The “Clinical Cases” section provides selected images, along with a short relevant discussion, from patient exams, contributed by the MR expert network community. This section will with time cover the breadth of clinical MR. Important aspects of imaging technique and clinical findings will be discussed. Each case will also include a downloadable file (corresponding to each presented image), enabling the user to replicate on his/her MR system the specific imaging technique employed.

Hepatocellular Carcinoma-2

This 54 year old woman presented to the gastroenterology clinic complaining of abdominal pain. A right upper quadrant ultrasound was performed demonstrating an ill-defined hypoechoic hepatic mass. MRI was recommended for further evaluation. [...]

DeQuervain’s tenosynovitis

A 53 year old female with left wrist pain for the past 4 months without any inciting event. [...]

Sacral spinal dysraphism with a meningocele.

A 40 year old female with history of spina bifida. [...]

Meningioma

An 87 year old male with anosmia and known diagnosis of meningioma. [...]

Invasive lobular carcinoma

Clinical history: 59 year old female presented for breast MRI after the ultrasound-guided core biopsy of a 10 x 11 mm mass in the 4 o’clock axis of the left breast showed invasive lobular carcinoma. [...]

Tear of the prepatellar quadriceps continuation

A 71 year old male presenting with pain in the right knee. [...]

Subcapsular/extracapsular hematoma

This is a 54-year-old Caucasian male with a past medical history of polymyositis and recent outside hospital admission for biliary tree obstruction with subsequent ERCP, cholecystectomy, and liver biopsy. He was admitted to our institution with elevated LFTs and abdominal pain. [...]

Radial tear with flipped meniscus

50 year old man with left knee pain which worsens with activity. [...]

Right cerebellar hemangioblastoma

A 49 year old male with worsening headache, mostly in the posterior neck, and vertigo. [...]

Multiple Arterial Stenoses

This 63-year-old man presented with a longstanding history of peripheral arterial occlusive disease, hypertension, diabetes, coronary artery disease, prior myocardial infarction, crossover bypass, and renal artery stenosis with increasing leg pain. [...]

Melanoma with brain metastases

A 77 year-old male with history of melanoma. [...]

Os-acromiale

This is a 26-year-old female with no history of trauma, who presents with left shoulder pain. [...]

Active Multiple Sclerosis

This is a 24-year-old male with left-sided weakness and numbness, headaches, and a clinical question of a recent stroke. [...]

Left Ovarian Dermoid

26 yr old woman presented with pelvic pain. [...]

Buford Complex

This is a 47-year-old male who has a chronic history of shoulder pain. [...]

Low Grade Astrocytoma

78 year old woman with symptoms of memory loss and dizziness for the past 6 months. She also has chronic headaches, confusion and ataxia. [...]

Cholangiocarcinoma

This is a 71-year-old male who presented with a diagnosis of adenocarcinoma with uknownn primary and liver metastases. [...]

Right-sided vestibular schwannoma

This is a 46-year-old female who presented with a history of right ear tinnitus and right ear sensorineural hearing loss. [...]

Biceps tendon rupture

This is a 56-year-old female with a several month history of right shoulder pain. The pain started after exercise classes which involve lifting weights. The patient had no reported history of trauma. [...]

Hepatocellular Carcinoma

65 year old woman being evaluated for liver transplant. The patient has a history of hepatocellular carcinoma status post RFA in 2005. [...]

Haglund’s syndrome

66 yr old woman with right ankle pain. [...]

Plasmacytoma (biopsy proven)

64 year old man with past medical history of HTN with complaint of abdominal pain and migratory rib, sternal and back pain for 1 year. [...]

Metastatic breast cancer

This is a 59-year-old female with a history of infiltrating ductal breast cancer, s/p partial mastectomy in 2007 and radiotherapy in 2008. [...]

Posterior ankle impingement syndrome (Os trigonum syndrome)

42 year old woman with right heel pain that started 6-8 months ago. [...]

Thoracic dural AV fistula

58 yr old woman presented with back pain. An MRI of the thoracic and lumbar spine was obtained. [...]

Synovial Osteochondromatosis

59 yr old woman with left knee pain. [...]

Arachnoid Cyst

49 year old man with lung cancer for evaluation of metastatic disease after chemotherapy and radiation. No neurological symptoms. [...]

Cervical fibroid

This is a 51-year-old postmenopausal female with lower abdominal and pelvic pain for a few weeks. The ultrasound showed revealed a cervical lesion, suspicious for a cervical mass versus fibroid. [...]

Talocalcaneal Fibrous Coalition

This is a 60-year-old male who presented with bilateral feet pain for five years. The pain was worse on the right and has been increasing recently. Sometimes he states that he cannot walk because the pain is so severe. Recently, he has noticed increased swelling. [...]

Vestibular Schwannoma

68 year old man with bilateral hearing loss. [...]

Endometrioma

65 year old woman with a calcified left adnexal lesion incidentally noted on a CT done to evaluate pyelonephritis. A subsequent transvaginal ultrasound showed an isoechoic left adnexal mass. MRI was obtained for further evaluation of the left adnexal mass. [...]

Cortical desmoid (distal femoral cortical irregularity)

12 year old female ballet dancer with slowly progressive knee pain, aggravated with flexion. [...]

Chiari I Malformation

This is a 21-year-old male with recent headaches. The headaches are described as intermittent throbbing and result in numbness, tingling, and blurred vision. [...]

Urethral diverticulum

46 year old female with complaints of dysuria and dyspareunia. Clinical consideration included a possible urethrocele. On physical examination no urethrocele was seen or palpated. Some tenderness was present in the urethra near the bladder neck. No purulent fluid was expressed from urethra. Cystoscopy was not diagnostic. CT scan of abdomen and pelvis showed a possible urethral diverticulum. Pathology showed urethral diverticulum with granulation tissue associated with acute and chronic inflammation. [...]

Transient Patellar Dislocation

This is a 13-year-old male who presented for initial evaluation of his left knee, after having a non-contact injury during athletics at school one week prior. He was unsure of the position of his knee at the time of injury. The patient localized the pain to the medial aspect of his knee. He ambulates with difficulty using a single crutch. [...]

Chiari II Malformation

This is an 11-year-old male being followed for loss of cognitive abilities and facial paralysis. [...]

Osteochondral defect (unstable)

This is a 14-year-old female with right knee pain for several months. She first started noticing the pain while running track, which she has stopped due to the degree of pain. She obtained radiographs (not shown) which showed an osteochondral defect. An MRI was then obtained to determine stability of the lesion. [...]

Invasive Ductal Carcinoma (Moderately Differentiated)

A 44-year-old female presented with an abnormal right breast imaging by routine screening mammography. She then obtained a breast ultrasound, which showed a solid mass in the right breast measuring. A core needle biopsy was performed revealing intraductal adenocarcinoma. An MRI was the obtained to evaluate the extent of the disease. [...]

Hypertrophic cardiomyopathy (HCM)

A 59 year-old man presents with long QT-syndrome and recurrent collapse. Neurologic assessment failed to reveal any abnormalities or pathologic findings. Ultrasound screening of the supraaortic arteries (including specifically the internal carotid and vertebral arteries) was unremarkable. [...]

Bucket handle tear in the left medial meniscus

58 yr old man with left knee pain. [...]

Cervical Cancer

This is a 58 year old female with known history cervical cancer. [...]

Arteriovenous malformation

22 year old man with left sided sensory seizures. The seizures are of focal onset, typically affecting the left arm and shoulder, with radiation to the entire left side within 2-3 seconds. He describes the seizures as an electric burning feeling that “is not pain”. [...]

Rectal Cancer

This is a 54-year- male with a polypoid mass in the distal rectum. [...]

Labral Tear

This is a 51 year old female with chronic right hip pain with burning sensation. [...]

Cavernous malformation or a “Cavernoma”

This is a 43 year old male with chronic headaches in the occipital region with nausea, visual disturbances, tinnitus, and vertigo. [...]

Prostate carcinoma

This is a 70 yr old man who presented with change in his PSA levels. It was 4.3 in 2007 and 7.13 in 2010. He was asymptomatic. A biopsy showed a Gleason score of 9 on the right and prostate intraepithelial neoplasia on the left. Both bone scan and CT did not show metastasis. [...]

Fracture of the Scapula

This 56 year old came to emergency room after a motorcycle crash. He had a dislocated wrist and was treated for a distal radius and ulnar styloid fracture. No other fractures were detected on plain radiographs. The patient continued to have shoulder pain three weeks after discharge, for which MRI of the shoulder was performed. [...]

Capillary telangiectasia

27 yr old woman presented with sudden onset of hearing loss in the right ear, severe headache, dizziness, double vision six years ago. MRI of the brain at that time revealed an incidental finding of capillary telangiectasia in the right pons. During recent visit to the hospital follow up MRI was performed. [...]

Articular Cartilage Defect

47 year old man presented with left knee pain and swelling and some loss of range of motion. He has no history of trauma to the left knee or locking of the left knee. [...]

Congenital Cystic Adenomatoid Malformation

36 year old woman came for routine antenatal screening. An abnormality was detected in the right hemithorax on ultrasound. An MRI was performed for better evaluation. [...]

Renal Cell Carcinoma

This is a 76 year old man who was admitted to the hospital for sharp chest pain and was incidentally thought to have splenomegaly on physical exam. An abdominal ultrasound was initially ordered. The spleen appeared normal but a lesion in the lower pole of the left kidney was identified, for which a follow up MRI was performed. The patient did not have any genitourinary symptoms. [...]

Vestibular Schwannoma

57 year old man with progressive hearing loss on the left side and sensory loss of cranial nerves V2 and V3. [...]

Ganglion Cyst

22 yr old woman with injury to her wrist one month ago. She noticed mild right wrist pain and swelling the day after the injury. She had pain with movement of her fingers. Recent X-rays were negative. [...]

Hypertrophic obstructive cardiomyopathy

32 year old male with a history of palpitations and a loud cardiac murmur. [...]

Nephroblastoma

This 8-year-old girl presented to the hospital with recurring abdominal pain on the left side and fever up to 39°C. In the urinalysis, protein, ketones and white blood cells were found, as well as hematuria. Ultrasound and a MR examination revealed a mass lesion in the left retroperitoneum with presumptive diagnosis of a nephroblastoma. [...]

Dilatative Arteriopathy

This 76-year-old man presented for diagnostic angiography with a longstanding history of dilatative and occlusive arteriopathy, hypertension, coronary artery disease and a popliteal aneurysm. Clinically an occlusion of the femoral-popliteal bypass to the right PIII segment was known. [...]

Metastatic Melanoma

This 36-year-old patient presented in December 2006 with a suspicious mole on the right lower leg which was surgically removed. Histopathology demonstrated a malignant melanoma. 2.5 years later the patient presented with an inguinal lymph node metastasis on the right side detected on lymph node dissection. MRI was ordered to further evaluate the right leg on which additional cutaneous lesions were noted. [...]

Severe Degenerative Changes of the Hip Joints

This 74-year-old woman presented with a longstanding history of hip and leg pain on both sides but more pronounced on the right side. She is also suffers from a significant scoliosis. [...]

Partial Rupture of the Posterior Cruciate Ligament

This 29-year-old man presented to his physician with pain in his left knee. He could remember a minor knee injury several weeks ago. In his spare time he goes running three times a week. His past medical history showed no relevant disease. [...]

Contrast Enhanced MRA of Dissection of the Carotid Artery

This 69-year-old man presented to the angiography department with a single episode of amaurosis fugax 6 months ago. Since that time he has been treated with thrombocyte aggregation inhibitors. Clinical symptomatology includes headaches and vertigo. [...]

An Overview of Imaging Techniques for the Carotid Bifurcation

Because it has been proven that there is a link between the development of nephrogenic systemic fibrosis (NSF) and the application of high volumes of magnetic resonance (MR) contrast agents in patients with impaired renal function, interest in non-contrast-enhanced techniques for MR angiography has experienced a renaissance. This set of images presents 5 different techniques for imaging the carotid bifurcation, one of the most critical and commonly diseased vascular regions within the entire arterial system. Except one (D), for best comparability, all exams were acquired with the same spatial resolution of 0.9 x 0.9 x 0.9 mm3 at 3 T (Magnetom Verio, Siemens Medical Solutions). [...]

Contrast Enhanced MRA of the Renal Arteries, with Renal Artery Stenosis

This 64-year-old man presented with an increased serum creatinine level (2.77 mg/dL) and significant asymmetry of renal size (reduced on the right) on ultrasound. The past medical history was pertinent for prior stenting of the right renal artery. [...]

MRA – False Aneurysm of the Renal Artery

This 71-year-old man presented to the emergency room with a fever up to 39°C and a general decline in his state of health. Two weeks previously, he underwent a partial resection of the right kidney due to suspected renal cell carcinoma, that turned out to be an hemorrhagic cyst. [...]

Contrast Enhanced MRA of a Pelvic Arteriovenous Malformation

This 43-year-old woman presented to the angiography department three years ago with pain in the lower abdomen. She underwent resection of an intrauterine fibroma in 1997 and a C-section in 2002. In September 2005, the question was raised regarding a possible malformation of iliac vessels on the left side. [...]

Arteriovenous Malformation

This 43-year-old female presented to clinic with a severe headache and neck neck pain for the last two weeks. This was associated with intermittent mental status changes. [...]

Cervical Carcinoma

This 48-year-old woman presented with new-onset vaginal bleeding between menses for more than two months duration. Following ultrasound and the MRI herein illustrated, the patient underwent surgical treatment of her condition. [...]

Two liver lesions – hemangioma and focal nodular hyperplasia

This is a 38 year old female who had a CT performed for nonrelated reasons, but had incidentally detected liver masses. An MRI was ordered for further workup. [...]

Continuous table movement MRA for diagnosis of generalized atherosclerotic disease

This 48 year old woman presented to the department of vascular surgery due to recurrent pain in both legs. She suffers from hypertension, hyperlipidemia and coronary artery disease. She has previously been diagnosed with a high-grade stenosis of the right internal carotid artery and occlusion of the left internal carotid artery, andis as well status post dilatation and stenting of the circumflex coronary artery. Additional relevant vascular disease and surgery include occlusion of the right subclavian artery, aortobifemoral bypass grafting due to high-grade stenosis, and occlusion of the common, external and internal iliac arteries on both sides. [...]

Meningioma

This 62-year-old woman presented with a six month history of nausea and vomiting. Recently, the woman complains of dysosmia, experiencing the smell of ammonia. These dysosmiac episodes last for several minutes but have recently increased in frequency. [...]

Optic Sheath Meningioma

This 54 year old female patient presented with subtle, progressive, partial loss of sight involving the left eye. Clinical exam showed papilledema and atrophy of the optic nerve on the left. [...]