Gallbladder and urinary tract precipitations associated with ceftriaxone therapy in children: a prospective study

The incidence and outcome of gallbladder and urinary tract complications in children receiving ceftriaxone therapy were evaluated prospectively. The subjects were given intravenous ceftriaxone, 100 mg/kg/day, in two divided doses infused over 20-30-minute periods, for 5-14 days. Serial abdominal ultrasonography revealed gallbladder and urinary tract precipitations in five of 35 children, three of whom had gallbladder pseudolithiasis, one gallbladder sludge and one gallbladder pseudolithiasis and urinary bladder sludge. The children who had gallbladder sludge and gallbladder pseudolithiasis with urinary bladder sludge had abdominal pain, nausea and vomiting. Three children remained symptom-free. The gallbladder precipitations were found after 4-9 days of ceftriaxone therapy, and resolved completely 7-19 days after the end of treatment. The urinary tract precipitation was found on the 5th day after cessation of ceftriaxone therapy and resolved 7 days later. Ceftriaxone-associated gallbladder pseudolithiasis, gallbladder sludge and urinary bladder sludge usually resolve spontaneously and physicians should be aware of these complications so as to avoid unnecessary therapeutic procedures.

MR imaging features of foot involvement in patients with psoriasis

OBJECTIVE

To determine alterations of the soft tissues, tendons, cartilage, joint spaces, and bones of the foot using magnetic resonance (MR) imaging in patients with psoriasis.

MATERIALS AND METHODS

Clinical and MR examination of the foot was performed in 26 consecutive patients (52 ft) with psoriasis. As a control group, 10 healthy volunteers (20 ft) were also studied. Joint effusion/synovitis, retrocalcaneal bursitis, retroachilles bursitis, Achilles tendonitis, soft-tissue edema, para-articular enthesophytes, bone marrow edema, sinus tarsi syndrome, enthesopathy at the Achilles attachment and at the plantar fascia attachment, plantar fasciitis, tenosynovitis, subchondral cysts, and bone erosions, joint space narrowing, subchondral signal changes, osteolysis, luxation, and sub-luxation were examined.

RESULTS

Clinical signs and symptoms (pain and swelling) due to foot involvement were present in none of the patients while frequency of involvement was 92% (24/26) by MR imaging. The most common MR imaging findings were Achilles tendonitis (acute and peritendinitis) (57%), retrocalcaneal bursitis (50%), joint effusion/synovitis (46%), soft-tissue edema (46%), and para-articular enthesophytes (38%). The most commonly involved anatomical region was the hindfoot (73%).

CONCLUSION

Our data showed that the incidence of foot involvement was very high in asymptomatic patients with psoriasis on MR imaging. Further MR studies are needed to confirm these data. We conclude that MR imaging may be of importance especially in early diagnosis and treatment of inflammatory changes in the foot.

Enhancement kinetics of normal ovaries on dynamic contrast-enhanced MR imaging

OBJECTIVE

The objective was to determine the enhancement kinetics of the normal ovaries in healthy women on dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging.

METHOD

Twenty-one women who had normal ovulatory cycles (volunteers; mean age=26.3 years, range=20-35), normal hormone profile, and apparently normal ovaries on ultrasonographic scan underwent DCE-MR imaging on a 1.5-T system (Philips Medical Systems, Gyroscan Intera, Best, The Netherlands) using a phased array pelvic coil. Sequential images with an imaging time of 14.4s per dynamic image were acquired before and after injection of a contrast bolus at 30s and at 1, 2, 3, 4, and 5 min. On postprocessing examination the following measurements were obtained for ovarian and muscle tissue: the signal intensity value per dynamic study, early phase enhancement rate, time to peak enhancement (Tp), and percentage of wash-out at the fifth minute were determined. Data of the ovaries and skeletal muscle were compared using Wilcoxon's rank sum test.

RESULTS

Most of the mean values of the postcontrast signal intensity measurements, the mean values of the early phase enhancement rate, and the percentage of wash-out at the fifth minute were found to be significantly higher in ovary than in muscle (p<0.05). The mean values of Tp, on the other hand, were nonsignificantly lower in ovary than in muscle (p>0.05). On the examination of the mean signal intensity-time data graphics the ovary showed a tendency toward greater and quicker enhancement and wash-out.

CONCLUSION

In our opinion, DCE-MR imaging, which determines contrast enhancement such as wash-in and wash-out kinetics, can provide knowledge of ovarian vascularization. Thus, by using DCE-MR imaging, determination of these vascularization changes in various ovarian diseases may provide us with additional parameters in the diagnosis of and treatment strategies for ovarian diseases.

Degenerative disc disease of the lumbar spine: a prospective comparison of fast T1-weighted fluid-attenuated inversion recovery and T1-weighted turbo spin echo MR imaging

OBJECTIVE

To compare fast T1-weighted fluid-attenuated inversion recovery (FLAIR) and T1-weighted turbo spin-echo (TSE) imaging of the degenerative disc disease of the lumbar spine.

MATERIALS AND METHODS

Thirty-five consecutive patients (19 females, 16 males; mean age 41 years, range 31-67 years) with suspected degenerative disc disease of the lumbar spine were prospectively evaluated. Sagittal images of the lumbar spine were obtained using T1-weighted TSE and fast T1-weighted FLAIR sequences. Two radiologists compared these sequences both qualitatively and quantitatively.

RESULTS

On qualitative evaluation, CSF nulling, contrast at the disc-CSF interface, the disc-spinal cord (cauda equina) interface, and the spinal cord (cauda equina)-CSF interface of fast T1-weighted FLAIR images were significantly higher than those for T1-weighted TSE images (P<0.001). On quantitative evaluation of the first 15 patients, signal-to-noise ratios of cerebrospinal fluid of fast T1-weighted FLAIR imaging were significantly lower than those for T1-weighted TSE images (P<0.05). Contrast-to-noise ratios of spinal cord/CSF and normal bone marrow/disc for fast T1-weighted FLAIR images were significantly higher than those for T1-weighted TSE images (P<0.05).

CONCLUSION

Results in our study have shown that fast T1-weighted FLAIR imaging may be a valuable imaging modality in the armamentarium of lumbar spinal T1-weighted MR imaging, because the former technique has definite superior advantages such as CSF nulling, conspicuousness of the normal anatomic structures and changes in the lumbar spinal discogenic disease and image contrast and also almost equally acquisition times.

Magnetic Resonance Neurography Diagnosed Brachial Plexitis: A Case Report

Idiopathic brachial plexitis is a rare disorder presenting with pain and weakness in the shoulder girdle and upper extremity. Idiopathic brachial plexitis can mimic other conditions that cause acute pain and weakness around the shoulder, and its diagnosis can be challenging. There is no special test for the diagnosis of idiopathic brachial plexitis, although electromyography may be useful. In this case of idiopathic brachial plexitis, we present magnetic resonance neurography findings for the first time.

MR imaging features of foot involvement in ankylosing spondylitis

OBJECTIVE

To determine alterations of the soft tissue, tendon, cartilage, joint space, and bone of the foot using magnetic resonance (MR) imaging in ankylosing spondylitis (AS) patients.

MATERIALS AND METHOD

Clinical and MR examination of the foot was performed in 23 AS patients (46 feet). Ten asymptomatic volunteers (20 feet) were studied on MR imaging, as a control group. MR imaging protocol included; T1-weighted spin-echo, T2-weighted fast-field echo (FFE) and fat-suppressed short tau inversion recovery (STIR) sequences in sagittal, sagittal oblique, and coronal planes using a head coil. Specifically, we examined: bone erosions, tendinitis (acute and chronic), para-articular enthesophyte, joint effusion, plantar fasciitis, joint space narrowing, soft tissue edema, bone marrow edema, enthesopathy in the Achilles tendon and plantar fascia attachment, subchondral signal intensity abnormalities (edema and sclerosis), tenosynovitis, retrocalcaneal bursitis, subchondral cysts, subchondral fissures, and bony ankylosis. Midfoot, hindfoot, and ankle were included in examined anatomic regions.

RESULTS

Clinical signs and symptoms (pain and swelling) due to foot involvement were present in 3 (13%) of the patients while frequency of involvement was 21 (91%) with MR imaging assessment. The MR imaging findings were bone erosions (65%), Achilles tendinitis (acute and chronic) (61%), para-articular enthesophyte (48%), joint effusion (43%), plantar fasciitis (40%), joint space narrowing (40%), subchondral sclerosis (35%), soft tissue edema (30%), bone marrow edema (30%), enthesopathy of the Achilles attachment (30%), subchondral edema (26%), enthesopathy in the plantar fascia attachment (22%), retrocalcaneal bursitis (22%), subchondral cysts (17%), subchondral fissures (17%), tendinitis and enthesopathy of the plantar ligament (13%), and bony ankylosis (9%). The most common involved anatomical region was the hindfoot (83%) following by midfoot (69% ) and ankle (22%).

CONCLUSION

In our experience, MR imaging may detect inflammatory and/or erosive bone, soft tissue, cartilage, tendon, and joint abnormalities in AS patients, even if AS patients did not have clinical signs and symptoms of foot involvement. If these data prove to be confirmed in further MR studies, MR imaging may be of importance especially in early diagnosis of inflammatory changes in the foot.

[The role of three dimensional MR myelography in lumbar discogenic disease]

PURPOSE

To evaluate the role of the three dimensional (3D) MR myelography (MRM) in the diagnosis of the lumbar discogenic disease compared with conventional MR imaging.

MATERIALS AND METHODS

Fifty consecutive patients with clinical symptoms of lumbar disc herniation were enrolled for the study. Conventional MR imaging and coronal 3D MRM were performed on a 1.5 T MR system. At each disc space level, the presence and the location of disc herniation and nerve root compression were evaluated. Note was also made if MRM had additional contribution to the determination of most significant level in the cases of multilevel disc disease and lumbar spinal stenosis.

RESULTS

Disc herniation was found in 60 disc space levels on conventional MR imaging and in 54 disc space levels on 3D-MRM imaging. As regards to disc herniation, the sensitivity, specificity, and accuracy of 3D-MRM was 90%, 100%, and 96%, respectively. Nerve root compression was seen in 91 levels on conventional MR images, as opposed to 98 on 3D-MRM. Regarding nerve root compression, the sensitivity, specificity, and accuracy of 3D-MRM was 100%, 97%, and 98%, respectively. In all of 13 patients with multilevel disc disease and lumbar spinal stenosis, 3D-MRM had additional contribution.

CONCLUSION

Scan time of 3D-MRM is short. It can be easily added to routine lumbar MR imaging. It may be a valuable modality in the diagnosis of the lumbar discogenic disease. The presence of false-negative and false-positive examinations necessitates caution in interpreting 3D-MRM images. 3D MRM technique may be useful in selected cases such as patients with multilevel disc abnormalities or lumbar spinal stenosis where it allows a rapid and easy appreciation of the level most likely to account for the pathology.

Polycystic ovary syndrome: dynamic contrast-enhanced ovary MR imaging

OBJECTIVE

to determine the enhancement behaviour of the ovaries in women with polycystic ovary syndrome (PCOS) by dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging and to compare these data with those of normal ovulating controls.

METHOD

24 women with PCOS and 12 controls underwent DCE-MR imaging. Dynamic images were acquired before and after injection of a contrast bolus at 30 s and the min of 1, 2, 3, 4 and 5. On postprocessing examination: (i) the ovarian volumes; (ii) the signal intensity value of each ovary per dynamic study; (iii) early-phase enhancement rate; (iv) time to peak enhancement (T(p)); and (v) percentage of washout of 5th min were determined. Data of the ovaries of the women with PCOS and controls were compared with Mann-Whitney U-test.

RESULTS

the mean values of T(p) were found to be significantly lower in women with PCOS than in controls (p < 0.05). On the other hand, the mean values of ovarian volume, the early-phase enhancement rate, and percentage of washout of 5th min of ovaries were significantly higher in PCOS patients (p < 0.05). Examination of the mean signal intensity-time curve revealed the ovaries in women with PCOS showed a faster and greater enhancement and wash-out.

CONCLUSION

the enhancement behaviour of ovaries of women with PCOS may be significantly different from those of control subjects on DCE-MR imaging examination. In our experience, it is a valuable modality to highlight the vascularization changes in ovarian stroma with PCOS. We believe that improved DCE-MR imaging techniques may also provide us additional parameters in the diagnosis and treatment strategies of PCOS.

Radiologic aspects of abdominal hydatidosis in children

OBJECTIVE

To determine the location and radiological characteristics in children with abdominal hydatid disease (HD).

MATERIALS AND METHODS

Thirty-one children (average age: 7.2 years) with abdominal HD were studied. The number, location, diameter and internal architecture of the cysts were assessed with abdominal ultrasonography (US) and computed tomography (CT). Density measurements and enhancement patterns were determined on CT.

RESULTS

Twenty-one children had hepatic HD. The remaining 10 children had both hepatic and extrahepatic cysts. There were splenic cysts in five children, peritoneal cysts in two children and combined splenic and peritoneal cysts in three children. The most common site of the cysts was the liver (64%), followed by the spleen (20%) and the peritoneal cavity (16%). The seven intraabdominal cysts, which were not detected by US, were 20 mm or less in diameter.

CONCLUSION

CT may demonstrate additional small intrahepatic or unsuspected extrahepatic cysts. Although rare, splenic or peritoneal hydatidosis should be included in the differential diagnosis of a cystic splenic or peritoneal lesion. Familiarity with atypical locations of HD may be helpful in making a prompt, accurate diagnosis. We think that in particular patients, especially those who had diagnostic problem and who are under surgical planning, CT should be performed additionally.

[High resolution MR neurography in patients with cervical radiculopathy]

PURPOSE

To image the cervical spinal nerves directly in patients with clinical and radiographic evidence of cervical radiculopathy via high resolution MR neurography by means of a qualitative and quantitative analysis.

MATERIALS AND METHODS

Twenty symptomatic patients with cervical radiculopathy and five asymptomatic volunteers were examined. A phased-array coil system was used to obtain high-resolution coronal T1-weighted spin echo and coronal/axial short tau inversion recovery (STIR) images of the cervical spine and spinal nerves. On the axial STIR images, nerve/muscle signal intensity ratio of the cervical spinal nerves were measured on both sides and compared with paired samples t test. P values below 0.05 were considered statistically significant (p<0.05).

RESULTS

A markedly increased signal in the distal portion of the affected spinal nerves was found. Nerve/muscle signal intensity ratio measurements of the affected spinal nerves showed a significantly increased intensity compared with the noninvolved spinal nerves (p<0.05). In controls, nerve/muscle signal intensity rate was nearly identical on both sides (p>0.05).

CONCLUSION

Magnetic resonance neurography performed with phased-array coils can detect signal abnormalities within compressed cervical spinal nerves in patients with corresponding radicular symptoms and findings. This technique may be helpful especially in evaluating patients with multi-level disc disease of the cervical spine.

Unusual Sonographic Appearance of Scrotal Calculi Without Hydrocele

Scrotal calculi are rare benign lesions of the scrotum. Scrotal calculi associated with hydrocele are occasionally reported, but to the best of the authors’ knowledge, scrotal calculi without hydrocele have not been previously reported. In this study, three cases of scrotal calculi without hydrocele are presented.

[Brown tumor of the maxillary sinus: a case report]

Brown tumor of the paranasal sinuses is rare. It is a benign fibro-osseous lesion, typically presenting as an expansile mass that leads to a cortical defect. We presented the radiological findings of a brown tumor of the right maxillary sinus in a 13-year-old boy who presented with complaints of swelling in the right maxillary region, headache, and epistaxis. Biochemical findings were compatible with primary hyperparathyroidism. The lesion was removed by partial parathyroidectomy. No recurrences or residual mass were detected during a six-month follow-up period.

Doppler measurement of blood flow velocities in extraocular orbital vessels in patients with obstructive sleep apnea syndrome

PURPOSE

We used color Doppler sonography to determine blood flow velocities in the extraocular orbital vessels of patients with obstructive sleep apnea syndrome (OSAS) and compared the results with those of healthy control subjects without OSAS.

METHODS

Patients with OSAS were classified according to the apnea-hypopnea index (AHI) as having mild OSAS (AHI < 20) or severe OSAS (AHI > or = 20). The peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index were measured in the ophthalmic artery (OA), central retinal artery (CRA), lateral short posterior ciliary artery, and medial short posterior ciliary artery using color Doppler sonography. Only 1 eye was measured in each study participant, and right and left eyes were chosen randomly. The blood flow velocities of patients with OSAS and those of control subjects were compared with the Kruskal-Wallis test and Wilcoxon's rank-sum test.

RESULTS

The study comprised 30 patients (15 with mild and 15 with severe OSAS) and 20 healthy control subjects. Blood flow velocities were higher in most measured vessels in patients with OSAS than they were in the control subjects. Among patients with mild OSAS, the PSVs and EDVs in the posterior ciliary arteries were statistically significantly higher than those of the control group (p < 0.05), but those in the OA and CRA did not differ significantly between the mild OSAS group and the control group (p > 0.05). However, as the severity of OSAS increased, the PSVs and EDVs of the OA and CRA were also affected (p < 0.05).

CONCLUSIONS

Color Doppler sonographic measurements of blood flow parameters in the orbital vessels may differ significantly between patients with OSAS and those without the syndrome. Therefore, OSAS should be considered in addition to other conditions when interpreting the results of color Doppler sonography of the extraocular orbital vessels if the clinical history points toward such a diagnosis.

A case of monostotic fibrous dysplasia of the maxillary sinus

Fibrous dysplasia is an uncommon benign disease of the bone, with slow progression. Monostotic involvement of the paranasal sinuses is rare. We report a 54-year-old woman who had complaints of facial asymmetry, chronic sinusitis, recurrent headaches, and nasal obstruction for two years. Conventional radiography showed opacification and expansion of the maxillary sinus. Axial and coronal computed tomography scans showed a heterogeneous mass that expanded the right maxillary sinus, leading to nasal obstruction and cortical thickening of the maxilla. No signs of destruction or erosion in the cortical bone were identified. An endonasal endoscopic biopsy was performed and the diagnosis of fibrous dysplasia was confirmed histologically.

Radiological characteristics of pulmonary hydatid disease in children: less common radiological appearances

OBJECTIVE

To evaluate the chest roentgenogram and CT characteristics of pulmonary hydatid disease (PHD).

MATERIAL AND METHODS

Forty-seven (27 male and 20 female, aged between 3 and 11 years) consecutive pediatric patients with surgically proven pulmonary hydatid cysts were enrolled for the study. Posteroanterior and lateral chest roentgenograms, CT of the chest, and laboratory findings (latex agglutination, Casoni skin test, and eosinophil count) were obtained from all of the patients. The radiological features (localization, internal architecture, number, diameter) were determined.

RESULTS

On CT examination, a total of 79 cysts were determined. On chest roentgenogram, 57 of 79 cysts were detected in all patients. Single cysts were seen in 33 patients, while multiple cysts were seen in 14. Median CT density of the cysts was 21 Hounsfield units (HU) (0-80). There were six giant cysts (>10 cm of cyst diameter). The crescent sign, water lily sign, and air-fluid level were seen in two, five and eight of the cysts, respectively. Apart from the classically described features of pulmonary hydatid cysts of the lung, a crescent-shaped rim of air at the lower end of the cyst (inverse crescent sign) was detected in three cysts. All of the liquid content of the cyst was expelled to the bronchial system (dry cyst sign) was observed in seven cysts. There were two infected cysts. Heavily calcified curvilinear cyst wall was present in one cyst. Pericystic reaction in the lung tissue was observed in five patients. Other features included pleural effusion (n=2), mediastinal shift (n=6) and atelectasis (n=7).

CONCLUSIONS

Chest roentgenogram is helpful for diagnosis of intact cysts but, it is impossible to define entire morphology of the complicated cysts. CT imaging recognize certain details of the lesions and discover others that are not visible by conventional radiography. In conclusion, CT examination should be done to elucidate cystic nature of the lung mass and for accurate localization in the preoperative period. In addition, inverse crescent sign should be recognized as feature of pulmonary hydatid cysts on CT.

Internal jugular phlebectasia: usefulness of color Doppler ultrasonography in the diagnosis

Jugular phlebectasia (JP) is an entity that has been increasingly recognized in recent years. It is a rare entity. This paper reports three new cases presenting with swelling on the right side of the neck, and reviews all cases of internal JP published in English literature up to 2001. This article also discusses the usefulness of color Doppler ultrasonography for the diagnosis of internal jugular venous ectasia.