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Résonance magnétique ouverte Open MR system

IMAGE DU MOIS - CASE OF THE MONTH

First toe axial T2 WI: tenosynovial cyst

(Avertissement: la majorité des images présentées ici ont encore été réalisées sur un modèle d'appareil ouvert qui n'est plus celui que nous utilisons actuellement)
(Warning: most images still presented here have been obtained with an older MRI model which we don't use any more)

Musculosketal cases

• Shoulder: tear of superior labrum and of inferior surface of supraspinatus tendon. Osteoarthritis of glenohumeral and acromioclavicular joints
• Shoulder: complete supraspinatus tendon rupture (long arrow) with passage of gadolinium into subdeltoid bursa (short arrow)
• Shoulder: spinoglenoid cyst (paralabral cyst) and subdeltoid bursitis with partial supraspinatus tendon rupture
• Shoulder: giant synovial cyst from degenerative acromioclavicular joint - Lateral extension images
• Supraspinatous tendon desinsertion, passage of Gd into subacromial bursa
• Partial rupture of shoulder rotator cuff
• R. shoulder, ax.: subscapular tendon rupture and retraction (yellow arrow) + biceps tendon luxation (blue arrow)
• Shoulder superior labrum tear (SLAP)
• Shoulder: Bankart lesion of the anterior labrum
• Shoulder: post-traumatic adhesive capsulitis with thickening of inferior recess capsula
• Shoulder: inferior paralabral cyst (Most paralabral cysts are related to a labrum tear. Spinoglenoid cysts may compress the suprascapular nerve)
• Elbow synovial osteochondromatosis
• Sternum transversal fracture
• Osteoid osteoma of the cubitus; edema of overlying skin (STIR)
• Wrist: de Quervain's tenosynovitis (abductor pollicis longus + extensor pollicis brevis)
• Wrist: Giant cell tumor of synovial sheath between flexor digitorum tendons
• Stress fracture of the left wing of the sacrum
• Hip arthrography: anterosuperior labrum tear with free fragment
• Hip MR arthrography: superolateral labrum tear
• Bilateral femoral head osteonecrosis (hemochromatosis)
• Hip spontaneous algodystrophy (transient regional osteoporosis)
• Hip: left trochanteric bursitis
• Hip: congenital dislocation with degenerative changes
• Grade II chondrosarcoma of proximal femur
• Femur chronic osteomyelitis with intramuscular abscess
• Knee: osteonecrosis of medial femoral condyle
• Knee medial femoral condyle osteonecrosis
• Knee, cor. T1 WI: osteochondritis dissecans of medial femoral condyle
• Knee: villonodular synovitis (enhancing proliferation + hemosiderin deposits)
• Double tear of medial meniscus - posterior horn
• Knee: medial meniscus body vertical tear
• Discoid external meniscus
• Lateral meniscus radial tear axial reconstruction with normal case comparison
• Torn lateral meniscus with luxation of the fragment into the intercondylar notch
• Knee: fracture of the medial tibial spine. Intact anterior cruciate ligament
• Knee: proximal rupture of the anterior cruciate ligament
• Knee: traumatic rupture of the anterior cruciate ligament
• Knee ACL rupture with bone bruises, medial meniscus avulsion and blood-liquid level
• Segond's fracture of lateral tibial plateau and anterior cruciate ligament rupture. Lesion of iliotibial tract
• Knee, T2WI sag.: Posterior cruciate ligament distal avulsion
• Knee: posterior cruciate ligament rupture; Baker's cyst; intraosseous ganglion (femur)
• Knee: multiple huge intra-articular foreign bodies consistent with synovial osteochondromatosis
• Baker's cyst (medial popliteal cyst)
• Knee: dysplastic femoro-patellar joint, lateral patellar tilt & subluxation with secondary degenerative arthritis
• Patella alta with severe patellofemoral dysplasia and osteochondral degeneration
• Knee: severe patellofemoral dysplasia with lateral chondromalacia
• Patella surface lesion of articular cartilage
• Patella cartilage laceration
• Knee: anterior ganglion cyst
• Knee: pain and edema of the tibial tuberosity consistent with Osgood-Schlatter disease
• Mirroring bone contusions after external patella luxation; rupture of medial alar ligament
• Fracture-luxation of the patella with bone bruise on the anterior aspect of the lateral condyle
• Knee: medial patellar plica / popliteal (Baker's) cyst
• Jumper's knee (proximal patellar tendinopathy) with thickening and partial rupture of the tendon
• Fracture of medial tibial plateau with hemarthrosis (blood-liquid level)
• Tibial proximal metaphysis fracture in a 63-y. old woman with osteoporosis
• Knee exostosis (osteochondroma) with reactional bursitis
• Tibial exostosis (osteochondroma)
• Tibial stress syndrome (shin splints)
• Calcaneum traumatic fracture with edema and fracture line
• Ankle: spontaneous lateral malleole fracture secondary to flat foot
• Ankle: stress fracture of navicular bone
• Ankle: degenerative changes in haemophilia
• Ankle: traumatic rupture of the anterior talofibular ligament
• Ankle: osteochondritis dissecans (osteochondral fracture) of the talar dome
• Ankle: osteochondral fracture (osteochondritis dissecans) of the talus
• Ankle intra-articular osseous foreign bodies
• Ankle, sag. medial T2WI: tenosynovitis of the flexor digitorum longus pedis
• Ankle: calcaneonavicular coalition

Head and neck cases

• Pineal cyst (asymptomatic)
• Acromegaly - Pituitary macroadenoma (Gd enhanced) encasing carotids & sinus cavernosus; chiasma compression
• Prolactine-secreting microadenoma (cor. T1 + Gd)
• Right pituitary lobe microadenoma (cor. T1 + Gd)
• Right pituitary lobe microadenoma (very small)
• Suprasellar arachnoid cyst with omega deformation of sellar diaphragm
• Intracanalar VIIIth nerve schwannoma (neurinoma) gadolinium enhancing; megacisterna magna (*)
• Righ enhancing acoustic neuroma (schwannoma of the VIIIth nerve)
• Cerebellar vermis atrophy (alcohol related)
• Ring enhancement of a multiple sclerosis lesion (brain)
• White matter lesions consistent with clinic suspicion of demyelinating disease (multiple sclerosis)
• Brain confluent periventricular white matter lesions - Binswanger's disease (vascular encephalopathy)
• Acute (24 hours) right occipital infarct with edema and diffusion coefficient change still without enhancement
• Acute left parietal brain infarct (4 days)
• Small enhancing cortical infarction (25 days, subacute)
• Left temporo-occipital encephalomalacia 30 y. after ischemic event
• Subacute nontraumatic brain haemorrhage (3 weeks) with edge enhancement
• MR angiography: left posterior cerebral artery originating from carotis interna ("fetal origin")
• Arteriovenous malformation
• Left orbit arterio-venous malformation with subcutaneous a-v fistula
• Cavernous angioma of the insula
• Transverse & sigmoid sinus thrombosis in a young girl under oral contraceptive
• Giant temporal arachnoidal cyst (without neurologic deficit)
• Bilateral plexus choroideus cyst - 2nd example
• Mega cisterna magna
• Cavum septi pellucidi with posterior extension as a cavum vergae (anatomic variants)
• Persistent cavum septi pellucidi and empty sella (partial)
• Trigeminal artery
• Multiple brain metastases (breast origin) with parietal edematous reaction
• Meningioma of the posterior fossa related to the transverse-sigmoid sinus
• Myopic deformity of ocular bulbs
• Maxillary sinusitis with fluid level and mucous membrane thickening
• Sphenoid sinusitis with mucosa thickening and left-sided liquid level
• Sphenoidal sinus mucous hypertrophy
• Concha bullosa (unilateral)
• Tongue base carcinoma with jugular nodal metastasis
• Carcinoma of left piriform sinus with invasion of the three folds region, nodal and perineural(X) spread, left jugular vein thrombosis
• Adenoids hypertrophy
• Temporomandibular joint: meniscus tear with anterior luxation in closed mouth position

Spine cases

• Cervical spine: Fracture of the dens of C2
• Rheumatoid arthritis with C1-C2 dislocation and severe medullary compression
• Cervical disc hernia
• Cervical spine: C6-C7 posterolateral disc hernia
• Left C6-C7 disc hernia
• C5-C6 disc hernia with indentation of the spinal cord
• Spinal cord compression by C3-C4 and C6-C7 herniation plus spinal canal stenosis with myelopathy
• Vertebral artery loop in the left C4-C5 foramen
• Enhancing cervical MS plaque in a young female with tranverse myelitis
• Syringomyelia (hardly any neurologic deficit)
• Dorsal spine intradural extramedullary enhancing tumor (meningioma)
• Breast cancer metastasis to T1 vertebra with peridural invasion and cord compression
• Thoracic spine vertebral metastases
• Dorsal renal carcinoma metastasis with invasion of posterior elements and epidural space
• Diastematomyelia
  
• L1-L2 disc hernia
• L5-S1 upward herniated disc
• Lumbar degenerative canal stenosis (L4-L5)
• Giant L3-L4 disc hernia
• Lumbar right foraminal herniated disc fragment (L4-L5 level)
• Lumbar spine: malformative spinal canal stenosis
• Lumbar spine: recent bilateral isthmic fracture of L4 (spondylolysis) with edema
• Stress fracture of left vertebral pedicle with evolution
• Extracanalar degenerative synovial cyst of L4-L5 posterior joint
• Lumbar spine S2 Tarlov (radicular) cyst [+ Subserous uterine myoma]
• Florid lumbosacral tuberculosis (Pott's disease) with epidural and sacral abscesses
• Sacral lipomeningocele + tethered cord

Abdominal cases

• Liver: normal MR cholangiography
• Liver: hemangioma signal characteristics in different sequences and after Gadolinium
• Liver: hemangioma signal caracteristics without / with IV superparamagnetic iron oxide particles (SPIO)
• Liver: acute cholecystitis with gallstone in the common bile duct at pancreatic level
• Liver: multiple adenocarcinoma metastases
• Sigmoid colon diverticulosis
• Bladder exophytic tumor with wall thickening and metastatic lymph nodes
• Uterus: double uterus malformation including vagina duplication
• Uterus: bicornuate malformation
• Uterine myoma
• Uterine myomas with typical hypointense signal
• Huge subserous anterior uterine leiomyoma with cystic degeneration
• Giant uterine myomas with cystic degeneration (T2)
• Anterior cervix wall adenocarcinoma (endometrioid type) showing no enhancement, with necrotic center
• Endometrial carcinoma
• Uterus: Nabothian cysts of the cervix
• Partially cystic and enhancing ovarian tumor (T1 & T2 WI, T1 with Gadolinium)
• Endometriotic ovarian cysts with shading effect on right
• Pelvimetry (sag. T1)
• Urethra diverticulum
• Rectum carcinoma (endoluminal) and vagina's Gartner's duct cyst (sag. T1&T2)
• Prostatic carcinoma invading bladder wall + paravesical fat, iliac adenopathies and multiple bone metastases

Soft parts

• Breasts: bilateral retroareolar haemorrhagic cysts
• Breast prosthesis extracapsular rupture
• Carotis externa saccular aneurysm (non traumatic)
• Head: multiple scalp epidermic cysts
• Neck: incidental hemorragic left lobe thyroid mass in Hashimoto Thyroiditis
• Left iliofemoral vein thrombosis
• Hip: rupture of rectus femoris muscle
• Thigh: partial rupture of rectus femoris muscle
• Thigh: benign subcutaneous lipoma
• Subacute musculo-aponeurotic haematoma of medial gastrocnemius muscle
• Denervation myopathy of tibial anterior muscle in recent paraparesia (cor. STIR)
• Traumatic rupture of Achilles tendon
• Achilles tendon proximal musculo-tendinous junction rupture
• Haglund's Syndrome with retrocalcaneal bursitis and calcaneal spur
• Retrocalcaneal bursitis with Achille's tendinopathy and partial rupture
• Morton's neuroma between 3rd and 4th metatarsal heads
• Morton's neuroma between 2nd and 3rd metatarsal heads

Remarque: pour de nombreux cas, il n'existe pas de confirmation opératoire ou histologique du diagnostic. Cependant, le choix s'est porté sur des exemples illustratifs où le diagnostic s'impose sur la base de l'anamnèse et de critères diagnostiques reconnus; parfois, il ne s'agit que d'un diagnostic de probabilité élevée mais dont l'intérêt méritait de figurer dans cette liste. L'anonymat des cas présentés ici respecte le secret médical.

Note: diagnoses on this page are often not surgically or histologically confirmed. However, for most cases diagnosis is unequivocal when considering clinical history and current diagnostic criteria; less often, diagnosis was only highly probable but the case was considered worth to be shown. Patient identities are hidden to preserve medical secret.