Sixteen patients with cirrhosis of the liver underwent cranial magnetic resonance (MR) imaging and transarterial portography to evaluate the relationship between basal ganglia lesions and portal-systemic collateral vessels. No neuropsychiatric disturbance was observed in any of the patients at the time of the MR examination, but four patients with portal-systemic encephalopathy were included in the study. Basal ganglia lesions, characterized by increased signal intensity on T1-weighted MR images, were observed in nine of the 16 patients, including the four with portal-systemic encephalopathy. These nine patients had large portal-systemic collateral vessels that were more than 10 mm in diameter. These collateral vessels were receiving blood from the superior mesenteric vein (SMV) in all nine patients. The lesions involved the globus pallidus and portions of internal capsules in a bilateral and symmetric fashion and did not exhibit mass effect. The authors conclude that there may be a significant relationship between high-intensity basal ganglia lesions and large portal-systemic collateral vessels receiving blood from the SMV.
To assess the role of magnetic resonance (MR) imaging in defining the surgical approach and in predicting permanent erectile dysfunction in patients with traumatic posterior urethral injury, 27 patients underwent MR imaging before open urethral reconstruction. MR findings were correlated with surgical findings, surgical approach, and sexual potency at 12-month follow-up. MR imaging correctly revealed the length of the urethral injury (allowing for 0.5-cm discrepancy) in 23 of 27 (85%) patients and displacement of the prostatic apex in 19 of 21 (90%) patients. MR findings prompted a change in the clinically planned surgical approach from perineal to combined perineal and transpubic in seven (26%) cases. Significant variables affecting permanent impotence were avulsion of the corpus cavernosum, (P < .001), separation of the corporeal body (P < .05), and superior and/or lateral prostatic displacement (P < .05). When MR imaging findings of both cavernous avulsion and superior and/or lateral prostatic displacement were present, the probability of permanent impotence was 95%. In the absence of these findings, the probability of normal potency was 83%. MR imaging can be performed to help select the most effective surgical approach and to assess permanent erectile dysfunction.
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