Mayo Clinic body MRI case review

881 Pages·2014·261.7 MB·English

by  Glockner

M ayo C l i n i C B o dy M R i
C a s e R ev i ew
Mayo Clinic Scientific Press
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Mayo CliniC B ody MR i
Case Review
Christine U. Lee, MD, PhD
ConSultant, DePartMent of r aDiology
Mayo CliniC, r oCheSter, MinneSota
aSSiS tant ProfeSSor of r aDiology
Mayo CliniC College of MeDi Cine
James F. Glockner, MD, PhD
ConSultant, DePartMent of r aDiology
Mayo CliniC, r oCheSter, MinneSota
aSSiS tant ProfeSSor of r aDiology
Mayo CliniC College of MeDi Cine
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Library of Congress Cataloging-in-Publication Data
Lee, Christine U., author.
Mayo Clinic body MRI case review / Christine U. Lee, James F. Glockner.
p. ; cm. — (Mayo Clinic scientific press)
ISBN 978–0–19–991570–5 (alk. paper)
I. Glockner, James F., author. II. Title. III. Series: Mayo Clinic scientific press (Series).
[DNLM: 1. Magnetic Resonance Imaging—methods—Case Reports. 2. Whole Body Imaging—
methods—Case Reports. 3. Image Interpretation, Computer-Assisted—Case Reports. WN 185]
RC386.6.M34
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2014001272
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DEDICATION
We would like to dedicate this book to our parents,
Dr W. Yee and Agnes Lee and Warren and Mary Glockner.

PREFACE
Body MRI was once considered the weak stepsister of neuro- and residents and fellows are continually forced to expose
logic MRI (and probably still is by many neuroradiologists). their knowledge (or lack thereof) in the semipublic forum
This was reflected in the MR schedule during our training, of case conferences. The texts that we remember most fondly
when body MRI cases were relatively few and far between, and from our training (and, for the most part, the ones that we
the job of the MR or abdominal fellow was to arrive at 6 am actually read all the way through) were teaching files, which
for the 2 early cases and then wait for all the neurologic MRI exposed us to pathologies not prevalent at our institution and
examinations to be completed during the prime hours from 8 provided us with perspectives and analytical approaches that
am to 3 pm, after which any remaining body MRI cases could were occasionally different from those of our staff, all in an
then be scanned. easily digestible format that could be incorporated into the
The development of body MRI was hindered by problems occasional short breaks in the daily schedule.
of motion, whether breathing, cardiac pulsation, or anxious The body MRI practice at Mayo Clinic has been large and
patients, and also by oddly shaped anatomy that couldn't be fairly robust for many years, and we have accumulated a siz-
accommodated by a single coil. Nevertheless, many of the able collection of interesting cases encompassing a wide range
early pioneers persisted, and now body MRI is well estab- of pathologies, organ systems, and imaging techniques. The
lished, widely accepted as a valuable imaging technique, and chapters in this book are arranged primarily by organ systems,
experiencing rapid growth in many areas. and we have attempted to include many examples of standard
Despite the increasingly prominent role of body MRI, pathology as well as the occasional unusual and interesting
training remains somewhat haphazard—there are relatively cases that were missed by us (and a few others) either justifi-
few dedicated body MRI fellowships, and exposure of resi- ably, because no one had ever heard of the diagnosis before,
dents and fellows to body MRI in the various subspecialty or less justifiably, because we hadn't heard of it but probably
rotations is often limited to interpretation of images generated should have, or because we overlooked or misinterpreted
remotely using a standard protocol, without much reflection some relevant findings. Our combined expertise (such as it
on how the images are obtained, which pulse sequences are is) encompasses the abdominal and pelvic chapters, while as
optimal for a given clinical situation, and what can be done individuals we participate in cardiac and vascular (J.F.G.) and
to fix the problems that inevitably arise. While protocol stan- breast and thoracic (C.U.L.) MRI practices. The musculoskel-
dardization does have the advantage of establishing a baseline etal chapter is something of an anomaly since neither of us
level of examination quality, it remains surprisingly easy to has read orthopedic MRI for many years; however, nearly all
generate truly horrible images, particularly when technolo- the examples in the chapter are cases that, for one reason or
gists and radiologists forget (or never learned) how to adapt another, were scheduled for abdominal MRI. It is true, how-
an individual examination to accommodate the wide variety ever, that all body MRI examinations include musculoskeletal
of sizes, breath-hold abilities, and temperaments of patients. anatomy, and we have attempted to provide a framework from
In our opinion, the opportunity for the technologist or the abdominal imager's perspective for handling the inevitable
radiologist to have a real impact on the quality of an examina- musculoskeletal-related abnormalities.
tion is one of the most rewarding elements of body MRI, and We have tried to make the text opinionated, readable, and
we try to encourage our residents and fellows (with varying at least somewhat entertaining, and we have eliminated refer-
degrees of success) to learn enough of the nuts and bolts of ences for the individual cases (we can count on 1 hand with
scanning so that they can recognize when they are being fed several fingers left over the number of references looked up
substandard images and can even occasionally suggest possible from texts we read during our training). The unwary reader
solutions. We have tried to incorporate that philosophy into should remember that our opinions are not universally shared
this book, particularly in the chapter on image artifacts, and and that, in fact, many aspects of body MRI remain extremely
have included several tangential but relatively brief discussions contentious. Most of all, we hope that this book will commu-
related to practical MR physics or optimization of protocols nicate our enthusiasm for the subject and stimulate a similar
throughout the text. interest in trainees and even practicing radiologists.
While there are several excellent texts covering the fun- We would like to acknowledge Benjamin H. Lee for his
damentals of body MRI, the teaching file format appeals to effort in creating the illustrations in Chapters 4 and 12—time
us because it represents the natural unit of radiologic analy- which could otherwise have been devoted to his primary
sis: Working radiologists examine a series of cases every day, hobby of creating aliens.
vii

TABLE OF CONTENTS
1. Liver: Focal Masses 1
2. Liver: Diffuse Disease 63
3. Biliary 135
4. Pancreas 189
5. Spleen 245
6. Adrenal Glands 283
7. Kidneys 307
8. Ureters and Bladder 373
9. Bowel 421
10. Uterus 479
11. Ovaries 531
12. Male Pelvis 565
13. Thorax and Heart 615
14. Musculoskeletal System 675
15. Breast 729
16. Vascular System 757
17. Artifacts 795
Index 851
ix