1,720,996 research outputs found
MRI in the evaluation of facial dermal fillers in normal and complicated cases
No full textOBJECTIVES: To ascertain by MRI the presence of filler injected into facial soft tissue and characterize complications by contrast enhancement.
METHODS: Nineteen volunteers without complications were initially investigated to study the MRI features of facial fillers. We then studied another 26 patients with clinically diagnosed filler-related complications using contrast-enhanced MRI. TSE-T1-weighted, TSE-T2-weighted, fat-saturated TSE-T2-weighted, and TIRM axial and coronal scans were performed in all patients, and contrast-enhanced fat-suppressed TSE-T1-weighted scans were performed in complicated patients, who were then treated with antibiotics. Patients with soft-tissue enhancement and those without enhancement but who did not respond to therapy underwent skin biopsy. Fisher's exact test was used for statistical analysis.
RESULTS: MRI identified and quantified the extent of fillers. Contrast enhancement was detected in 9/26 patients, and skin biopsy consistently showed inflammatory granulomatous reaction, whereas in 5/17 patients without contrast enhancement, biopsy showed no granulomas. Fisher's exact test showed significant correlation (p 10 mm) was found in 16 complicated patients (65 %; levels IA/IB/IIA/IIB).
CONCLUSIONS: MRI is a useful non-invasive tool for anatomical localization of facial dermal filler; IV gadolinium administration is advised in complicated cases for characterization of granulomatous reaction.
KEY POINTS: • MRI is a non-invasive tool for facial dermal filler detection and localization. • MRI-criteria to evaluate complicated/non-complicated cases after facial dermal filler injections are defined. • Contrast-enhanced MRI detects subcutaneous inflammatory granulomatous reaction due to dermal filler. • 65 % patients with filler-related complications showed lymph-node enlargement versus 31.5 % without complications. • Lymph node enlargement involved cervical levels (IA/IB/IIA/IIB) that drained treated facial areas
Imaging Evaluation and Management of Complications after MacrolaneTM Breast Enhancement
No full textBackground: MacrolaneTM is a hyaluronic gel acid for breast augmentation, claimed to be reabsorbable and biocompatible. Despite these producer’s assertions MacrolaneTM may last more than 2 years after its placement, causing complications as product migration and lumps.
Objective:In this study High Frequency Ultrasound (HFUS) is compared to Magnetic Resonance Imaging (MRI) in MacrolaneTM complications diagnostics, with costs analysis. Complication treatment is discussed.
Methods: Five female patients, aged 27 to 45, sought medical advice for non tender breast deformity and lumpiness after MacrolaneTM breast enhancement performed 2 to 24 months before. All patients underwent HFUS and MRI.
Results: Both techniques identified the filler’s site and quantity. HFUS has lesser costs and better patient acceptance, MRI consent better product visualization with respect with regional anatomy. Three patients required MacrolaneTM removal, two refused any treatment.
Conclusions: HFUS and MRI are useful diagnostic tools after MacrolaneTM consenting differential diagnosis with other breast lumps. Complete surgical removal of MacrolaneTM may be difficult to achieve
The utility of HFUS and MRI in dermal fillers evaluation
No full textThe utility of High frequency US and MRI in dermal fillers evaluation.
Background and objective: many new materials were introduced in the market for cosmetic tissue augmentation claiming to be permanent or long lasting, inert, well tolerated, non migrating and easily removable in the rare event of complication. Patients aren’t always aware of the materials implanted in previous treatments, or may disguise that they have already had a treatment: this make difficult to safely perform further cosmetic procedures as required. Severe complications may show up even years after the subcutaneous injection of dermal fillers. The aim of the study is to describe the use of high frequency ultrasound (HFUS) and MRI to ascertain the site, quantity and type of filler injected in the soft tissue of the face for cosmetic purposes with respect to reliability of the procedure and the analysis costs.
. Materials and methods: 45 subjects were enrolled in the study after treatment with temporary or permanent dermal fillers, of these 19 didn’t show complications (Group A) while 26 presented with filler related complications (Group B) as erythema and swelling, lumps, cutaneous blisters and ulceration. The composition of filler was diverse: in Group A were included pts with hyaluronic acid (7), Collagen (5), Polylactic acid (1), Polyacrylamide hydrogel (3), polyalkylimide (2), synthetic calcium hydroxyl apatite (1), silicone (2). Group B included pts with hyaluronic acid (2), collagen (2), Polylactic acid (1), Polyacrylamide hydrogel (3), Polyalkylimide (4), synthetic calcium hydroxylapatite(1), polymethylmethacrylate with collagen (3), Polyvinyl alcohol (2), DEAE Sephadex and hyaluronic acid (2), silicone (4), unknown (6). 2 pts in Group A and 5 pts in Group B were treated with multiple fillers. All the sample underwent high frequency US and MRI examinations of the face seeking the presence, the site and quantity of dermal filler, its nature, and the presence of granuloma or fluid collections. Results: In all pts but 2, it was possible to detect the filler at the site of injection, even in pts without its clinical evidence. HFUS and MRI consented to discover a silent inflammatory reaction, otherwise unsuspected and to diagnose granulomatous reactions or abscess formation. Both techniques consent to precisely measure the dimension of the dermal fillers, and to evaluate its extension and depth in the soft tissue of the face. HFUS images differed according with the temporary or permanent nature of the filler. HFUS has proved to be an useful, non invasive tool for the identification of the presence and type of the filler injected. MRI clearly determined the site of dermal fillers, allowing its precise anatomical location considering the anatomical landmarks on axial and coronal scans. Co operation between radiologists and plastic surgeons is mandatory in order to obtain the best diagnostic results, aiming to offer optimal and customized cares to patients presenting with a clinical history of dermal fillers or with complications related to the treatment
MRI and MR voiding cystourethrography in the evaluation of male primary bladder neck obstruction: preliminary experience
No full textPurpose Evaluation of male with primary bladder neck obstruction (PBNO) using MRI and MR voiding cystourethrography (MR-VCU) to study both anatomical aspects of bladder neck and urethral lumen. Methods In this retrospective study 21 male patients (mean age 33 +/- 14) with urodynamic diagnosis of PBNO and 5 healthy volunteers ((mean age 28 +/- 2) as control group were enrolled. Both patients and control group underwent 1.5 T MRI. Sagittal and oblique coronal Turbo-Spin-Echo T2-weighted scans were performed. Only patients underwent MR voiding cystourethrography (MR-VCU) performed with T1-weighted spoiled 3D gradient-echo sagittal acquisitions. Bladder lumen was filled with contrast-material-enhanced urine. Blinded test by two radiologists was performed to evaluate causes of bladder outlet obstruction evaluating MR-VCU. Anatomical MRI features of both control group and patients were compared in consensus by senior radiologist and urologist using the analysis of variance (ANOVA) test. Results MRI allowed evaluation of the bladder neck muscular structures. We found 4 groups of PBNO patients: 52% hypertrophy of posterior lip of bladder sphincter; 20% asymmetry of lateral portion of bladder sphincter; 14% bladder neck cyst; 14% showed normal aspect of bladder neck. Comparison between the control group and first and second PBNO groups was considered statistically significant (p < 0.05) with diagnostic accuracy of 87%. Only 13 patients (61%) were able to perform MR-VCU and radiologists always made the diagnosis of PBNO. Conclusion MRI together with MR-VCU provides useful anatomical and functional information in the study of bladder neck and urethral lumen. These preliminary results suggest that MRI could substitute for standard cystourethrogram in patients with PBNO
Multi-modality imaging approach in a challenging case of surgically corrected partial anomalous pulmonary venous return and atrial tachycardia treated with radiofrequency ablation
Full text linkPulmonary anomalous venous return (PAPVR) is defined as a congenital anomaly in which at least one but not all of the pulmonary veins abnormally drain into a systemic vein or directly into the right atrium. Signs and symptoms related to this condition are due to the hemodynamic abnormalities secondary to left-to-right shunt and the possible presence of other associated cardiac anomalies (e.g., sinus venous atrial septal defect). Therefore, depending on the extent of the shunt, the clinical presentation of PAPVR is variable, ranging from asymptomatic patients to patients affected by severe heart failure with right-sided volume overload. PAPVR with a clinically significant shunt should be referred for surgical correction with different techniques depending on the presence of associated cardiac anomalies. We are presenting a case of partial anomalous venous return (PAPVR) in a 66-year-old man who underwent surgery 26 years ago to correct an anomalous venous connection between the right superior pulmonary vein (RSPV) and the superior vena cava (SVC) through a veno-atrial baffle. The patient was admitted to the emergency department due to atrial tachycardia. Trans-thoracic echocardiography (TTE) showed a dilated right ventricle (RV) with mild RV systolic dysfunction and pulmonary hypertension.Cardiac magnetic resonance (CMR) further confirmed the findings described by TTE and also demonstrated areas of fibrosis replacement in the hinge points. Cardiac computed tomography (CCT) was able to accurately depict and evaluate the surgically created veno-atrial baffle and also showed an anomalous connection between the left superior pulmonary vein (LSPV) and the brachiocephalic vein (BCV) through a vertical vein. The patient was successfully treated with radiofrequency ablation for his arrhythmia
Diagnosis and management of dermal filler complications in the perioral region.
No full textBackground: Lip augmentation with injectable materials is a popular aesthetic procedure. When complications occur, patients often ignore which material was implanted, thus making subsequent treatments difficult. This study aims to present the diagnosis and management of dermal filler complications in the perioral region. Study design: The Medical charts of 26 patients with filler complications in the oral region were reviewed. All patients were submitted to High Frequency Ultrasound, often complemented by Magnetic Resonance Imaging (MRI) and White Blood Cell Scintigraphy, to evaluate filler characteristics and complication types. Antibiotic, corticosteroid or surgical treatment was therefore planned. Results: Imaging always identified dermal fillers in the oral region, distinguishing among infections, fibrosis, granulomatous inflammation and product migration. Nine patients received surgery, ten received medical treatments, six received both, and one refused treatment. Eighty percent of the patients presented an improvement after three- year follow-up. Conclusions: Complications of oral region fillers are similar in clinical presentation but differ in etiology, therefore necessitating different clinical approaches. Imaging techniques add useful information for treatment planning.Background: Lip augmentation with injectable materials is a popular aesthetic procedure. When complications occur, patients often ignore which material was implanted, thus making subsequent treatments difficult. This study aims to present the diagnosis and management of dermal filler complications in the perioral region. Study design: The Medical charts of 26 patients with filler complications in the oral region were reviewed. All patients were submitted to High Frequency Ultrasound, often complemented by Magnetic Resonance Imaging (MRI) and White Blood Cell Scintigraphy, to evaluate filler characteristics and complication types. Antibiotic, corticosteroid or surgical treatment was therefore planned. Results: Imaging always identified dermal fillers in the oral region, distinguishing among infections, fibrosis, granulomatous inflammation and product migration. Nine patients received surgery, ten received medical treatments, six received both, and one refused treatment. Eighty percent
Assessment with magnetic resonance of laryngeal and oropharyngeal movements during phonation
No full texthe latest MR units are provided with the Turbo-Field-Echo technique which permits gradient-echo imaging with very short TE and TR and is optimized to yield the highest possible image quality within a very short acquisition time--i.e., less than 5 seconds. This dynamic study was aimed at depicting normal laryngeal and oropharyngeal movements during maximal inspiration and the prolonged uttering of vowels, in both a normal and a loud voice. We examined 10 healthy volunteers (7 men and 3 women) with an 0.5-T superconductive unit (Gyroscan T5 III, Philips Medical System). We used Turbo-Field-Echo sequences with the following acquisition parameters: TR 12 ms, TE 6 ms, flip angle 30 degrees, 4 acquisitions, acquisition time: 5 seconds. A single coronal scan was acquired at the larynx, while a midsagittal scan and 2 coronal scans were acquired at the oropharynx. The volunteers were asked to breathe in long and deep, to prolong the emission of the vowel [i] during laryngeal studies and to prolong the emission of the fundamental vowels [a], [i] and [u] in a normal (50 db) and a loud (70 db) voice during oropharyngeal studies. The movements of true and false vocal cords were clearly depicted in all the volunteers, and the activity of the different anatomical structures of the oropharyngeal cavity (lips, tongue, hard and soft palate, pharynx and epiglottis) was also demonstrated. During vowel production in a loud voice, the vocal tract was enlarged at the oral cavity for the vowels [a] and [u] and at the pharynx for the vowel [i]. To conclude, fast MRI with midsagittal scans is the best imaging modality to study different vocal tract patterns during speech and can thus replace midsagittal radiography and xeroradiography in the study of vowel production.
PMID: 8966270 [PubMed - indexed for MEDLINE
Role of sonography in the evaluation of the parotid gland in HIV children undergone higly active antiretroviral therapy(HAART)
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