Brain aging affects an increasing segment of the population and the role of chronic cerebrovascular disease is considered to be one of the main parameters involved. For this purpose we compared retrospectively MRI data with digitized subtraction angiography (DSA) data in a group of 50 patients focusing onto the watershed area of the carotid artery vascular territories. In order to evaluate the presence of white matter lesions (WML) in the hemispheric watershed areas, coronal fluid-attenuated inversion-recovery or axial T2 weighted MRI images of patients with symptomatic cerebrovascular insufficiency areas were compared with the capillary phase of DSA studies in anterior-posterior projection. Presence of cerebrovascular occlusive disease was evaluated on DSA using North American symptomatic carotid endarterectomy trial criteria and including evaluation of collateral vascular supply. Pathological MRI findings in the region of the watershed territories correlated overall in 66% of cases with a defect or delayed filling on DSA. In the case of asymmetrical MRI findings, there was a pathological finding of the capillary phase in the watershed area in 92% of DSA studies. Hypoperfusion in the capillary phase of the watershed area as seen on DSA correlated with the stenosis degree of the concerned carotid artery. Our findings suggest that asymmetrical findings of WML in the watershed areas as seen on MRI are caused by hemodynamic effect and a differentiation between small vessel disease and a consequence of distant stenosis may be possible under such conditions.

The initial outcome in infants with congenital diaphragmatic hernia is mainly related to the associated lung hypoplasia. However, these patients frequently present with additional gastrointestinal pathology that also influences their quality of life and final prognosis. Congenital gastrointestinal anomalies are often observed and the displacement of the liver, the stomach and/or the intestines into the thorax may cause distortion of the vascular axis of these organs, increasing the risk of congestion and/or ischemia. Some of these gastrointestinal complications are already visible at imaging studies performed in utero and/or in newborns.This pictorial essay describes the imaging findings of the most frequently detected gastrointestinal complications in fetuses and infants with congenital diaphragmatic hernia, focusing on prenatal exams.

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A 21-year-old woman with a history of i. v. drug abuse presented with pain due to an ulcer on the left forearm. The ulcer had originated from a burn that the patient had been treating herself. When entering the hospital she usually injected her drugs at the site of the ulcer. On physical examination, the mobility of the left hand and forearm was heavily impaired by the ulcer. The ulcer was located on the posterior side of the forearm. Anemia was found. The white blood cell count was normal with segmented neutrophiles at 69 %.Anteroposterior and lateral radiographs ( Fig. 1) showed an extensive periosteal reaction along the diaphysis of the radius and ulna. Along the radius the periosteal reaction contained lamellated elements with the typical onion-peel aspect near the proximal and distal ends of the lesion. At its center, radiating spiculae branched off perpendicularly from the bone. They interrupted the lamellated layers, thereby forming Codman's triangles. Amorphous, oval calcifications could be detected along the radius. The ulna showed well-organized (reactive) single-layer periosteal response. A whole-body bone scintigraphy showed a single area of increased Tc-99 m MDP uptake in the radius and ulna of the left forearm. Magnetic resonance imaging was performed on the same day. The axial T2-weighted images (Fig. 2) showed muscular infiltration of flexors as well as the extensor compartments as a hyperintense area and a circumferential area of low signal around the radius corresponding to amorphous calcifications. The interosseous membrane was interrupted distally and in the medullary cavity of the radius the bone marrow signal was slightly increased. On the sagittal T1-weighted sequence after gadolinium (Fig. 3) the zone of periosteal reaction showed intermediate signal intensity and did not substantially enhance after gadolinium injection.