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[Pitfalls in MR imaging of neurological diseases]
Abstract:
MR imaging is useful for the diagnosis of neurological diseases but it has many pitfalls. The author presented one patient with syringobulbia of whom neurological examinations revealed lesions in the medulla. MR images showed slit-like lesions in the medulla and pontine tegmentum of which signal intensity was similar to that of cerebrospinal fluid. However, a sagittal scout image reveals syringomyelia in the upper cervical spinal cord that was important abnormal finding for the diagnosis of this case. In a case of hypertrophic cranial pachymeningitis, neurological examinations showed right lower cranial palsies and MR images showed lesions along the right temporal bone with T1- and T2 shortening. After injection of the contrast medium, abnormal contrast enhancement was observed in the medial side of the lesions. In the anterior cranial fossa, however, the anterior falx was thick and it showed low signal on T2-weighted images and abnormal contrast enhancement. These findings of the falx indicated that the patient had hypertrophic cranial pachymeningitis. It is important to see lesions which neurological examinations detect. However, all of the images must be seen, because in the distant location, the key findings for the diagnosis may be present.
Insights
Magnetic resonance imaging (MRI) aids neurological disease diagnosis but has pitfalls. Comprehensive review of all MRI sequences, even distant ones, is crucial for accurate diagnosis, as demonstrated in cases of syringobulbia and hypertrophic cranial pachymeningitis.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Context:
- Magnetic resonance (MR) imaging is a valuable tool for diagnosing neurological conditions.
- However, MR imaging interpretation can be challenging due to potential diagnostic pitfalls.
- This study highlights the importance of a thorough review of all imaging sequences.
Purpose:
- To illustrate diagnostic challenges and key findings in specific neurological cases using MR imaging.
- To emphasize the necessity of examining all MR imaging sequences for accurate diagnosis.
- To present cases of syringobulbia and hypertrophic cranial pachymeningitis.
Summary:
- A patient with syringobulbia presented with medullary lesions on neurological examination; MR images revealed slit-like lesions in the medulla and pontine tegmentum. A sagittal scout image identified concurrent syringomyelia in the upper cervical spinal cord, crucial for diagnosis.
- Another case involved hypertrophic cranial pachymeningitis with right lower cranial palsies. MR imaging showed lesions along the right temporal bone with characteristic signal changes and contrast enhancement, including thickening and abnormal enhancement of the anterior falx.
Impact:
- Demonstrates that critical diagnostic findings may be located in areas distant from the primary neurological deficits.
- Underscores the importance of not overlooking subtle or distant abnormalities on MR imaging.
- Reinforces the need for comprehensive radiological assessment in neurological disease diagnosis.