bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic Stimulation of the Ictal Onset Zone
Authors: Sprengers Mathieu , Carrette Sofie , Vonck Kristl , Boon Paul
Published: December 2018

Brain stimulation has emerged as an alternative treatment for patients with refractory epilepsy and an increasing number of trials evaluating its efficacy and safety have been published. Various brain structures have been targeted, focusing either on the ictal onset zone or on remote epileptogenic network structures. This chapter focuses on stimulation of the ictal onset zone. The rationale for these targets and the results obtained in open-label and randomized controlled trials (RCTs), when available, are discussed. It is concluded that promising results have been published, although mainly in open-label trials. More RCTs are needed to establish the value of ictal onset stimulation for the treatment of epilepsy.
Case 1.22
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

8-year-old boy whose sister noticed that the right side of his abdomen was larger than the left

Coronal SSFSE (Figure 1.22.1), axial fat-suppressed FSE T2-weighted (Figure 1.22.2), and axial fat-suppressed 2D SSFP (Figure 1.22.3) images reveal a large, markedly hyperintense, heterogeneous, well-circumscribed mass expanding the right hepatic lobe. The mass has extensive septations and more solid-appearing components in the periphery of the lesion. Axial IP and OP T1-weighted 2D SPGR images (...
Case 1.24
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

57-year-old man with a history of alcoholic cirrhosis

Axial fat-suppressed FSE T2-weighted (Figure 1.24.1) and diffusion-weighted (b=100 s/mm2) (Figure 1.24.2) images demonstrate a peripheral right hepatic lobe mass that has mildly increased signal intensity relative to adjacent liver. Notice the higher signal intensity and greater contrast on the diffusion-weighted image (b=100 s/mm...
Case 2.1
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

47-year-old woman with a genetic disorder

Coronal SSFSE (Figure 2.1.1) and axial T1-weighted FSE (Figure 2.1.2) images demonstrate innumerable variable-sized cysts throughout the liver and kidneys. Some cysts show high T1-signal intensity. Axial fat-saturated 2D SSFP images (Figure 2.1.3...
Case 2.2
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

52-year-old man with elevated AST and ALT levels

Axial IP and OP T1-weighted 2D SPGR images (Figure 2.2.1) demonstrate diffuse homogeneous signal loss on OP images, consistent with the presence of intravoxel fat.

Diffuse fatty infiltration of the liver

This case provides a fairly typical example of diffuse fatty infiltration of the liver. ...
Case 2.5
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

69-year-old woman with irritable bowel syndrome and new low back pain; CT showed multiple hepatic lesions suspicious for metastases

Axial T1-weighted IP and OP 2D SPGR images (Figure 2.5.1) demonstrate multiple rounded masses, with peripheral halos of signal dropout seen on only the OP images. Axial fat-suppressed, T2-weighted images (...
Case 2.8
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

24-year-old man with a chronic disease

Axial fat-suppressed FSE T2-weighted image (Figure 2.8.1) demonstrates diffuse, markedly decreased signal intensity in the liver, spleen, and bone marrow compared to paraspinal muscles. Signal intensity in the renal cortex is moderately reduced, suggesting iron deposition. Axial T1-weighted IP and OP 2D SPGR images (...
Case 2.18
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

31-year-old man with abdominal pain

Axial diffusion-weighted images (b=100 s/mm2) (Figure 2.18.1) reveal no normal hepatic veins, prominent collateral veins in the periphery of the liver, and a small tangle of collateral vessels anterior to the IVC. Notice also small, hyperintense filling defects in diminutive hepatic veins (confirmed on postgadolinium images). Coronal fat-suppressed 2D SSFP image (...
Case 2.19
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

32-year-old man status post living donor liver transplantation for PSC

Postgadolinium arterial phase image (Figure 2.19.1) demonstrates a hepatic artery stump (cutoff) at the level of the anastomosis. A subsequent axial portal venous phase image (Figure 2.19.2) at the level of the porta hepatis shows an absent main portal vein, which is confirmed on the coronal reformatted image (...
Case 2.21
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

57-year-old man status post liver transplantation 13 years ago, now with increasing cholestasis

Coronal SSFSE (Figure 2.21.1), axial fat-suppressed FSE T2-weighted (Figure 2.21.2), and diffusion-weighted (b=600 s/mm2) (Figure 2.21.3) images demonstrate heterogeneous high signal intensity in the porta hepatis, with mild dilatation of peripheral intrahepatic biliary ducts. MIP image from 3D MRCP (...
Case 2.26
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

60-year-old woman with PSC

Axial fat-suppressed FSE T2-weighted images (Figure 2.26.1) demonstrate a cirrhotic configuration of the liver with bands of increased T2 signal and associated capsular retraction involving the hepatic dome, as well as the anterior right and medial left lobes. Axial equilibrium phase postgadolinium 3D SPGR images (...
Case 2.27
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

51-year-old woman with advanced liver disease

Axial fat-suppressed FSE T2-weighted images (Figure 2.27.1) and axial arterial, portal venous, and equilibrium phase postgadolinium 3D SPGR images (Figure 2.27.2) demonstrate macronodularity of the hepatic parenchyma, marked atrophy of the right hepatic lobe, and hypertrophy of the caudate lobe....
Case 2.28
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

57-year-old man with history of chronic hepatitis B virus infection

Axial multiecho (TEs of 2.4, 6.3, 10.0, and 14.2 ms) GRE images (Figure 2.28.1) demonstrate innumerable hypointense nodules throughout the liver and spleen that become more prominent as the TE increases. Notice also the large mass in the lateral right hepatic lobe. Axial fat-suppressed FSE T2-weighted (...
Case 2.29
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

47-year-old woman with chronic liver disease

Axial fat-suppressed FSE T2-weighted images (Figure 2.29.1) and diffusion-weighted images (b=100 s/mm2) (Figure 2.29.2) demonstrate focal, decreased signal intensity surrounding peripheral portal vein branches, or “periportal halos.” Axial fat-suppressed 2D SSFP images (...
Case 2.33
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

62-year-old man with cirrhosis

Coronal SSFSE (Figure 2.33.1) and axial fat-suppressed FSE T2-weighted (Figure 2.33.2) images demonstrate a cirrhotic liver with heterogeneous signal intensity, splenomegaly, and ascites. Ill-defined increased signal intensity in the left hepatic lobe involves nearly all of the liver inferiorly. Note also soft tissue expansion of the main portal vein, depicted in the coronal SSFSE image. Arterial, portal venous, and equilibrium phase postgadolinium 3D SPGR images (...
Case 3.3
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

65-year-old woman with rectal cancer and indeterminate hepatic lesions on CT

Coronal SSFSE (Figure 3.3.1) and axial FSE T2-weighted (Figure 3.3.2) images demonstrate low signal intensity in the gallbladder fundus, with a markedly hypointense rim. Coronal reformatted image from contrast-enhanced CT (...
Case 3.4
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

32-year-old man with chronic hepatitis C and recent elevation of liver enzyme levels

Axial SSFSE (Figure 3.4.1) and fat-suppressed SSFP (Figure 3.4.2) images demonstrate marked diffuse thickening of the gallbladder wall.

Hepatitis with marked gallbladder wall thickening

Gallbladder wall thickening is associated with a large number of pathologic conditions, including cirrhosis, acute and chronic cholecystitis, ascites, hypoalbuminemia, viral hepatitis, chronic renal failure, and heart failure. The physiologic mechanism responsible for diffuse gallbladder thickening in the presence of systemic or diffuse hepatic disease is uncertain but probably is related to elevated portal venous pressure or decreased intravascular osmotic pressure, or both....
Case 3.8
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

68-year-old woman who developed abdominal pain 6 months previous, had an abnormal HIDA scan, and subsequently underwent laparoscopic cholecystectomy at an outside institution; since the surgery, she has had intermittent abdominal pain and cramping, as well as a 20-lb weight loss

Coronal SSFSE images (...
Case 3.18
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

52-year-old man with ulcerative colitis and renal failure secondary to chronic glomerulonephritis; new onset of right upper quadrant pain, fever, jaundice, and elevated liver function tests

Volume-rendered images from 3D FRFSE MRCP in anterior and posterior projections (Figure 3.18.1) demonstrate mild to moderate dilatation of intrahepatic biliary ducts with multiple strictures. Multiple calculi are visible in a posterior right duct. Follow-up volume-rendered MRCP images from an examination performed 4 years later (...
Case 3.19
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

21-year-old woman who noticed a right upper quadrant bulge, which her physician thought was a hernia; eventually, CT was performed, revealing a complex hepatic mass

Coronal 3D SSFP images (Figure 3.19.1) and axial postgadolinium 3D SPGR images (Figure 3.19.2) demonstrate a multicystic lesion with multiple mildly enhancing septations. The inferior axial image shows a more prominent enhancing soft tissue component along the lateral margin of the mass. A volume-rendered image reconstructed from 3D SSFP source data (...
Case 3.20
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

56-year-old man with abnormal liver function tests; abdominal US revealed a large hepatic mass

Axial fat-suppressed FSE T2-weighted images (Figure 3.20.1) demonstrate a large heterogeneous, hyperintense mass in the right hepatic lobe. Arterial, portal venous, equilibrium, and delayed-phase postgadolinium 3D SPGR images (...
Case 3.25
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

29-year-old woman with a history of Crohn disease and neurofibromatosis with jaundice and abdominal pain

A volume-rendered image from 3D FRFSE MRCP (Figure 3.25.1) reveals diffuse intrahepatic biliary dilatation with central obstruction. Coronal SSFSE image (Figure 3.25.2) demonstrates an expansile soft tissue mass involving the entire extrahepatic CBD. Axial fat-suppressed FSE images (...
Case 3.27
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

75-year-old woman with jaundice

Volume-rendered image from 3D FRFSE MRCP (Figure 3.27.1) demonstrates central biliary obstruction. Coronal SSFSE (Figure 3.27.2), axial fat-suppressed FSE (Figure 3.27.3), and axial arterial (Figure 3.27.4A), portal venous (Figure 3.27.4B), equilibrium (...
Case 4.7
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

33-year-old man with a chronic illness

Coronal SSFSE images through the posterior lungs (Figure 4.7.1) reveal chronic peribronchial infiltrates and bronchiectasis. Axial fat-suppressed SSFP images (Figure 4.7.2) and coronal SSFSE images (Figure 4.7.3) through the upper abdomen demonstrate a cirrhotic liver, splenomegaly, splenic siderotic nodules (Gamna-Gandy bodies), and complete fatty replacement of the pancreas....
Case 5.1
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

35-year-old man with a long history of diabetes mellitus and recent episode of peritonitis now presents with recurrent abdominal pain and fever

Axial fat-suppressed FSE T2-weighted images (Figure 5.1.1) show multiple hyperintense lesions in the spleen. The diffuse, decreased signal intensity throughout the remainder of the spleen is due to hemosiderosis and iron deposition. Gadolinium-enhanced axial 3D SPGR images (...
Case 5.2
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

51-year-old man with a hepatic mass detected on US at another medical facility

Axial fat-suppressed FSE T2-weighted images (Figure 5.2.1) show markedly hyperintense lesions in the spleen and inferior right hepatic lobe. There is early enhancement of the splenic lesion on an arterial phase postgadolinium 3D SPGR image (...
Case 5.7
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

38-year-old man with a history of a benign asymptomatic chest mass and mild thrombocytopenia

Coronal SSFSE (Figure 5.7.1) and axial fat-suppressed FSE T2-weighted images (Figure 5.7.2) show multiple large cystic lesions throughout the spleen. Note the fluid-fluid levels in the inferior FSE image as well as the cystic mass in the right upper chest on the SSFSE image. Axial postgadolinium equilibrium phase 3D SPGR images (...
Case 5.8
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

31-year-old woman with a venous malformation of the right lower extremity

Axial fat-suppressed FSE T2-weighted images (Figure 5.8.1) show multiple small hyperintense splenic lesions; several appear cystic. Note also the markedly hyperintense, poorly defined lesion in the right lateral subcutaneous tissues. Arterial phase (...
Case 5.11
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

51-year-old woman with a history of breast cancer

Axial fat-suppressed FSE T2-weighted images (Figure 5.11.1), axial diffusion-weighted images (b=100 s/mm2) (Figure 5.11.2), and axial portal venous phase postgadolinium 3D SPGR images (Figure 5.11.3) show multiple nodules in the liver and spleen. Hepatic lesions have increased signal intensity relative to liver, while the splenic lesions show decreased signal intensity compared with normal spleen on T2- and diffusion-weighted images. Most lesions show hypoenhancement compared with liver and spleen, although several hepatic lesions have central enhancement. Note also small enhancing lesions in an upper lumbar vertebral body....
Case 6.6
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

35-year-old woman with a genetic disease

Axial fat-suppressed FSE T2-weighted images (Figure 6.6.1) demonstrate a large right adrenal mass with scattered regions of high T2-signal intensity. The lesion shows moderately high signal intensity on diffusion-weighted image (b=600 s/mm2) (Figure ...
Case 6.9
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

68-year-old woman with back pain, leg weakness, and new-onset renal failure; renal US at another medical facility showed bilateral renal masses

Coronal fat-suppressed SSFSE images (Figure 6.9.1) demonstrate large bilateral hypointense adrenal masses. The lesions show uniform, moderate signal intensity on axial fat-suppressed FRFSE images (...
Case 7.8
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

85-year-old man with acute on chronic renal failure

Coronal SSFSE (Figure 7.8.1), axial FSE (Figure 7.8.2), and axial diffusion-weighted (b=100 s/mm2) (Figure 7.8.3) images reveal a small left kidney with hydronephrosis of upper pole calyces. Nodular thickening involves the renal capsule and Gerota fascia, with larger nodules adjacent to the renal hilum and within the perinephric fat. Note also the right-sided renal cysts....
Case 7.9
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

57-year-old man with a 2-month history of fatigue, weight loss, and left-sided flank pain

Coronal SSFSE images (Figure 7.9.1), axial fat-suppressed FSE T2-weighted images (Figure 7.9.2), and axial venous phase postgadolinium 3D SPGR images (Figure 7.9.3) demonstrate a large, heterogeneously enhancing exophytic mass in the left kidney abutting and possibly invading the left lateral abdominal wall....
Case 7.11
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

4-year-old girl with vomiting, diarrhea, fever, and a palpable abdominal mass

Axial fat-suppressed FSE (Figure 7.11.1) and axial postgadolinium 3D SPGR (Figure 7.11.2) images show a large heterogeneous mass originating from the anterior right kidney.

Wilms tumor

Wilms tumor is the most common abdominal malignancy in children, with an annual incidence of 8 cases per 1 million persons. Most patients (80%) present between ages 1 and 5 years, usually with an incidentally discovered abdominal mass. Bilateral tumors are found in 5% of cases, and these are associated with an earlier presentation, a higher incidence of associated congenital abnormalities, and a higher incidence of nephroblastomatosis (multiple rests of persistent embryonic renal parenchyma). Among children with Wilms tumor, 12% have associated congenital abnormalities, including GU abnormalities (5%), hemihypertrophy (2%), and aniridia (1%). Syndromes associated with Wilms tumor include Beckwith-Wiedemann (macroglossia, exomphalos, and gigantism), Denys-Drash (male pseudohermaphroditism and glomerular disease), WAGR (Wilms tumor, aniridia, GU abnormalities, and mental retardation), Sotos (cerebral gigantism), and Bloom (immunodeficiency and facial telangiectasia)....
Case 7.18
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

49-year-old woman with intermittent right upper quadrant pain; an incidental right renal mass was noted on CT

Axial fat-suppressed T2-weighted FSE image (Figure 7.18.1) demonstrates an exophytic mass with predominantly low signal intensity projecting from the upper pole of the right kidney. Axial IP 2D SPGR image (...
Case 7.20
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

2-year-old boy with a history of anorectal malformation and imperforate anus, status post surgical repair

Coronal fat-suppressed T2-weighted FRFSE images (Figure 7.20.1) reveal an atrophic right kidney replaced by cysts of various sizes. Also note hydronephrosis and hydroureter of the left kidney....
Case 7.24
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

10-year-old boy with a history of chronic ascites

Coronal SSFSE (Figure 7.24.1) and axial fat-suppressed SSFP (Figure 7.24.2) images show cystic lesions surrounding the renal contours bilaterally, as well as prominent abdominal ascites. Coronal postgadolinium 3D SPGR image (Figure ...
Case 8.3
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

80-year-old woman with dysuria and urinary retention

Axial fat-suppressed FSE T2-weighted image (Figure 8.3.1) and coronal (Figure 8.3.2) and sagittal (Figure 8.3.3) FSE T2-weighted images demonstrate a large, lobulated periurethral cystic lesion adjacent to the posterior lateral margin of the urethra and slightly displacing the course of the urethra. Note the Foley catheter in the urethra and bladder....
Case 8.5
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

56-year-old woman with hematuria

Axial (Figure 8.5.1) and sagittal (Figure 8.5.2) fat-suppressed FSE T2-weighted images demonstrate diffuse soft tissue infiltration of the urethra that protrudes into the bladder base on the sagittal image. Axial postgadolinium 3D SPGR images (Figure ...
Case 8.6
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

64-year-old woman with severe pelvic pain, dysuria and urinary frequency, and gross hematuria

Axial fat-suppressed FSE T2-weighted image (Figure 8.6.1) shows prominent, diffuse bladder wall thickening. Note the fluid-fluid level in the bladder. Axial (Figure 8.6.2) and coronal (Figure ...
Case 8.16
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

68-year-old man with hematuria

Axial T2-weighted (Figure 8.16.1) and T1-weighted (Figure 8.16.2) FSE images, axial diffusion-weighted image (b=800 s/mm2) (Figure 8.16.3), and sagittal T2-weighted FSE image (Figure 8.16.4) demonstrate marked heterogeneous thickening of the posterior and lateral bladder walls, with high signal intensity on the diffusion-weighted image. The mass has extended posteriorly to invade and encase the seminal vesicles and prostate. Note also a large filling defect present in the bladder lumen, with a hyperintense rim on the T1-weighted image....
Case 8.17
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

68-year-old man with a history of prostatectomy for prostate adenocarcinoma, increasing nocturnal urinary frequency, and rising PSA level

Sagittal FSE T2-weighted image (Figure 8.17.1) obtained using an endorectal coil shows a large lobulated mass in the posterior bladder wall extending superiorly to the dome and inferiorly to the vesicourethral junction. The mass has high signal intensity on an axial diffusion-weighted image (b=1,000 s/mm...
Case 9.2
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

56-year-old man with progressive solid-food dysphagia and a 15-lb weight loss over the past 3 months

Axial fat-suppressed FSE T2-weighted images (Figure 9.2.1) show circumferential thickening and mildly increased signal intensity in the distal esophagus. Axial diffusion-weighted images with a b value of 600 s/mm...
Case 9.6
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

35-year-old man admitted to an outside hospital 3 weeks previously with pancreatitis; he was treated and dismissed but returned a few days later with nausea and vomiting; endoscopy demonstrated a complex lesion in the duodenum

Coronal SSFSE (Figure 9.6.1) and axial fat-suppressed FSE T2-weighted (...
Case 9.7
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

44-year-old woman with a 2-year history of abdominal pain and bloating; CT identified a hepatic mass that was indeterminate but thought to most likely be a hemangioma, as well as a mass in the second portion of the duodenum

Axial arterial phase postgadolinium 3D SPGR images (...
Case 9.27
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

59-year-old woman with abdominal pain and partial small-bowel obstruction visualized on plain radiographs

A volume-rendered image from 3D contrast-enhanced MRA (Figure 9.27.1) shows the presence of a single mesenteric vessel, the celiac artery. The SMA and the inferior mesenteric artery are not visualized. Coronal SSFSE (...
Case 10.8
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

20-year-old woman with a congenital uterine anomaly

Axial (Figure 10.8.1) and coronal (Figure 10.8.2) FSE T2-weighted images reveal 2 separate uterine horns and separate cervices. Note also 2 distinct vaginal canals, both distended with fluid.

Uterine didelphys with vaginal septum...
Case 10.13
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

25-year-old woman with a long history of heavy, irregular menstrual bleeding

Sagittal (Figure 10.13.1), coronal (Figure 10.13.2), and axial (Figure 10.13.3) oblique FSE T2-weighted images show expansion of the junctional zone in the inferior uterine body and fundus with multiple small, cystic lesions. Note also the small hypointense lesion inferiorly on the coronal image. Sagittal DWI (b=600 s/mm...
Case 11.3
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

11-year-old girl with a 3-month history of increasing intermittent right lower quadrant pain

Coronal oblique FSE T2-weighted images (Figure 11.3.1) demonstrate a markedly enlarged right ovary that contains a prominent cyst (the normal left ovary can be seen along the left superior margin of the right ovary, with multiple small follicles). Sagittal fat-suppressed FSE T2-weighted image (...
Case 11.8
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

50-year-old perimenopausal woman with intermittent mild abdominopelvic pain

Fat, water, IP, and OP images from a 3D SPGR Dixon acquisition (Figure 11.8.1) reveal a posterior right adnexal lesion with a fluid-fluid level. The anterior nondependent layer is lipid, which appears bright on the fat image and dark on the water image. Notice also the chemical shift artifact appearing at the fat-fluid interface on the OP image....
Case 11.9
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

75-year-old woman with a 6-month history of anorexia and weight loss

Axial fat-suppressed 2D SSFP images (Figure 11.9.1) demonstrate a cystic lesion in the left adnexa with a thin wall and no internal features. Axial IP T1-weighted 2D SPGR image (Figure ...
Case 11.16
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

57-year-old woman with a pelvic mass

Axial fat-suppressed FSE T2-weighted images (Figure 11.16.1) demonstrate a large heterogeneous mass in the central and right pelvis with regions of high and intermediate signal intensity. Axial postgadolinium 3D SPGR images (Figure 11.16.2) reveal heterogeneous enhancement of the lesion with anterior and inferior cystic or necrotic regions....
Case 12.5
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

49-year-old man with mild pain and a palpable abnormality at the base of the penis

Axial T1-weighted (Figure 12.5.1) and T2-weighted (Figure 12.5.2) FSE images demonstrate homogeneous focal expansion of the left corpora cavernosum at the base of the penis with increased T1-signal intensity and decreased T2-signal intensity in relation to the normal cavernosal signal. Axial fat-suppressed T2-weighted FSE image (...
Case 12.24
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

50-year-old man with an elevated PSA level and an enlarged prostate on physical examination

Axial FSE T2-weighted images (Figure 12.24.1) obtained with an endorectal coil reveal a heterogeneous mass containing cystic and solid components replacing the prostate. Postgadolinium axial 2D SPGR images (...
Case 13.2
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

74-year-old man with shortness of breath and fatigue; CT showed large central pulmonary emboli

Axial double inversion recovery (Figure 13.2.1) and triple inversion recovery (Figure 13.2.2) proton density-weighted and T2-weighted ECG-gated FSE images reveal a nearly occlusive soft tissue mass with increased T2-signal intensity in the main pulmonary artery and extending into the right and left main pulmonary arteries. Coronal postgadolinium 3D SPGR images (...
Case 13.10
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

66-year-old woman with a mediastinal mass incidentally seen on chest radiograph; thoracic CT revealed a fatty mass along the right anterior heart border

Axial T1-weighted FSE images (Figure 13.10.1) and sagittal T2-weighted SSFSE images (Figure 13.10.2) reveal herniation of fat through an anterior diaphragmatic defect into the mediastinum anterior to the right side of the heart....
Case 13.11
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

37-year-old woman with occasional stridor and abnormal findings on chest radiograph

Axial fat-suppressed T2-weighted FSE images (Figure 13.11.1) reveal a thoracic inlet cystic lesion that deviates and compresses the trachea and contains several fluid-fluid levels. Axial postgadolinium 3D SPGR images (Figure ...
Case 13.14
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

25-year-old man with multiple episodes of pleuritic chest pain

Short-axis SSFP image (Figure 13.14.1) reveals a small, predominantly inferior pericardial effusion, a small left pleural effusion, and left base atelectasis. Short-axis and horizontal long-axis LGE inversion recovery T1-weighted images (Figure 13.14.2...
Case 13.16
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

72-year-old woman with known coronary artery disease; echocardiography noted a possible left atrial mass, and MRI was suggested for further assessment

Horizontal long-axis images from a cine SSFP acquisition (Figure 13.16.1) demonstrate dumbbell-shaped widening of the interatrial septum with uniform high signal intensity. Axial double inversion recovery FSE proton density-weighted images (...
Case 13.20
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

79-year-old man with a history of CABG surgery 15 years ago now has gradually increasing chest pain and shortness of breath; chest radiography demonstrated a mass along the right heart border, and echocardiography identified a corresponding lesion, likely a vascular structure, adjacent to the right atrium...
Case 13.23
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

16-year-old male adolescent with an arrhythmia during elective surgery

Axial end-systolic SSFP images (Figure 13.23.1) demonstrate small focal outpouchings along the free wall of the right ventricle. Axial double inversion recovery proton density-weighted FSE image (Figure 13.23.2) reveals minimal fatty replacement in the right side of the ventricular septum. Short-axis MDE image (...
Case 13.25
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

27-year-old man with a 3-month history of chest pain and mild shortness of breath

Four-chamber SSFP image (Figure 13.25.1) demonstrates a large well-defined mass in the right ventricular free wall. Four-chamber double (Figure 13.25.2) and triple (Figure 13.25.3) inversion recovery FSE images with proton density- and T2-weighting reveal mildly decreased signal intensity relative to myocardium. Four-chamber MDE image (...
Case 14.9
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

29-year-old woman who noted an abdominal wall mass during the third trimester of her pregnancy

Axial diffusion-weighted image (b=600 s/mm2) (Figure 14.9.1) and sagittal T1-weighted FSE image (Figure 14.9.2) demonstrate a fairly well-defined mass within the rectus muscle with high signal intensity on the diffusion-weighted image and mild hypointensity relative to skeletal muscle on the T1-weighted image. Axial arterial (...
Case 14.20
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

29-year-old woman with gradually increasing intermittent back pain

Axial fat-suppressed FSE T2-weighted images (Figure 14.20.1) demonstrate a complex multicystic mass involving the right sacrum, sacroiliac joint, and iliac bone. Axial postgadolinium 2D SPGR images (Figure 14.20.2) reveal similar findings, with prominent enhancement of the septations separating the cystic components of the lesion....
Case 14.22
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

17-year-old male adolescent with intermittent testicular pain; CT from another medical facility demonstrated a pelvic mass

Axial FSE T1-weighted images (Figure 14.22.1) and fat-suppressed FSE T2-weighted images (Figure 14.22.2) demonstrate a large heterogeneous pelvic mass with regions of high signal intensity on both T1- and T2-weighted images and a more solid-appearing component posteriorly. Axial postgadolinium 2D SPGR images (...
Case 16.10
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

50-year-old man with a gradually increasing exercise limitation and a cardiac murmur on examination; he has a family history of aortic aneurysm and coronary artery dissection

VR image from 3D CE MRA (Figure 16.10.1) reveals marked dilatation of the aortic root, extending to the sinotubular junction. Coronal oblique SSFP image through the aortic valve and root (...
Case 16.11
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

22-year-old man with a history of multiple episodes of bleeding, bruising, and hematomas

Coronal VR image from 3D CE MRA of the abdomen and pelvis (Figure 16.11.1) reveals lobulated aneurysms of both external iliac arteries and the right common femoral artery. Note the severe stenosis of the left external iliac artery distal to the aneurysm....
Case 16.18
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

64-year-old woman with a history of fevers and anemia

Coronal SSFSE (Figure 16.18.1) and fat-suppressed SSFP (Figure 16.18.2) images demonstrate a heterogeneous mass expanding the intrahepatic IVC. Coronal source image from venous phase acquisition of a 3D CE MRA (...
Case 17.5
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

26-year-old woman with elevated liver function tests

Axial diffusion-weighted images (b=400 s/mm2) (Figure 17.5.1) from an examination performed with a 3-T magnet demonstrate marked signal loss in the left hepatic lobe as well as a generally reduced SNR. Axial respiratory-triggered FSE T2-weighted image (...
Case 17.12
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

56-year-old man with cirrhosis and suspected hepatocellular carcinoma

Axial respiratory-triggered T2-weighted FSE images obtained without fat suppression (Figure 17.12.1) demonstrate extensive phase ghosting artifact. T2-weighted images obtained with fat suppression (Figure 17.12.2) reveal minimal ghosting artifact and also allow improved visualization of confluent peripheral fibrosis....
Case 17.13
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

43-year-old man with primary sclerosing cholangitis

Axial respiratory-triggered fat-suppressed FSE T2-weighted images (Figure 17.13.1) demonstrate inhomogeneous fat suppression and mild motion blurring throughout the liver. FSE T2-weighted images performed with parallel imaging (Figure 17.13.2) and otherwise identical imaging parameters demonstrate sharper images with no significant motion artifact....
Case 17.23
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

22-year-old man with history of primary sclerosing cholangitis

Axial hepatobiliary phase postgadolinium 3D SPGR images obtained following gadoxetate disodium (Eovist) administration (Figure 17.23.1) demonstrate mild irregularity of intrahepatic biliary ducts, consistent with primary sclerosing cholangitis. MIP images from 3D FRFSE MRCP obtained between contrast injection and hepatobiliary phase acquisition (...
Case 17.27
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

60-year-old man with hypertension resistant to medical therapy

MIP images from noncontrast 3D SSFP renal MRA (Figure 17.27.1) demonstrate poor visualization of the renal arteries, with low contrast and low SNR. VR images from CE 3D MRA (Figure 17.27.2) reveal 2 left renal arteries and aneurysmal dilatation of the distal right main renal artery....
Case 17.28
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

68-year-old man with abdominal aortic aneurysm

Anterior and lateral VR images from 3D CE MRA (Figure 17.28.1) reveal diffuse atherosclerosis of the abdominal aorta, severe stenosis of the proximal celiac artery, and mild dilatation of the infrarenal aorta. Axial postgadolinium 2D SPGR images (...
Typological features of grammaticalization in Semitic
Authors: Esseesy Mohssen
Published: December 2018

This study highlights some notable typological features of ancient and modern Semitic languages. It sheds light on a number of shared intragenetic similarities and parallels within Semitic in the processes and outcomes of grammaticalization. Specifically, it examines the emergence and evolution of prepositionals from certain body-part terms; the shift from synthetic towards more analytic possessive strategies; and independent personal pronouns becoming inherently bound agreement markers as prefixes and suffixes on the imperfective and perfective verb stems, respectively. Moreover, with supporting evidence from corpus data, this study argues for the primacy of third-person pronouns, which assume expanded grammatical functions as copulas, expletives, and discourse-related functions. Finally, this study draws attention to the sociolinguistic factors, such as native speakers’ attitudinal stance, which directly impinge on language change within the diglossic nature of Arabic, and calls for consideration of sociolinguistic factors in the study of language evolution by grammaticalization.
The Unexpected Activeness of Passive Investors: A Worldwide Analysis of ETFs
Authors: Cheng Si , Massa Massimo , Zhang Hong
Published: December 2018

The global ETF industry provides more complicated investment vehicles than low-cost index trackers. Instead, we find that the real investments of ETFs may deviate from their benchmarks to leverage informational advantages (which leads to a surprising stock-selection ability) and to help affiliated OEFs through cross-trading. These effects are more prevalent in ETFs domiciled in Europe. Moreover, ETF flows seem to respond to additional risk. These results have important normative implications for consumer protection and financial stability.

Received March 18, 2017; Editorial decision October 14, 2018 by Editor Raman Uppal. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
MWDS-2016: THE SLOW DISSOLUTION RATE FOR PLUTONIUM NITRATE INTAKES AT THE MAYAK FACILITY
Authors: Bull R K , Puncher M
Published: December 2018

The slow dissolution rate of material deposited in the lung plays a key role in determining the eventual radiation dose received by the lung. It is therefore of great importance to establish a reliable value for this parameter, to incorporate into the latest Mayak Worker Dosimetry System (MWDS-2016). Disparate values have been obtained for the slow dissolution rate of plutonium nitrate. A volunteer study performed by Public Health England (PHE) and an analysis of United States Transuranium and Uranium Registries (USTUR) case 0269 have yielded slow dissolution rates in the region of 10–40 × 10−4 d−1. However, autopsies performed on 20 Mayak workers, exposed predominantly to nitrates, have resulted in estimates of slow dissolution rates of around 2.4 × 10−4 d−1. Three hypotheses have been proposed to explain this discrepancy: (1) a slower dissolution rate in the interstitium, (2) a third exponential component in the dissolution function and (3) a small component of oxide in the aerosol to which Mayak ‘nitrate’ workers were exposed. This paper describes tests of these competing hypotheses. Bayesian methods have been applied to the following datasets: PHE volunteer data; Beagle dog data; USTUR cases and Mayak worker data. It is concluded that a mixture of oxide and nitrate material, with the oxide forming ~14% of the intake, best describes the Mayak dissolution rate, without introducing values for other parameters which conflict with other studies.
Using Yield Response Curves to Measure Variation in the Tolerance and Resistance of Wheat Cultivars to Fusarium Crown Rot
Authors: Forknall Clayton R. , Simpfendorfer Steven , Kelly Alison M.
Published: December 2018

The disease crown rot, caused predominantly by the fungal pathogen Fusarium pseudograminearum, is a major disease of winter cereals in many regions of the world, including Australia. A methodology is proposed, using response curves, to robustly estimate the relationship between grain yield and increasing crown rot pathogen burdens. Using data from a field experiment conducted in northern New South Wales, Australia in 2016, response curves were derived for five commercial wheat cultivars exposed to six increasing rates of crown rot inoculum, where the rates served to establish a range of crown rot pathogen burdens. In this way, the response curve methodology is fundamentally different from alternate approaches that rely on genetic or environmental variation to establish a range in pathogen burdens over which yield loss relationships are estimated. By manipulating only the rates of crown rot inoculum and, thus, pathogen burden directly, the number of additional confounding factors and interactions are minimized, enabling the robust estimation of the rate of change in yield due to increasing crown rot pathogen burdens for each cultivar. The methodology revealed variation in the rate of change in yield between cultivars, along with the extent of crown rot symptoms expressed by the cultivars. Variation in the rate of change in yield between cultivars provides definitive evidence of differences in the tolerance of commercial Australian wheat cultivars to crown rot caused by F. pseudograminearum, while variation in the extent of crown rot symptoms signifies differences in the resistance of the cultivars to this disease. The response curve methodology also revealed variation in how the different mechanisms of tolerance and resistance act to limit yield losses due to crown rot for different cultivars.
Genetic advances in gout: potential applications in clinical practice
Authors: Tai Vicky , Merriman Tony R. , Dalbeth Nicola
Published: December 2018

Purpose of review

Many novel genetic associations in the field of hyperuricaemia and gout have been described recently. This review discusses advances in gout genetics and their potential clinical applications.

Recent findings

Genome-wide association studies have identified approximately 30 serum urate-associated loci, some of which represent targets for drug development in gout. Some genes implicated in initiating the inflammatory response to deposited crystals in gout flares have also been described. In addition, genetic studies have been used to understand the link between hyperuricaemia and other comorbidities, particularly cardiometabolic diseases. ABCG2 has been established as a key genetic determinant in the onset of gout, and plays a role in the progression and severity of disease. Recent pharmacogenetic studies have also demonstrated the association between ABCG2 and poor response to allopurinol, and the link between HLA-B

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58:01 genotype and adverse drug reactions to allopurinol.

Advances in gout genetics have provided important molecular insights into disease pathogenesis, better characterized the pharmacogenetics of allopurinol, and raised the possibility of using genetic testing to provide personalized treatment for patients. Prospective studies are now needed to clarify whether genetic testing in gout provides further benefit when added to established clinical management.
The Outcome of Patients With Localized Undifferentiated Pleomorphic Sarcoma of the Lower Extremity Treated at Stanford University
Authors: Kamat Nikhil V. , Million Lynn , Yao Dong-han , Donaldson Sarah S. , Mohler David G. , van de Rijn Matt , Avedian Raffi S. , Kapp Daniel S. , Ganjoo Kristen N.
Published: December 2018

Background:

As a diagnosis of exclusion, Undifferentiated Pleomorphic Sarcoma (UPS) has unclear clinical characteristics. The objective of this retrospective cohort study is to investigate which clinical and prognostic factors of primary lower-extremity UPS will determine failure.

Methods:

We retrospectively reviewed 55 primary lower-extremity UPS cases treated at Stanford between 1998 and 2015. Overall Survival (OS) and Disease-Free Survival (DFS) curves were calculated. Univariate Fisher’s Exact Tests were used to examine relationships between disease recurrence, treatment, patient factors, tumor characteristics, and surgical margins.

Results:

5-year DFS and OS rates were 60% (95% CI, 45%-72%) and 68% (95% CI, 53%-79%), respectively. The 5-year DFS rate for patients with positive margins was 33.3% (95% CI, 5%-68%) compared with 63% (95% CI, 47%-76%) for patients with negative margins. (Log-rank, P=0.03). The OS rate for those with disease recurrence was 42% % (95% CI, 16%-67%) compared with 76% (95% CI, 59%-87%) for patients who did not have disease recurrence (log-rank, P=0.021). Local failure occurred more frequently with omission of radiation therapy (Fisher’s exact test, P=0.009).

Conclusions:

Positive surgical margins are an important prognostic factor for predicting relapse in UPS. Relapse of any kind led to worse OS. Radiation therapy improved local control of disease but had no statistically significant effect on DFS, highlighting the need for improved diagnostics to identify those at highest risk for hematogenous metastasis and for selection of patients for adjuvant systemic treatment.
Opioid Prescribing Patterns After Micrographic Surgery: A Follow-up Retrospective Chart Review
Authors: Donigan Jessica M. , Franco Abigail I. , Stoddard Gregory J. , Hedderman Amanda , Tristani-Firouzi Payam , Bowen Glen M. , Millican Eric A. , Duffy Keith L.
Published: December 2018

BACKGROUND

The abuse of opioids has reached epidemic proportions in the United States, and leftover medications are a primary source for nonmedical pain relievers. A past study at the University of Utah showed that micrographic surgeons were likely overprescribing opioids, with 35% of patients receiving a postoperative prescription.

OBJECTIVE

To examine the current opioid prescribing habits of the micrographic surgeons at the University of Utah compared with those in 2010.

METHODS

Retrospective chart review of the patient records of 4 micrographic surgeons between February and May 2017.

RESULTS

Four hundred patient visits were reviewed. An opioid prescription was provided after 12% of encounters, 23% lower than in 2010 (p = .004). Younger patient age, increased number of stages and defect size, repair of the defect, and particular surgeons predicted opioid prescription.

CONCLUSION

The percentage of patients who received an opioid prescription after undergoing micrographic surgery at the University of Utah decreased from 35% in 2010 to 12% in 2017. Reports of the minimal need of opioids after micrographic surgery, the authors' past study showing an institutional tendency to overprescribe, and reports of the national opioid epidemic likely all contributed to the decrease in opioid prescriptions at the authors' institution.
Cannula-Assisted Technique to Unfold Grafts in Descemet Membrane Endothelial Keratoplasty
Authors: Sarnicola Caterina , Sabatino Francesco , Sarnicola Enrica , Perri Paolo , Cheung Albert Y. , Sarnicola Vincenzo
Published: December 2018

Purpose:

To describe the use of irrigating single-port cannulas to unfold Descemet membrane endothelial keratoplasty (DMEK) grafts when traditional tapping techniques are challenging.

Methods:

This study is a retrospective, comparative, nonrandomized, interventional case series that includes 143 DMEKs performed between February 2014 and November 2015. All eyes were divided into 2 groups: in one group, there were 48 cases that underwent DMEK using tap techniques only (Tapping DMEK group), and in another group, there were 30 cases in which irrigating cannulas were used to unfold the graft as a secondary approach (Cannula DMEK group). Intraocular manipulation time and total graft manipulation time were assessed. Uncorrected visual acuity, best spectacle-corrected visual acuity, and endothelial cell count were evaluated at 6 and 12 months postoperatively. We also reviewed DMEK procedures performed between December 2015 and January 2017 to evaluate the use of irrigating cannulas to unfold the graft.

Results:

All grafts were clear. There was a statistically significant improvement in uncorrected visual acuity and best corrected visual acuity at 6 and 12 months postoperatively in both groups (P < 0.01). Endothelial cell loss was 32.10% and 32.11% at 12 months in the Cannula and Tapping DMEK groups, respectively (P > 0.05). Total graft manipulation time was 3 minutes 40 ± 22 seconds in the Cannula DMEK group and 3 minutes 07 ± 26 seconds in the Tapping DMEK group (P < 0.01). Irrigating cannulas were used as a secondary approach in a smaller percentage of cases between December 2015 and January 2017 (26.2%) compared with DMEK performed during this study (38.5%).

Conclusions:

When it is difficult to unscroll the endothelium–Descemet membrane graft using only tap techniques, the use of Sarnicola cannulas is useful and effective without negatively affecting the postoperative endothelial cell count.