junction. Cam impingement is most common in young athletic males. The second, pincer impingement, is the result of an abnormal morphology or orientation of the acetabulum. Pincer impingement is most common in middle-aged women. This article reviews the imaging findings of cam and pincer type femoroacetabular impingement. Recognition of these entities will help in the selection of the appropriate treatment with the goal of decreasing the likelihood of early degenerative change of the hip.
Sub-pubic cartilaginous cyst is an unusual, non-neoplastic, cystic lesion arising secondary to degenerative change in the symphysis pubis and usually is seen in multiparous women. Only a few case reports have been published describing the pathological findings and characteristic MRI appearances of the lesion. This report is the first to illustrate the diagnostic utility of CT-guided contrast injection into the cyst to diagnose this benign lesion. This is a simple procedure which can provide the diagnosis accurately and help to prevent excessive morbidity from wide local excision of what may be assumed to be a sarcoma.
Since 1989, four Canadian Consensus Conferences on the Diagnosis and Treatment of Dementia (CCCDTDs) have provided evidence-based dementia diagnostic and treatment guidelines for Canadian clinicians and researchers. We present the results from the Neuroimaging and Fluid Biomarkers Group of the 5th CCCDTD (CCCDTD5), which addressed topics chosen by the steering committee to reflect advances in the field and build on our previous guidelines. Recommendations on Imaging and Fluid Biomarker Use from this Conference cover a series of different fields. Prior structural imaging recommendations for both computerized tomography (CT) and magnetic resonance imaging (MRI) remain largely unchanged, but MRI is now more central to the evaluation than before, with suggested sequences described here. The use of visual rating scales for both atrophy and white matter anomalies is now included in our recommendations. Molecular imaging with [ 18 F]-fluorodeoxyglucose ([18F]-FDG) Positron Emisson Tomography (PET) or [ 99m Tc]hexamethylpropyleneamine oxime/ethylene cysteinate dimer ([ 99m Tc]-HMPAO/ECD) Single Photon Emission Tomography (SPECT), should now decidedly favor PET. The value of [ 18 F]-FDG PET in the assessment of neurodegenerative conditions has been established with greater certainty since the previous conference, and it has now been recognized as a useful biomarker to establish the presence of neurodegeneration by a number of professional organizations around the world. Furthermore, the role of amyloid PET has been clarified and our recommendations follow those from other groups in multiple countries. SPECT with [ 123 I]-ioflupane (DaTscan TM ) is now included as a useful study in differentiating Alzheimer's disease (AD) from Lewy body disease. Finally, liquid biomarkers are in a rapid phase of development and, could lead to a revolution in the assessment AD and other neurodegenerative conditions at a reasonable cost.We hope these guidelines will be useful for clinicians, researchers, policy makers, and the lay public, to inform a current and evidence-based approach to the use of neuroimaging and liquid biomarkers in clinical dementia evaluation and management.
Purpose Magnetic resonance imaging (MRI) of the brain allows for the identification of structural lesions typical of Alzheimer's disease (AD), the main cause of dementia. However, to have a clinical impact, it is imperative that acquisition and reporting of this MRI-based evidence be standardized, ensuring the highest possible reliability and reproducibility. Our objective was to validate a systematic radiological MRI acquisition and review process in the context of AD. Methods We included 100 individuals with a suspicion of dementia due to AD for whom MRI were acquired using our proposed protocol of clinically achievable acquisitions and used a unified reading grid to gather semi-quantitative evidence guiding diagnostic. MRIs were read by 3 raters with different experience levels. Interrater reliability was measured using Cohen's kappa statistic. Results Interrater reliability average for lesions occupying space, hemorrhage, or ischemia, was respectively 0.754, 0.715, and 0.501. Average reliability of white matter hyperintensity burden (Fazekas), global cortical atrophy, and temporal lobe atrophy (Scheltens) scales was 0.687, 0.473, and 0.621 (right)/0.599 (left), respectively. The kappas for regional cortical atrophy (frontal, parietal, occipital, temporal, and posterior cingulum) varied from 0.281–0.678. The average MRI reading time varied between 1.43-5.22 minutes. Conclusions The presence of space occupying lesions, hemorrhagic or ischemic phenomena, and radiological scales have a good interrater reproducibility in MRI. Coupled with standardized acquisitions, such a protocol should be used when evaluating possible dementias, especially those due to probable AD.
A 60-year-old right-handed woman was admitted to the hospital and discharged the same day following an uneventful endovascular repair (coil embolization) of an asymptomatic aneurysm. She returned to the emergency deparment (ED) on the next day with fever and confusion. She was described by family as doing well in the morning, but vomiting several times after lunch. She also showed a brief but sustained deviation of the eyes and head to the left, followed by clonic movements of the left hemibody. On her way to the ED, she showed amnesia for recent events and repeatedly asked why she was going to the hospital. In fact, she could not recall events that occurred in a 2-week period surrounding neurosurgery.Her medical history included hypertension, hypothyroidism, migraines, and a complex partial seizure 6 months prior to coiling treated with levetiracetam 500 mg BID. She was also followed by neurosurgery for 2 small saccular aneurysms of the right middle cerebral artery. There was no history of alcohol or drug abuse. Family history was negative for neurologic disorders.Upon arrival to the ED, her blood pressure was 128/84 mm Hg, her temperature was 38.6°C, and she showed confusion. She did not report any headaches. Neurologic examination revealed no focal motor or sensory deficits.
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