Differential diagnosis in magnetic resonance imaging PDF
Preview Differential diagnosis in magnetic resonance imaging
I II III Differential Diagnosis in Magnetic Resonance Imaging Francis A. Burgener, M.D. Raymond K. Tan, M.D. Professor of Radiology Assistant Professor of Radiology University of Rochester Medical Center University of Rochester Medical Center Rochester, NY, USA Rochester, NY, USA Steven P. Meyers, M.D., Ph.D. Wolfgang Zaunbauer, M.D. Associate Professor of Radiology Institute of Radiology University of Rochester Medical Center Kantonsspital St. Gallen Rochester, NY, USA St. Gallen, Switzerland 1964 illustrations Thieme Stuttgart · New York IV LibraryofCongressCataloging-in-PublicationData Any reference to or mention of manufacturers or specific isavailablefromthepublisher. brandnamesshouldnotbeinterpretedasanendorsement ofadvertisementforanycompanyofproduct. Someoftheproductnames,patents,andregisteredde- signs referred to in this book are in fact registered trade- marksorproprietarynameseventhoughspecificreference to this fact is not always made in the text. Therefore, the appearanceofanamewithoutdesignationasproprietary isnottobeconstruedasarepresentationbythepublisher Contributorsofillustrations thatitisinthepublicdomain. KevinG.J.Ibach,M.D.,F.R.C.P.C. Thisbook,includingallpartsthereof,islegallyprotected Lecturer by copyright. Any use, exploitation, or commercialization UniversityofToronto outside the narrow limits set by copyright legislation, UniversityHealthNetwork without the publisher’s consent, is illegal and liable to TorontoGeneralHospital prosecution.Thisapplies inparticulartophotostatrepro- Toronto,Ontario,Canada duction, copying, mimeographing or duplication of any kind,translating,preparationofmicrofilms,andelectronic UreshPatel,M.D. dataprocessingandstorage. Radiologist IdeGroup,PC Rochester,NY,USA BrianK.Tan,M.D. ChiefResident DepartmentofRadiology UniversityofRochesterMedicalCenter Rochester,NY,USA ©2002GeorgThiemeVerlag, Rüdigerstraße14,D-70469Stuttgart,Germany Important Note: Medicine is an ever-changing science ThiemeNewYork,333SeventhAvenue, undergoingcontinualdevelopment.Researchandclini- NewYork,N.Y.10001USA cal experience are continually expanding our knowl- edge,inparticularourknowledgeofpropertreatment CoverdesignbyRenateStockinger,Stuttgart and drug therapy. Insofar as this book mentions any Drawings by Christiane and Dr. Michael von Solodkoff, dosageorapplication,readersmayrestassuredthatthe Neckargmünd authors,editors,andpublishershavemadeeveryeffort toensurethatsuchreferencesareinaccordancewiththe TypesettingbyprimustypeRobertHurlerGmbH stateofknowledgeatthetimeofproductionofthebook. 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ISBN1-58890-085-1(TNY) 1 2 3 4 5 V Foreword Since1985,whenIhadthepleasureandhonorofpublish- information for a single-volume textbook has become a ingthefirsteditionofthetextbook“DifferentialDiagnosis verydemandingtask.Itgoeswithoutsayingthatadiffer- inConventionalRadiology”withDr.FrancisA.Burgener,it entialdiagnostictextbookaboutMRIwillbesubstantially hasbecomecustomarytouseasimilarapproachinwriting largerthanoneonCT.Theauthorsaretobecongratulated radiological textbooks, i.e. to structure the books on the fortheirsuccessinfittingasignificantamountofessential basis of radiographic findings instead of disease entities. radiologicalinformation,hundredsofdifferentialdiagnos- Whenthebookfirstappeared,theapproachwaswellre- tic tables, and approximately 2000 state-of-the-art draw- ceivedbyradiologyresidentspreparingfortheirspecialist ings,charts,andMRimagesintoatextbookofalmost700 examinations. Even non-radiologist physicians, occasion- pages. ally called upon to interpret radiographic findings, used The structure and layout of Differential Diagnosis in thetextasitdoesnotrequireextensivereadingtofindthe Magnetic Resonance Imaging is essentially similar to the essentialdiagnosticcriteria. previous two differential diagnostic textbooks, published In 1996 we published another textbook using a similar by Thieme, of which Dr. Burgener is the first author. It is approach,namely“DifferentialDiagnosisinComputedTo- dividedintoanatomicalsections,includingthebrain,head mography,” which also proved successful. Even then, we andneck,spine,musculoskeletalsystem,chest,abdomen, hadplanstocontinuetheseriesbywritinganothervolume andpelvis.Thebookcoversthemostcommondiseasesand on differential diagnosis in magnetic resonance imaging. a multitude of rare and unusual conditions, providing Tomysinceredismay,Iwasunabletoinvestenoughtime quickaccesstodifferentialdiagnosticinformation. andenergytofinishmypartoftheplannedMRItextbook Iamconvincedthatthisguidetodifferentialdiagnosisin intime.SoitwasagreatreliefbothtomyselfandDr.Bur- MRI will receive the same enthusiastic acceptance as the generthathefoundthreetalentedandproficientyounger previousbooksinthisseries.Itwillbehelpfultoradiolo- radiologists, Dr. Stephen P. Meyers, M.D. Ph.D and Ray- gistsandotherphysiciansinvolvedininterpretingMRim- mond K. Tan, M.D. of the University of Rochester Medical ages.Residentsandfellowswillfinditaninvaluableboard Center, Rochester, N.Y., and Wolfgang Zaunbauer, M.D. of preparationtool. Kantonsspital,St.Gallen,Switzerlandtocompletethebook ondifferentialdiagnosisinMRIwithoutunduedelay. MarttiKormano,M.D. MRI is still developing rapidly and new imaging ProfessorandChairman sequences are published almost daily. New diagnostic DepartmentofDiagnosticRadiology signs continue to be discovered in great numbers. With UniversityofTurku this overflow of new information, selecting the essential Turku,Finland VI Preface All good things must come to an end. After having co- other radiology textbooks, which are disease oriented. authoredwithDr.MarttiKormanothetextbooks“Differen- Since many diseases present with MRI in a variety of tialDiagnosisinConventionalRadiology”and“Differential manifestations,someoverlapinthetextisunavoidable.To Diagnosis in Computed Tomography,” which were trans- minimizerepetition,thedifferentialdiagnosisispresented lated into five languages and produced several spin-off intabularformwhereverfeasible.Thetableslistnotonly books,Dr.Kormanohadtobackoutatthelastminutefrom the various diseases that may present with MRI in a this project because of too many other professional com- specific way, but also include the characteristically as- mitments as chairman of a radiology department and sociatedMRIfindingsandpertinentclinicaldatainasuc- manynationalandinternationalsocieties,asclinician,re- cinctform.Illustrationsanddrawingsareenclosedtovisu- searcher,andteacher,andlastbutnotleastasberryfarmer. allydemonstratetheMRIfindingsunderdiscussion. It was impossible to replace Dr. Kormano with his exten- This book is intended for radiologists and physicians sive knowledge in the entire field of diagnostic radiology with some expertise in diagnostic imaging who wish to byasingleperson.Iwas,however,fortunateenoughtofind strengthentheirdiagnosticacumeninMRI.Itisacompre- threecolleaguesandfriendsofminetowritethepartorigi- hensiveoutlineofMRIfindingsandweexpectittobepar- nallyassignedtoDr.KormanoandIbelievetheyperformed ticularly useful to radiology residents who are preparing anoutstandingjob. fortheirspecialistexaminations.Anyphysicianinvolvedin MRI has gained worldwide acceptance and, in addition the interpretation of MRI studies should find this book tomanynewindications,hasreplacedotherdiagnosticim- helpfulindirectproportiontohisorhercuriosity.Itismy agingtechniques.MRIisnolongertheexclusivedomainof hope that this new textbook will be as well received by theradiologist,butisalsopracticedand/orinterpretedbya medical students, interns, residents, radiologists, and largenumberofcliniciansandsurgeons.Witheachexami- physicians—allbeinginvolvedintheinterpretationofMRI nation, one is confronted with a number of MRI findings examinations—asmyprevioustexts“DifferentialDiagnosis thatrequireinterpretationinordertoarriveatageneraldi- in Conventional Radiology” and “Differential Diagnosis in agnostic impression and a reasonable differential diagno- ComputedTomography,”writtenwithDr.Kormano,which sis.Toassistthephysicianinattainingthisgoal,ourbookis werebasedonthesameconcept. based upon MRI findings. This offers a contrast to most FrancisA.Burgener,M.D. Acknowledgements Itisimpossibletothankindividuallyallthosewhohelped JohnnyU.V.Monu,alloftheUniversityofRochesterRadi- to prepare this textbook. We wish to acknowledge the ology Department, and by Dr. Claude Jean-Pierre of the Thieme staff, in particular Dr. Clifford Bergman and Mr. RadiologyDepartmentoftheUniversityofOslo,Norway. GertA.Krüger. WewishtoexpressourthankstoThereseBurgenerfor Wewishalsotoexpressourgratitudetomanyradiolo- preparing a large number of drawings and to Catherine gistswhosecooperationhelpedmakethisillustrativecol- Tan, M.D. for typing and proofreading a portion of the lection of MRI cases available. We are indebted to Drs. manuscript. Iona Mackey’s work in preparing the refer- Barry R. Armandi Jr., Ja-Kwei Chang, Gary M. Hollenberg, encesisalsogreatlyappreciated.Last,butnotleast,weare DeborahJ.Klein,ValehLevy,AmitL.Mehta,BradleyR.Pe- mostgratefultoAlyceNorderwhoorchestratedtheexecu- ters,RodolfoQueiroz,StuartJ.Rubin,GwySukSeo,JohnG. tionofthisproject.Notonlydidshedoasuperbjobintyp- Strang,EricP.Weinberg,Per-LennartWestesson,andIanJ. ing,editing,andproofreadingthemanuscript,butshewas Wilson,allcurrentorformermembersoftheUniversityof alsoinchargeofthetransatlanticcoordinationofthisun- Rochester Radiology Department, and to Drs. Masoom dertaking. Without Alyce there would be no manuscript HaiderandNaeemMerchantoftheUniversityofToronto, yet. who all supplied cases from their personal files. Valuable Finally,weappreciatethesupportofourfamilies.They assistanceinpreparationandexecutionofthemanuscript havegenerouslygivenoftheirpreciousfamilytimeforthe was given by Drs. Mark J. Adams, Patrick J. Fultz, and preparationofthisbook. VII Table of Contents Introduction ........................................................ 1 Section I 1A Brain .......................................................... 6 Brain 1B CerebralVasculaturewithMagneticResonanceAngiography ...... 130 2A Ventricles and Cisterns ......................................... 142 2B LesionsInvolvingtheMeninges(Dura/Leptomeninges) and Skull ...................................................... 170 Section II 3 SkullBaseandTemporalBone ................................... 190 Head and Neck 4 Orbit and Eye .................................................. 209 5 ParanasalSinusesandNasalCavity ............................... 224 6 UpperNeck .................................................... 232 7 LowerNeck,Larynx,andHypopharynx ........................... 254 Section III 8 SpineandSpinalCord ........................................... 272 Spine Section IV 9 Soft-TissueDisease ............................................. 334 Musculoskeletal System 10 JointDisease ................................................... 354 10A Shoulder ....................................................... 364 10B Elbow ......................................................... 372 10C WristandHand ................................................ 376 10D Hip ............................................................ 385 10E Knee .......................................................... 390 10F AnkleandFoot ................................................. 401 10G TemporomandibularJoint ....................................... 409 11 GeneralizedBoneandBoneMarrowDisease ...................... 411 12 LocalizedBoneandBoneMarrowDisease ........................ 423 Section V 13 Lungs ......................................................... 452 Chest 14 Pleura,Diaphragm,ChestWall,andBreast ........................ 456 15 HeartandMediastinum ......................................... 463 Section VI 16 Liver .......................................................... 490 Abdomen and Pelvis 17 BiliaryTract .................................................... 518 18 Spleen ......................................................... 528 19 Pancreas ....................................................... 538 20 AbdominalWall ................................................ 548 21 GastrointestinalTract ........................................... 554 22 Peritoneum and Mesentery ..................................... 564 23 Retroperitoneum ............................................... 572 24 Kidneys ....................................................... 582 25 AdrenalGlands ................................................. 598 26 Pelvis .......................................................... 606 References .......................................................... 636 Index ............................................................... 637 VIII Abbreviations ABC aneurysmalbonecyst FSPGR fastspoiledgradient-recalledecho ACTH adrenocorticotropichormone GB gallbladder ADEM acutedisseminatedencephalomyelitis Gd gadoliniumchelates AFP alpha-fetoprotein GD- gadoliniumchelatecontrast AIDS acquiredimmunedeficiencysyndrome contrast ALL acutelymphoblasticleukemia Gd-DTPA gadoliniumdiethylene-triamine-pentaacetic AML acutemyeloblasticleukemia acid ANCA antineutrophilcytoplasmoticautoantibodies GE gastroesophageal ANT anterior GI gastrointestinal AP anteroposterior GRASS gradient-refocusedacquisitioninthesteady APUD amineprecursoruptakeanddecarboxylation state APVR anomalouspulmonaryvenousreturn GRE gradient-refocusedechopulsesequence ARDS acuterespiratorydistresssyndrome GTD gestationaltrophoblasticdisease ATN acutetubularnecrosis GU genitourinary AV arteriovenous Hb hemoglobin AVF arteriovenousfistula HD Hodgkindisease AVM arteriovenousmalformation HIV humanimmunodeficiencyvirus AVN avascularnecrosis HRCT high-resolutionCT Bx biopsy Hx history +C aftergadoliniumcontrastenhancement IAC internalauditorycanal Ca calcium ICA internalcarotidartery CAD coronaryarterydisease IM intramuscular CAM cysticadenomatoidmalformation IMA inferiormesentericartery CBD commonbileduct IMV inferiormesentericvein CHD commonhepaticduct IR inversionrecovery CHF congestiveheartfailure IS ileosacral,internalstandard CLL chroniclymphaticleukemia IV intravenous CMV cytomegalovirus IVC inferiorvenacava CNS centralnervoussystem IVP intravenouspyelogram COPD chronicobstructivepulmonarydisease L left CPA cerebellopontineangle LA leftatrium CPPD calciumpyrophosphatedihydratedeposition LCH Langerhanscellhistiocytosis disease LDH lactatedehydrogenase CRMD chronicrecurrentmultifocalosteomyelitis LE lupuserythematosus CSF cerebrospinalfluid LL lowerlobes CSI chemicalshiftimaging LLL leftlowerlobe CT computedtomography LLQ leftlowerquadrant 2D two-dimensional LUL leftupperlobe 3D three-dimensional LUQ leftupperquadrant DD differentialdiagnosis LV leftventricle DDH developmentaldysplasiaofthehip M male DES diethylstilbestrol MAI Mycobacteriumaviumintracellulare 3DFT three-dimensionalFouriertransform MCK multicystickidney DIC disseminatedintravascularcoagulation MCP metacarpophalangeal DISH diffuseidiopathicskeletalhyperostosis MEA multipleendocrineadenomas DISI dorsalintercalatedsegmentalinstability MEN multipleendocrineneoplasia EAC externalauditorycanal MFH malignantfibroushistiocytoma ECA externalcarotidartery MIP maximumintensityprojection EG eosinophilicgranuloma ML middlelobe ERCP endoscopicretrogradecholangiopancreato- MPGR multiplanargradientrecall graphy MPS mucopolysaccharidosis F female MR magneticresonance FAST Fourier-acquiredsteadystate MRA magneticresonanceangiography FISP fastimagingwithsteady-stateprecession MRC magneticresonancecholangiography FLAIR fluidattenuatedinversionrecovery MRCP magneticresonancecholangiopancreatography FLASH fastlow-angleshot MRI magneticresonanceimaging FNH follicularnodularhyperplasia MRS magneticresonancespectroscopy FS fat-suppressed(saturation) MTP metatarsophalangeal FSE fastspinecho NHL non-Hodgkinlymphoma Abbreviations IX NUC nuclearmedicine SI sacroiliac PA posteroanterior SLAC scapholunateadvancedcollapse PAPVR partialanomalouspulmonaryvenousreturn SLE systemiclupuserythematosus PATH pathology SMA superiormesentericartery PAVM pulmonaryarteriovenousmalformation SMV superiormesentericvein PCKD polycystickidneydisease SR surface-rendering PCP Pneumocystiscariniipneumonia SR saturationrecovery PD proton density weighted imaging (long TR/ STIR shorttau(T1)inversionrecovery shortTEsequences) SVC superiorvenacava PDA patentductusarteriosus T1 spin-latticeorlongitudinalrelaxationtime PDWI protondensityweightedimaging T2 spin-spinortransverserelaxationtime PE pulmonaryembolism T2* effectivespin-spinrelaxationtime PET positronemissiontomography T1W1 T1-weightedimaging PHPV persistenthyperplasticprimaryvitreous T2WI T2-weightedimaging PIP proximalinterphalangeal TAPVR totalanomalouspulmonaryvenousreturn PNET primitiveneuroectodermaltumor TB tuberculosis PO peroral TE echotime PSA prostatespecificantigen TFC triangularfibrocartilage PTHC percutaneoustranshepaticcholangiography TFCC triangularfibrocartilagecomplex PVNS pigmentedvillonodularsynovitis TI inversiontime RA rheumatoidarthritis TNM tumor-node-metastasis RA rightatrium TOF time-of-flight RBC redbloodcell TR repetitiontime RDS respiratorydistresssyndrome TURP transurethralresectionofprostate RES reticuloendothelialsystem UGI uppergastrointestinalseries RF radiofrequency UPJ ureteropelvicjunction RLL rightlowerlobe US ultrasound RLQ rightlowerquadrant VIP vasoactiveintestinalpeptides RML rightmiddlelobe VISI volarintercalatedsegmentalinstability RSD reflexsympatheticdystrophy WBC whitebloodcells RUL rightupperlobe WDHA waterydiarrhea,hypokalemia,achlorhydria RV rightventricle WDHH waterydiarrhea,hypokalemia,hypochlorhydria SE spinecho
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