bluuebunny/crossref_metadata_2025 huggingface dataset:
Case 2.20
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

29-year-old man with history of liver transplantation for advanced PSC performed 5 weeks ago, now with increasing elevation of hepatic enzymes

Axial fat-suppressed FSE T2-weighted image (Figure 2.20.1) demonstrates a subtle area of mildly increased signal intensity in the periphery of the right hepatic lobe. Biliary ducts were unremarkable on MRCP (images not shown). Pregadolinium, portal venous, and equilibrium phase postgadolinium 3D SPGR images (...
Case 2.23
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

55-year-old woman with chronic liver disease

Axial fat-suppressed FSE T2-weighted images (Figure 2.23.1) demonstrate a cirrhotic liver with diffuse, innumerable, small low-signal-intensity nodules. Axial arterial, portal venous, and hepatobiliary phase postgadolinium (Eovist) 3D SPGR images (Figure 2.23.2) demonstrate heterogeneous enhancement of the background parenchyma, particularly in the right hepatic lobe. The multiple nodules are initially hypointense on arterial and portal venous phase images but become hyperintense relative to adjacent liver on the hepatobiliary phase image....
Case 2.24
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

56-year-old man with chronic liver disease

Axial fat-suppressed FSE T2- weighted (Figure 2.24.1) and axial IP and OP T1-weighted 2D SPGR (Figure 2.24.2) images demonstrate a nodular hepatic contour and parenchymal background. Axial arterial phase postgadolinium 3D SPGR image (...
Case 2.34
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

80-year-old man with loss of energy and easy fatigability

Coronal SSFSE (Figure 2.34.1), axial fat-suppressed FSE T2-weighted (Figure 2.34.2), and diffusion-weighted (b=100 s/mm2) (Figure 2.34.3) images demonstrate multiple heterogeneous hyperintense masses in the liver, with a large, poorly defined mass in the right hepatic lobe. Axial arterial, portal venous, and equilibrium phase postgadolinium 3D SPGR images (...
Case 2.37
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

50-year-old woman being evaluated for common variable immunodeficiency

Coronal SSFSE (Figure 2.37.1), axial fat-suppressed T2-weighted FSE (Figure 2.37.2), and axial diffusion-weighted (b=100 s/mm2) (Figure 2.37.3) images demonstrate a heterogeneous mass with lobulated margins in the right hepatic lobe, as well as extensive adenopathy in the celiac axis, porta hepatis, and portocaval space. Note also moderate splenomegaly. Arterial, portal venous, equilibrium, and delayed phase postgadolinium 3D SPGR images (...
Case 3.6
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

54-year-old man with a chronic biliary disorder; MRI was performed for routine surveillance

Coronal SSFSE (Figure 3.6.1) and axial fat-saturated FSE (Figure 3.6.2) images demonstrate an irregular lesion in the gallbladder, abutting the superior wall. Coronal, delayed phase 3D SPGR images (...
Case 3.9
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

52-year-old woman who underwent laparoscopic cholecystectomy at an outside institution 1 month ago; bilious drainage has been noted through a surgically placed drain, and subsequent ERCP showed complete cutoff of the distal CBD

Axial FSE (Figure 3.9.1) and portal venous phase (...
Case 3.13
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

25-year-old man who had an episode of severe abdominal pain following a meal; abdominal CT was abnormal

Coronal SSFSE images (Figure 3.13.1) demonstrate focal dilatation of the mid CBD, as well as moderate gallbladder wall thickening. Axial and coronal 3D SPGR images (...
Case 3.14
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

28-year-old man with a known syndrome

Volume-rendered image from 3D FRFSE MRCP (Figure 3.14.1) demonstrates diffuse intra- and extrahepatic biliary dilatation, most prominently in the right hepatic lobe. Axial T2-weighted FSE images (Figure 3.14.2) and axial portal venous phase postgadolinium 3D SPGR images (...
Case 3.15
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

52-year-old woman with a recent episode of right upper quadrant pain, fever, and chills

Axial fat-suppressed SSFP images (Figure 3.15.1) and axial pre- (Figure 3.15.2) and arterial phase postgadolinium (Figure 3.15.3) 3D SPGR images demonstrate diffuse dilatation of intra- and extrahepatic biliary ducts. Note the numerous intraductal stones (bright on precontrast T1-weighted 3D SPGR images) in intrahepatic ducts. Arterial phase postcontrast images demonstrate patchy parenchymal enhancement and mild periductal enhancement, indicative of acute inflammation. A volume-rendered image from 3D FRFSE MRCP (...
Case 3.22
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

53-year-old man with an elevated level of alkaline phosphatase; US revealed intrahepatic biliary dilatation

A partial volume MIP image from 3D FRFSE MRCP (Figure 3.22.1) shows dilatation of right-sided intrahepatic ducts with obstruction in the hilum at the level of the right duct division. Left-sided ducts are normal in caliber. Axial arterial (...
Case 4.3
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

50-year-old man with abdominal pain

Coronal SSFSE images (Figure 4.3.1) demonstrate pancreatic tissue and the pancreatic duct wrapping around the duodenum on successive images. Thick slab anterior (Figure 4.3.2A) and posterior (Figure 4.3.2B) SSFSE images reveal similar findings, again showing the pancreatic duct in the pancreatic head wrapping around the duodenum....
Case 4.8
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

74-year-old man with abdominal pain

Axial fat-suppressed FSE T2-weighted images (Figure 4.8.1) reveal a small residual pancreas surrounded by a large, complex fluid collection that extends into the right paracolic gutter and contains extensive internal debris. Axial portal venous phase postgadolinium 3D SPGR images (...
Case 4.11
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

58-year-old woman with suspected mesenteric ischemia

VR image from 3D FRFSE MRCP (Figure 4.11.1) reveals multiple small cystic lesions throughout the pancreas, many connecting to the pancreatic duct.

Multiple side-branch IPMNs

Diagnostic imaging of IPMN provides an interesting case study of the effect of imaging technology on disease prevalence. In the 1990s, IPMN was a rare and exotic diagnosis, leading to case reports and excited presentations at imaging conferences. As magnetic resonance technology improved and the use of abdominal MRI and MRCP increased, IPMN became a more pedestrian diagnosis. (In our practice, if we’re not reporting a potential IPMN at least 2 or 3 times a day, it probably means that we’re forgetting to look at the pancreas again.)...
Case 4.13
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

66-year-old man with a history of a cystic pancreatic lesion and increasing abdominal pain

Coronal fat-suppressed 2D SSFP images (Figure 4.13.1) reveal marked biliary and pancreatic ductal dilatation. Note also the large soft tissue nodules in the proximal and distal pancreatic duct and the small nodules at the bifurcation of the common duct. Axial fat-suppressed T2-weighted FSE image (...
Case 4.15
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

44-year-old woman with pancreatitis

Coronal SSFSE (Figure 4.15.1) and axial fat-suppressed 2D SSFP (Figure 4.15.2) images reveal a complex cystic mass in the tail of the pancreas containing multiple septations and a focal nodule. A large encapsulated fluid collection surrounds the anterior aspect of the pancreas. Coronal (...
Case 4.16
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

32-year-old pregnant woman with an abdominal mass; MRI was performed without intravenous contrast

Axial fat-suppressed FSE T2-weighted images (Figure 4.16.1) reveal a complex predominantly cystic mass in the pancreatic body and tail with a prominent solid component along the posterior margin. Note the multiple small fluid-fluid levels within the lesion. Axial diffusion-weighted images (b=600 s/mm...
Case 4.17
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

61-year-old woman with a known syndrome

Coronal SSFSE (Figure 4.17.1) and axial diffusion-weighted images (b=600 s/mm2) (Figure 4.17.2) demonstrate marked rugal fold thickening in the fundus and body of the stomach. A heterogeneous hypoenhancing mass at the neck of the pancreas is seen on arterial phase postgadolinium 3D SPGR images (...
Case 4.18
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

52-year-old man with severe mitral insufficiency; an incidental pancreatic mass was detected on preoperative CT angiography

Axial T1-weighted in-phase 2D SPGR image (Figure 4.18.1) demonstrates a round low-signal-intensity mass in the pancreatic uncinate process. Axial diffusion-weighted image (b=600 s/mm2) (...
Case 4.22
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

76-year-old man with weight loss and jaundice

Coronal fat-suppressed 2D SSFP images (Figure 4.22.1) reveal an ill-defined mass involving the pancreatic uncinate process and completely encasing the superior mesenteric artery. Note also multiple small lymph nodes and associated soft tissue stranding adjacent to the duodenum. Axial portal venous phase postgadolinium 3D SPGR images (...
Case 5.3
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

53-year-old man with a history of idiopathic thrombocytopenic purpura, elevated liver function tests, and splenomegaly and abdominal CT that showed a focal splenic mass

Coronal SSFSE images (Figure 5.3.1) show a large, mildly heterogeneous mass in the spleen. The mass is hypointense compared to the spleen on axial fat-suppressed FRFSE T2-weighted image (...
Case 5.5
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

42-year-old man with abdominal pain and elevated liver enzymes

Axial fat-suppressed FSE T2-weighted images (Figure 5.5.1) show multiple round splenic lesions that are predominantly hypointense compared to normal spleen, with small hyperintense centers. On equilibrium phase postgadolinium 3D SPGR images (Figure ...
Case 5.6
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

37-year-old woman with a history of recurrent pancreatitis and abdominal pain

Arterial phase (Figure 5.6.1A), portal venous phase (Figure 5.6.1B), equilibrium phase (Figure 5.6.1C), and 8-minute delayed phase (Figure 5.6.1D) postgadolinium 3D SPGR images show multiple splenic lesions that are initially hypoenhancing relative to adjacent spleen and become hyperintense on delayed images....
Case 5.12
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

60-year-old woman with a chronic hematologic disorder

Coronal SSFSE images (Figure 5.12.1) show massive splenomegaly. Axial fat-suppressed FSE T2-weighted images (Figure 5.12.2) show splenomegaly and prominent high-signal soft tissue adjacent to the lower thoracic vertebral bodies.

Myelofibrosis with massive splenomegaly and extramedullary hematopoiesis...
Case 5.15
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

75-year-old man with a history of hepatocellular carcinoma

Axial fat-suppressed SSFP-weighted image shows cardiomegaly with biatrial enlargement (Figure 5.15.1). Fat-suppressed FSE T2-weighted image shows a wedge-shaped region of increased signal within the spleen (Figure 5.15.2). Axial in-phase and out-of-phase SPGR images (...
Case 5.16
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

68-year-old man with a history of polycythemia vera and a recent episode of pancreatitis, which required endoscopic drainage of a pancreatic pseudocyst with a cystogastrostomy tube

Coronal SSFSE (Figure 5.16.1) and axial fat-suppressed FSE T2-weighted (Figure 5.16.2) images show splenomegaly with a cyst in the posterior spleen. Note also the decreased signal intensity in the liver and spleen due to hemosiderosis from multiple blood transfusions. A round structure in the splenic hilum is bright on T2-weighted images and is surrounded by a small amount of fluid containing a fluid-fluid level. Axial arterial phase and portal venous phase postgadolinium 3D SPGR images (...
Case 6.2
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

72-year-old man with a history of autoimmune hemolytic anemia and recurrent fevers of unknown origin presenting with new right flank pain

Coronal SSFSE (Figure 6.2.1) and axial fat-suppressed T2-weighted FSE images (Figure 6.2.2) demonstrate a lenticular right adrenal lesion with a hyperintense outer margin. Diffusion-weighted image (b=600 s/mm...
Case 6.3
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

52-year-old woman with chest discomfort; chest CT showed an indeterminate adrenal lesion

A well-circumscribed left adrenal mass shows signal intensity similar to that of the normal adrenal gland on coronal SSFSE (Figure 6.3.1) and axial fat-suppressed FSE T2-weighted (Figure 6.3.2) images. Notice the extensive signal loss within the lesion between IP (...
Case 6.7
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

53-year-old man with a 4-year history of spells consisting of palpitations, sweating, shortness of breath, and hypertension and 1 episode in which he fainted and was admitted to the hospital with mildly elevated troponin levels and electrocardiographic changes; an incidental adrenal mass was noted on cardiac MRI...
Case 6.8
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

76-year-old man with weight loss and progressive weakness

Coronal SSFSE images (Figure 6.8.1) reveal a large heterogeneous left adrenal mass and expansion of the adrenal vein. Axial fat-suppressed T2-weighted FRFSE image (Figure 6.8.2) demonstrates similar findings. Venous phase axial postgadolinium 3D SPGR images (...
Case 6.10
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

56-year-old woman with abdominal pain and a renal mass, which was found on CT at another medical facility

Coronal SSFSE image (Figure 6.10.1) demonstrates a small left adrenal lesion and a large heterogeneous mass in the right kidney. Axial fat-suppressed T2-weighted FSE image (...
Case 7.2
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

71-year-old woman with gradual onset of early satiety and minimal left flank pain; CT at an outside institution demonstrated a large left renal mass

Axial fat-suppressed FSE T2-weighted images (Figure 7.2.1) reveal complete replacement of the left kidney with high-signal-intensity tumor and expansion of the left renal vein with tumor thrombus. Note the metastatic lesion in a lumbar vertebral body. Diffusion-weighted image (b=800 s/mm...
Case 7.3
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

62-year-old man with neck and back pain; a left renal mass was incidentally noted on lumbar spine MRI

Coronal SSFP image (Figure 7.3.1) and axial fat-suppressed FSE image (Figure 7.3.2) reveal a large, complex cystic mass with a thick wall projecting from the lower pole of the left kidney (and a simple cyst in the upper pole). Axial arterial phase 3D SPGR image (...
Case 7.4
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

64-year-old man with a history of necrotizing glomerulonephritis who has new-onset left flank pain

Axial images from noncontrast-enhanced renal stone protocol CT (Figure 7.4.1) show hyperdense subcapsular material along the posterior margin of the left kidney. Axial fat-suppressed FSE T2-weighted images (...
Case 7.5
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

68-year-old man with new-onset anuria and a remote right nephrectomy; an obstructing left ureteral stone was found on CT, as well as a cystic left renal mass

Coronal SSFP images (Figure 7.5.1) reveal a complex, septated cystic mass projecting from the lower pole of the left kidney. Axial arterial phase (...
Case 7.15
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

51-year-old man with a palpable left abdominal mass

Coronal SSFSE (Figure 7.15.1), axial fat-suppressed T2-weighted FSE (Figure 7.15.2), axial IP-OP 2D SPGR (Figure 7.15.3), and axial postgadolinium 3D SPGR (Figure 7.15.4) images reveal a large exophytic mass originating from the left kidney. The mass is composed almost entirely of fat, interspersed with prominent vessels....
Case 7.17
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

42-year-old woman with a long-standing multisystemic disorder

Coronal SSFSE images (Figure 7.17.1) show massive bilateral renal enlargement and replacement of renal parenchyma. Axial IP-OP 2D SPGR images (Figure 7.17.2) demonstrate fatty replacement of much of the renal parenchyma. Coronal postgadolinium 3D SPGR images (...
Case 7.22
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

8-year-old girl with chronic kidney disease, hypertension, and growth delay; a dilated common bile duct was noted incidentally at renal sonography

Axial fat-suppressed FSE T2-weighted images (Figure 7.22.1) demonstrate replacement of much of the renal parenchyma with small, fairly uniform cysts. The common bile duct is dilated, the liver has a mildly cirrhotic appearance, and the spleen is markedly enlarged. Axial fat-suppressed SSFP images (...
Case 7.28
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

39-year-old man with complications following hepatic transplantation

Coronal fat-suppressed SSFP images (Figure 7.28.1) show 2 kidneys fused in the left abdomen, with absence of a kidney in the right renal fossa. Note also heterogeneous increased signal intensity in the transplant liver secondary to ischemic injury....
Case 7.31
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

19-year-old man with recent renal transplantation for focal segmental glomerulosclerosis who now has declining renal function and new-onset diffuse alveolar hemorrhage and reduced cardiac function

Axial SSFSE images (Figure 7.31.1) reveal diffuse increased signal intensity throughout the featureless right lower quadrant renal transplant. Axial postgadolinium 2D SPGR images (...
Case 7.34
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

66-year-old man with a recent episode of meningitis; hypointense lesions in the liver and kidneys were noted on a recent non–contrast-enhanced CT

Axial fat-suppressed T2-weighted FRFSE images (Figure 7.34.1) show subtle hypointense nodules in the kidneys bilaterally. Axial arterial phase (Figure ...
Case 8.1
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

51-year-old woman with dysuria and sensation of a mass in the region of the urethra

Axial FSE T1-weighted image (Figure 8.1.1) and axial (Figure 8.1.2) and coronal (Figure 8.1.3) FSE T2-weighted images demonstrate a lobular cystic structure immediately adjacent to the urethral orifice in the perineum....
Case 8.12
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

10-year-old girl with urinary frequency and urgency and dysuria

Sagittal (Figure 8.12.1) and axial (Figure 8.12.2) fat-suppressed FSE T2-weighted images demonstrate a heterogeneous mass with cystic components in the posterior bladder. An axial T1-weighted FSE image (Figure 8.12.3) shows uniform moderate signal intensity throughout the bladder mass....
Case 8.13
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

37-year-old pregnant woman with episodes of shortness of breath, headache, visual changes, and palpitations occurring with urination

Axial fat-suppressed FSE T2-weighted images (Figure 8.13.1) and coronal fat-suppressed SSFP images (Figure 8.13.2) demonstrate a well-defined mass with high T2-signal intensity adjacent to or originating from the left bladder wall. Note also the vascular flow voids near the inferior medial margin of the mass on the axial images, as well as the gravid uterus, on the coronal images....
Case 8.18
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

25-year-old man with 3-year history of gross hematuria

Axial (Figure 8.18.1) and coronal (Figure 8.18.2) fat-suppressed FSE T2-weighted images show a large frondlike mass in the posterior left bladder. Note the dilated distal left ureter on the coronal image. Axial postgadolinium 2D SPGR images (...
Case 8.25
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

68-year-old woman with microhematuria

Coronal oblique arterial phase 3D SPGR images from MR urography (Figure 8.25.1) demonstrate soft tissue thickening surrounding the renal pelvis and proximal ureter, with mild hydronephrosis and hydroureter.

Periureteral lymphoma

Involvement of the GU system by non-Hodgkin lymphoma is not infrequent, and the kidneys are most often affected. Ureteral lymphoma generally occurs as a result of contiguous spread from adjacent retroperitoneal nodes or from the kidney. This case is unusual in that ureteral involvement was the primary manifestation of the disease....
Case 9.4
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

34-year-old man with a history of gastroesophageal reflux and recent solid food dysphagia

Axial fat-suppressed FSE T2-weighted images (Figure 9.4.1) and coronal SSFSE images (Figure 9.4.2) demonstrate an infiltrative mass in the gastric cardia and fundus with marked mural thickening and slight hyperintensity relative to normal stomach. Axial diffusion-weighted images with a b value of 600 s/mm...
Case 9.11
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

33-year-old man with a 13-year history of Crohn disease and recent episodes of abdominal pain and cramping

Coronal SSFSE images (Figure 9.11.1) show thickening and narrowing of the terminal ileum. Fat-suppressed axial SSFP image (Figure 9.11.2) reveals no mural edema in this region, and an axial oblique reformatted 3D SPGR image (...
Case 9.17
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

35-year-old woman with a history of IBD and moderately active IBD symptoms

Coronal SSFP images (Figure 9.17.1) and coronal postgadolinium 3D SPGR images (Figure 9.17.2) show an ahaustral right and transverse colon with mild mural thickening and enhancement. Note the relatively normal appearance of the descending and sigmoid colon and the mild thickening and hyperenhancement of the terminal ileum....
Case 9.18
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

20-year-old man with chronic GI symptoms, including bloody diarrhea

Coronal postgadolinium 3D SPGR images (Figure 9.18.1) demonstrate an ahaustral colon with mild, diffuse mural thickening and enhancement. Note the enhancing polyp in the transverse colon. Axial fat-suppressed 2D SSFP images (Figure ...
Case 9.19
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

54-year-old woman with intermittent abdominal cramps, bloating, and diarrhea

Coronal SSFSE images (Figure 9.19.1) demonstrate a large ovoid, T2-hyperintense lesion in the descending colon that serves as the lead point for an intussusception. Notice also a second, smaller lesion proximally in the descending colon. The lesions are hyperintense on axial T1-weighted images (...
Case 9.25
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

68-year-old woman with gradual onset of occasional incontinence and bright red blood per rectum; colonoscopy showed a low rectal mass

Axial fat-suppressed FSE T2-weighted images (Figure 9.25.1) demonstrate a lobulated hyperintense mass in the low rectum and anus. Axial arterial phase (...
Case 9.26
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

23-year-old man with Crohn disease diagnosed at age 11 years, with large- and small-bowel involvement

Axial fat-suppressed FSE T2-weighted images (Figure 9.26.1) reveal a horseshoe-shaped fluid collection along the posterior and right lateral margin of the anus that contains foci of gas. Note the small, faintly visualized communication with the lumen of the anus on the most inferior image. Coronal FSE T2-weighted images (...
Case 9.28
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

11-year-old boy with suspected IBD

Coronal SSFSE images (Figure 9.28.1) demonstrate abnormal orientation of large and small bowel, with small bowel in the right abdomen and colon in the left abdomen.

Malrotation

Classic thinking regarding malrotation holds that most cases are detected within the first few months of life. However, in the new era of cross-sectional imaging for everyone, more and more adults with asymptomatic malrotations are noted and the true incidence is not entirely certain. Estimates in the literature range from 1 in 6,000 to 1 in 200 live births. Autopsy studies suggest that some form of malrotation exists in 0.5% to 1% of the population....
Case 10.3
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

69-year-old woman with a vaginal lesion noted on physical examination

Axial FSE T2-weighted images without (Figure 10.3.1) and with (Figure 10.3.2) fat suppression obtained following instillation of vaginal US gel demonstrate a uniformly hypointense lesion along the right lateral margin of the vagina. Axial postgadolinium 3D SPGR image (...
Case 10.11
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

26-year-old woman with a 2-year history of infertility

Axial oblique FSE T2-weighted image (Figure 10.11.1) reveals a minimally concave uterine fundal contour. There are 2 uterine horns, and the endometrial cavity and cervix are divided by a linear structure with dark T2-signal intensity. Coronal FSE T2-weighted image (...
Case 10.12
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

49-year-old woman with a right-sided pelvic mass on physical examination

Axial fat-suppressed FSE T2-weighted images (Figure 10.12.1) and sagittal FSE T2-weighted images without fat suppression (Figure 10.12.2) demonstrate a large lobulated mass with low T2-signal intensity. An axial arterial phase postgadolinium 3D SPGR image (...
Case 10.18
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

72-year-old woman with vaginal bleeding

Sagittal fat-suppressed FSE T2-weighted images (Figure 10.18.1) demonstrate an ill-defined mass in the endometrial cavity that extends into the myometrium of the uterine fundus superiorly and protrudes into the lower uterine segment. There are multiple round, T2-hypointense fibroids within the uterine body and fundus. Notice the bulky, heterogeneously enhancing mass centered in the vagina and extending anteriorly to encase the urethra and bladder base and abutting the rectum posteriorly. Axial FSE T2-weighted image through the inferior pelvis (...
Case 10.19
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

38-year-old woman with a 2-week history of pelvic pain

Axial diffusion-weighted images (b=800 s/mm2) (Figure 10.19.1) reveal an infiltrative mass centered in the posterior and right lateral myometrium with heterogeneous increased signal intensity. Sagittal oblique FSE image (Figure 10.19.2...
Case 10.20
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

43-year-old woman with a uterine mass

Axial fat-suppressed SSFP image (Figure 10.20.1) reveals a large, predominantly cystic mass in the uterine fundus that contains peripheral nodular soft tissue components. The soft tissue rim has high signal intensity on axial DWI (b=800 s/mm...
Case 10.26
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

32-year-old woman with abnormal obstetric US

Coronal oblique fat-suppressed 2D SSFP images (Figure 10.26.1) show a complex cystic and solid supratentorial mass replacing most of the fetal brain. Note also macrocephaly and polyhydramnios.

Fetal intracranial teratoma

Fetal and congenital tumors represent less than 3% of all tumors diagnosed before age 15 years. The reported incidence of congenital tumors ranges from 1.7 to 13.5 per 100,000 live births and is likely greater in stillborn and aborted fetuses. If the definition of ...
Case 11.1
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

28-year-old woman with secondary amenorrhea and hirsutism

Axial fat-suppressed 2D SSFP images (Figure 11.1.1) demonstrate multiple follicles arranged in the periphery of the ovaries bilaterally.

Polycystic ovary syndrome

PCOS is the most common endocrine disorder in women of reproductive age, affecting between 6% and 15%, depending on the criteria used for diagnosis. It typically presents with anovulatory or oligo-ovulatory menstrual cycles leading to oligomenorrhea, polycystic ovaries, and clinical and biochemical hyperandrogenism. PCOS is also associated with increased risk of obesity, insulin resistance, diabetes mellitus, metabolic syndrome, and infertility....
Case 11.11
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

50-year-old woman with an ovarian mass incidentally detected on screening CT colonography

Axial FSE T1-weighted (Figure 11.11.1) and T2-weighted (Figure 11.11.2) images demonstrate a low-signal-intensity ovoid mass in the right adnexa anterior to the uterus. Axial arterial phase postgadolinium 3D SPGR image (...
Case 11.17
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

51-year-old woman with a 1-month history of increasing lower abdominal pain

Axial oblique FSE T2-weighted images (Figure 11.17.1) reveal enlarged ovaries bilaterally that contain elements of high and low signal intensity, as well as a small cystic component in the inferior right ovary. Axial oblique postgadolinium 2D SPGR images (...
Case 11.18
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

46-year-old woman with history of appendiceal goblet cell carcinoid, resected 3 years previously, who underwent MRI to assess for hepatic metastases

Axial fat-suppressed FSE T2-weighted images (Figure 11.18.1) and sagittal fat-suppressed 2D SSFP image (Figure 11.18.2) reveal a large, mildly heterogeneous mass in the central pelvis superior to the uterus with diffusely high signal intensity and a few scattered cystic components. Axial diffusion-weighted image (b=800 s/mm...
Case 12.2
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

32-year-old man with infertility and azospermia

Axial fat-suppressed FSE T2-weighted images (Figure 12.2.1) reveal 2 ovoid hyperintense structures in the anterior right pelvis and lateral left pelvis.

Bilateral undescended testicles

Cryptorchidism is the most common genitourinary anomaly in male infants, occurring in 1% to 3% of term infants and in up to 30% of premature infants. Boys with cryptorchidism are at increased risk for infertility and testicular cancer, with the incidence of both complications increasing the longer the testicle remains undescended; therefore, orchiopexy is generally recommended at 12 months of age....
Case 12.3
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

73-year-old man with a gradually enlarging scrotal mass

Coronal T2-weighted FSE images (Figure 12.3.1) demonstrate a complex predominantly fatty scrotal mass with prominent septations as well as a nodular nonfatty central component and a small hydrocele. Note that the lesion extends superiorly into the inguinal canal. Axial FSE T1-weighted images (...
Case 12.9
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

34-year-old man with dysuria and urinary frequency

Axial (Figure 12.9.1) and coronal (Figure 12.9.2) fat-suppressed FSE T2-weighted images reveal a hypointense infiltrative mass surrounding the bulbous and penile urethra. Coronal postgadolinium 2D SPGR images (Figure 12.9.3) show heterogeneous enhancement of the lesion and irregular margins. Notice on both T2-weighted and postgadolinium coronal images disruption of the normal low-signal-intensity rim of the tunica albuginea with extension into the corpora cavernosa....
Case 12.11
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

58-year-old man with a history of a fungating penile mass that has grown slowly over 2 to 3 years

Axial fat-suppressed FSE T2- weighted images (Figure 12.11.1) and sagittal postgadolinium 3D SPGR images (Figure 12.11.2) reveal a large mass involving the penis, scrotum, and perineum with multiple frondlike projections demonstrating mild heterogeneous enhancement....
Case 12.14
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

24-year-old man with left-sided lower abdominal pain

Axial (Figure 12.14.1), sagittal (Figure 12.14.2), and coronal (Figure 12.14.3) FSE T2-weighted images demonstrate a small midline cystic lesion in the posterior portion of the prostate base.

Prostatic utricle cyst...
Case 12.17
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

62-year-old man with difficulty voiding and occasional dysuria and urinary frequency; a cystic prostatic lesion has been followed for more than 30 years at another medical institution

Axial (Figure 12.17.1) and sagittal (Figure 12.17.2) FRFSE T2-weighted images and axial (...
Case 12.20
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

46-year-old man with hematuria

Axial T2-weighted FRFSE images (Figure 12.20.1) demonstrate a multilobulated cystic lesion with several thin septations in the prostate apex. Axial FRFSE images from an examination performed 1 year later (Figure 12.20.2) demonstrate decreasing size of the cystic lesions but with new soft tissue nodularity. Axial FRFSE images from an examination performed 2 years later (...
Case 12.21
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

53-year-old man who underwent robotic prostatectomy 4 years ago with a small positive margin in the right apex; PSA was initially zero postoperatively, but it has been slowly increasing in the past year

Axial (Figure 12.21.1) and sagittal (Figure 12.21.2) T2-weighted FRFSE images obtained with an endorectal coil demonstrate a lobulated mass with mildly increased signal intensity along the right posterior margin of the bladder outlet extending inferiorly into the prostatectomy bed. Axial arterial phase postgadolinium 3D SPGR images (...
Case 12.22
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

70-year-old man with a history of prostate cancer diagnosed 12 years ago and treated with radical prostatectomy; a recurrence diagnosed 2 years later was treated with radiotherapy, and he now presents with nausea and signs of bladder outlet obstruction

Axial fat-suppressed (Figure 12.22.1...
Case 13.4
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

60-year-old woman with chronic pulmonary disease and upper extremity swelling

Axial (Figure 13.4.1) and coronal (Figure 13.4.2) postgadolinium 3D SPGR images show extensive perihilar infiltrates, hilar and mediastinal adenopathy, and mild enlargement of the central pulmonary arteries.

Sarcoidosis...
Case 13.6
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

3-year-old girl with a chest wall mass that her mother noticed

Axial (Figure 13.6.1) and coronal (Figure 13.6.2) FSE T2-weighted images demonstrate a large heterogeneous mass that has multiple regions of high signal intensity and occupies much of the left hemothorax. Note involvement of the lateral chest wall and a lower rib best seen on the coronal images....
Case 13.8
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

62-year-old man with shortness of breath and an abnormal chest CT

Axial 3D SPGR postgadolinium images (Figure 13.8.1) demonstrate diffuse thickening and enhancement of the left pleura, with a few minimally enhancing, focal right-sided pleural plaques.

Malignant pleural mesothelioma

Malignant pleural mesothelioma is a rare neoplasm that originates from the mesothelial cells lining the visceral and parietal pleura. The incidence of malignant pleural mesothelioma in the United States is 15 cases per million; there is a strong correlation with asbestos exposure. Malignant pleural mesothelioma is divided into 3 histologic subtypes: epithelial (55%-65%), sarcomatoid (10%-15%), and mixed (20%-35%). Patients with epithelial malignant pleural mesothelioma have the best prognosis, and among those with limited disease who undergo extrapleural pneumonectomy (removal of the pleura, lung, hemidiaphragm, and part of the pericardium), survival is longer (5-year survival, 39%) than among all patients (median survival, 8-18 months after diagnosis)....
Case 13.12
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

52-year-old woman with chest discomfort; chest CT revealed an indeterminate mediastinal lesion

Axial proton density-weighted double inversion recovery FSE images (Figure 13.12.1) demonstrate a large mildly heterogeneous lesion with moderately increased signal intensity relative to adjacent skeletal muscle and a well-defined low-signal-intensity capsule. Axial T2-weighted triple inversion recovery FSE images (...
Case 13.13
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

45-year-old woman with a cardiac abnormality that was noted incidentally on abdominal CT

Axial double (Figure 13.13.1) and triple (Figure 13.13.2) inversion recovery FSE images and axial SSFP image (Figure 13.13.3) demonstrate an ovoid cystic lesion containing simple fluid along the left heart border....
Case 13.15
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

34-year-old man with chest pressure and elevated troponin levels

Short-axis MDE images obtained 2 minutes after gadolinium injection (Figure 13.15.1) and horizontal long-axis MDE images obtained 10 minutes after gadolinium injection (Figure 13.15.2) demonstrate early heterogeneous enhancement of the lateral and inferior left ventricular myocardium and late patchy enhancement predominantly involving the lateral wall in an epicardial, nonischemic distribution....
Case 13.18
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

76-year-old man with progressive exertional dyspnea

Two-chamber (Figure 13.18.1) and 4-chamber (Figure 13.18.2) systolic frames from cine SSFP acquisitions demonstrate hypertrophy of the mid myocardium sparing the base of the left ventricle and severe thinning of the apex. Two-chamber postgadolinium MDE image (...
Case 13.21
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

62-year-old man with new-onset chest pain

Horizontal long-axis (4-chamber) (Figure 13.21.1) and vertical long-axis (2-chamber) (Figure 13.21.2) MDE images demonstrate transmural enhancement of the left ventricular apex. Note the prominent nonenhancing filling defect in the apical cavity adjacent to the enhancing infarct....
Case 13.30
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

46-year-old woman receiving chemotherapy and radiotherapy for cervical carcinoma diagnosed 6 months ago; she now has new-onset chest pain

Axial double (Figure 13.30.1) and triple (Figure 13.30.2) inversion recovery FSE images with proton density- and T2-weighting demonstrate a poorly defined mass involving the anterior wall of the right atrium and free wall of the right ventricle. Short-axis contrast-enhanced LGE images (...
Case 14.8
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

69-year-old man with a hepatic lesion that was detected on CT

Coronal SSFSE image (Figure 14.8.1) demonstrates 2 hyperintense lesions in lower thoracic and upper lumbar vertebral bodies. Axial IP-OP 2D SPGR images (Figure 14.8.2) show that the superior-most lesion has increased signal intensity relative to adjacent bone marrow without significant dropout on the OP image. The lesion shows mild hyperintensity on an axial fat-suppressed FSE T2-weighted image (...
Case 14.10
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

52-year-old man with a hereditary disorder

Axial fat-suppressed FSE T2-weighted images (Figure 14.10.1) demonstrate multiple exophytic lesions extending from the right and left iliac bones and the right femoral neck. All the lesions have a thin outer margin with high signal intensity. Axial T1-weighted FSE images (...
Case 14.11
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

17-year-old adolescent male with lower extremity numbness

Axial fat-suppressed FSE T2-weighted images (Figure 14.11.1) demonstrate innumerable hyperintense lesions containing central low-signal-intensity foci along the course of virtually all nerves in the pelvis. Coronal FSE T2-weighted image (Figure 14.11.2) through the posterior thighs reveals diffuse expansion of the sciatic nerves with lesions similar to those in the pelvis....
Case 14.15
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

78-year-old woman with a large retroperitoneal mass discovered on a preoperative CT performed before ventral hernia repair

Axial IP 2D SPGR images (Figure 14.15.1) demonstrate a large heterogeneous mass in the left abdomen abutting and displacing the left kidney anteriorly. Note that the anterior portion of the mass has high signal intensity. Axial postgadolinium 2D SPGR images (...
Case 14.18
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

52-year-old man with right upper quadrant pain and a right abdominal mass

Axial fat-suppressed FSE T2-weighted images (Figure 14.18.1) demonstrate a large, hyperintense lobulated mass arising from the right iliac bone. Axial postgadolinium 3D SPGR images (Figure 14.18.2) reveal mild enhancement of the multiple septations within the lesion. Note the prominent mass effect and distortion involving the adjacent psoas muscle. Axial CT images (...
Case 14.23
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

32-year-old woman with a complex pelvic mass that was incidentally detected on prenatal US

Axial FSE T1-weighted images (Figure 14.23.1) and fat-suppressed FSE T2-weighted images (Figure 14.23.2) demonstrate a heterogeneous mass with moderately high T2-signal intensity and low T1-signal intensity originating from the left superior pubic ramus. Prominent soft tissue components extend both anteriorly and posteriorly from the epicenter of the lesion. Axial postgadolinium 2D SPGR images (...
Case 14.24
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

64-year-old man with right buttock pain and lower extremity weakness

Axial fat-suppressed FSE T2-weighted images (Figure 14.24.1) demonstrate multiple markedly hyperintense masses involving the paraspinous regions bilaterally and the anterior and posterior right lower pelvis. Axial postgadolinium 2D SPGR images (Figure ...
Case 15.3
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

47-year-old woman with a BRCA1 mutation and recent negative mammogram and US

The MIP images at peak enhancement with (Figure 15.3.1A) and without (Figure 15.3.1B) CAD color overlay demonstrate a small nonmass enhancement with persistent enhancement kinetics in the middle-depth right breast. This nonmass enhancement has intermediate to increased signal intensity on the T2-weighted water image (...
Case 15.5
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

49-year-old woman with a history of invasive ductal carcinoma and DCIS of the right breast status post right mastectomy with bilateral subpectoral silicone implants and left mastopexy and currently taking tamoxifen; a screening breast MRI was requested

The MIP image at peak enhancement with CAD color overlay (...
Case 15.8
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

46-year-old woman with a history of metachronous bilateral breast cancers status post bilateral mastectomies with implant reconstruction; her physician detected an area of palpable concern in the 12 o’clock position of the right breast

Water images (Figure 15.8.1) from a T2-weighted FSE acquisition using a modified 3-point Dixon (IDEAL) method for fat suppression demonstrate features suggestive of dual-lumen implants. Corresponding T2-weighted IR images with water suppression (...
Case 15.9
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

61-year-old woman with a history of a ruptured left silicone implant 12 to 15 years ago. At that time, the ruptured implant and as much free silicone as possible were removed and a new silicone implant was placed. Recently, the patient was called back after screening mammography for a dense left axillary lymph node that on subsequent US was thought to contain silicone. Etiologic considerations included residual silicone from the prior implant rupture vs rupture of the current silicone implant. MRI was recommended for evaluation of implant integrity...
Case 15.10
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

36-year-old woman with biopsy-proven left-sided infiltrating ductal carcinoma; MRI was ordered for staging purposes

The MIP images at peak enhancement with (Figure 15.10.1A) and without (Figure 15.10.1B) CAD color overlay demonstrate a left-sided irregular mass with predominantly plateau and scattered washout enhancement corresponding to known malignancy. More anteriorly in the left breast, there is a small area of nonmass enhancement that was attributed to background and, possibly, some motion....
Case 15.11
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

58-year-old woman status post stereotactic-guided biopsy of grouped pleomorphic calcifications in the left breast with pathology indicating DCIS. Mammographically in this region, there were scattered parenchymal densities with areas of relatively greater density associated with the known cancer; MRI was performed 8 days after the biopsy to exclude other areas of disease...
Case 15.13
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

35-year-old woman who during the ninth month of pregnancy noticed some nipple deviation of the left breast. After she gave birth to a healthy baby, the breast abnormality persisted along with a palpable area of concern; an MRI was ordered

The MIP images at peak enhancement with (...
Case 16.3
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

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

Focal dilatation of the right renal artery at its bifurcation is seen on VR images from 3D CE MRA (Figure 16.3.1).

Renal artery aneurysm

Renal artery aneurysms are relatively infrequent, but nevertheless they are the second most common visceral artery aneurysm after splenic artery aneurysms. The estimated incidence on autopsy studies is approximately 0.01%, while an incidence of 0.3% to 1% has been reported for patients undergoing renal angiography. Renal artery aneurysms are most often detected in middle age and are more common in women. Patients are typically asymptomatic. The aneurysms are associated with hypertension in as many as 73% of cases, but it is not always clear whether the aneurysm is the result or the cause of hypertension. Certainly poststenotic dilatation can result from severe renal artery stenosis, and distal embolization from renal artery aneurysms could result in parenchymal loss and activation of the renin-angiotensin cascade. Renal artery aneurysms have several potential causes, but the 2 most common are atherosclerosis and FMD. Both tend to occur most frequently in the main renal artery, at its bifurcation, or in the proximal branches. Aneurysms due to arteritis, such as polyarteritis nodosa, Wegener granulomatosis, and necrotizing angiitis, as well as most posttraumatic aneurysms and pseudoaneurysms, occur within intrarenal arteries. Additional causes include EDS, neurofibromatosis, infection (mycotic), and iatrogenic causes. FMD is discussed more completely in ...
Case 16.6
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

79-year-old with abdominal pain and nausea

VR images from 3D CE MRA (Figure 16.6.1) demonstrate occlusion of the celiac artery, severe stenosis of the superior mesenteric artery origin, and a patent inferior mesenteric artery with a prominent arc of Riolan. Coronal SSFSE images (...