Asunto(s)
Artritis Infecciosa/diagnóstico por imagen , Gota/diagnóstico por imagen , Hallux/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Anciano , Humanos , Masculino , Cintigrafía , Radiofármacos , Staphylococcus aureus/aislamiento & purificación , Medronato de Tecnecio Tc 99mRESUMEN
This retrospective study evaluated the diagnostic value of computed tomography in patients with sacroiliac pain. Computed tomography scans of the sacroiliac joints of 62 patients with sacroiliac joint pain were reviewed. The criteria to include the patient in the current study were pain relief after a local injection in the sacroiliac joint under computed tomography guidance, a physical examination consistent with a sacroiliac origin of the pain, and negative magnetic resonance imaging of the lumbar spine. A control group consisted of 50 patients of matched age who had computed tomography scans of the pelvis for a reason other than pelvic or back pain. Computed tomography scans showed one or more findings in 57.5% and 31% of the sacroiliac joints in the symptomatic and the control groups, respectively. The computed tomography scans were negative in 37 (42.5%) symptomatic sacroiliac joints with a positive sacroiliac joint injection test. The sensitivity of computed tomography was 57.5 % and its specificity was 69%. The finding of the current study suggests limited diagnostic value of computed tomography in sacroiliac joint disease because of its low sensitivity and specificity. With clinical suspicion of a sacroiliac origin of pain, intraarticular injection is currently the only means to confirm that diagnosis.
Asunto(s)
Artralgia/diagnóstico por imagen , Articulación Sacroiliaca/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Anquilosis/diagnóstico por imagen , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Artralgia/tratamiento farmacológico , Betametasona/administración & dosificación , Betametasona/uso terapéutico , Quistes Óseos/diagnóstico por imagen , Estudios de Casos y Controles , Femenino , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Humanos , Inyecciones Intraarticulares , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Osteosclerosis/diagnóstico por imagen , Examen Físico , Radiografía Intervencional , Estudios Retrospectivos , Sensibilidad y EspecificidadAsunto(s)
Neoplasias Óseas/diagnóstico por imagen , Costillas/diagnóstico por imagen , Sarcoma de Ewing/diagnóstico por imagen , Neoplasias de la Columna Vertebral/secundario , Neoplasias Óseas/patología , Niño , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Costillas/patología , Sarcoma de Ewing/patología , Neoplasias de la Columna Vertebral/patología , Tomografía Computarizada por Rayos XRESUMEN
We used a mathematical model to determine whether the approach to derotation of the malrotated femur can be improved for use in corrective osteotomy of the femur. Rotational corrective osteotomy of the femur (RCOF) is a procedure performed by orthopedic surgeons to correct congenital femoral torsion deformities and posttraumatic femoral shaft malunions. In the conventional technique, osteotomy is performed at the malrotation site, and correction is achieved by rotating the distal segment of the femur so that the patella and toes point upward, symmetric with the normal leg when the patient is in the supine position. This approach does not ensure the rotational position of the proximal segment of the femur, and malrotation can still persist. Intraoperative muscle spasm or preoperative soft tissue contracture may alter the proximal segment rotation immediately after osteotomy. Although marked improvement in the accuracy of measuring the malrotation angle for RCOF has been made possible by the computed tomography and magnetic resonance imaging, the orthopedic surgeon does not have a defined approach for transforming this value from degrees to millimeters so that derotation of the femur can be achieved intraoperatively with precision. We carried out studies using ten cadaver femurs with malrotation angles of 15 to 44 degrees to see if this surgical technique can be improved by a mathematical model that converts the malrotation angle value (in degrees) to an equivalent value on the circle circumference (in millimeters). Our results show errors of 0.5 to 4.5 degrees in the rotation angle and virtually eliminate the error of malrotation associated with RCOF. We suggest that our model is clinically applicable and that its definitive value will arise from clinical applications.
Asunto(s)
Fémur/cirugía , Osteotomía/métodos , Cadáver , Fémur/anomalías , Humanos , Matemática , Reproducibilidad de los Resultados , RotaciónRESUMEN
Chordoma is a malignant neoplasm believed to arise from notochordal remnants. It is most often found in the midline of the sacrococcygeal region (50%), skull base (35%), and the mobile spine (15%). When present in the sacral region, chordomas most often grow anteriorly. We present an unusual case of sacral chordoma with posterior extension.
Asunto(s)
Cordoma/diagnóstico por imagen , Sacro , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Cordoma/diagnóstico , Cordoma/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Radiografía , Sacro/diagnóstico por imagen , Sacro/patología , Neoplasias de la Columna Vertebral/diagnóstico , Neoplasias de la Columna Vertebral/patologíaRESUMEN
STUDY DESIGN: This study reviewed the magnetic resonance imaging characteristics of atraumatic compression fractures or vertebral lesions caused by osteoporosis of tumor. OBJECTIVES: The purpose of this study was to evaluate the magnetic resonance imaging characteristics that will allow differentiation of compression fractures or vertebral lesions due to osteoporosis or tumor. SUMMARY OF BACKGROUND DATA: Previous reports have identified several magnetic resonance imaging characteristics of benign and malignant compression fractures. However, diagnosis has been confirmed primarily by clinical follow-up and not pathologic biopsy specimen. METHODS: Thirty-four cases of atraumatic compression fractures or vertebral lesions that had undergone magnetic resonance imaging evaluation followed by biopsy were retrospectively reviewed. Conventional magnetic resonance imaging with T1- and T2-weighted images were obtained in all cases and gadolinium was used in 21 cases. Each case was evaluated for magnetic resonance imaging characteristics of the compression fractures or vertebral lesions that included decreased T1 and increased T2 signal, marrow preservation on the T1 image, gadolinium lesion enhancement, multiple level involvement, associated soft tissue mass, posterior vertebral expansion, and pedicle involvement. RESULTS: Eighteen of the compression fractures or vertebral lesions were confirmed as tumor and 16 were confirmed as osteoporosis by biopsy. Decreased T1- weighted and increased T2-weighted signals are sensitive but not specific for tumor involvement. Normal marrow preservation of the compressed vertebral body on T1 imaging is consistent with an osteoporotic fracture or lesion. Gadolinium enhancement, multiple level involvement, and posterior vertebral expansion are not useful for differentiation of osteoporotic from tumor fractures or lesions. Pedicle involvement or an associated soft tissue mass are specific for a tumor compression fracture or vertebral lesion. CONCLUSIONS: There are characteristic magnetic resonance imaging findings of compression fractures or vertebral lesions that allow sensitive and specific differentiation of osteoporosis from tumor.
Asunto(s)
Osteoporosis/complicaciones , Fracturas de la Columna Vertebral/diagnóstico , Fracturas de la Columna Vertebral/etiología , Neoplasias de la Columna Vertebral/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Estudios de Evaluación como Asunto , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/etiología , Osteoporosis/diagnóstico , Neoplasias de la Columna Vertebral/diagnósticoRESUMEN
The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on the first page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.
Asunto(s)
Mieloma Múltiple/diagnóstico , Dolor/etiología , Hombro , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Mieloma Múltiple/fisiopatologíaRESUMEN
In summary, a case of Ewing's tumor of the proximal phalanx of the long finger of the right hand was presented. This case is unusual because of its location as well as the unusually long clinical course before the correct diagnosis was made. The major point to be stressed is that Ewing's tumor may initially present with a "benign" appearance mimicking a bone cyst [17] or angioma [12]. Timely follow-up of so-called benign lesions, particularly when recurrent swelling occurs, would help in avoiding prolonged delays in diagnosis.
Asunto(s)
Neoplasias Óseas/diagnóstico , Dedos/diagnóstico por imagen , Sarcoma de Ewing/diagnóstico , Neoplasias Óseas/patología , Niño , Diagnóstico Diferencial , Dedos/patología , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Radiografía , Sarcoma de Ewing/patología , Factores de TiempoAsunto(s)
Tornillos Óseos , Fijación Interna de Fracturas , Fracturas Cerradas/cirugía , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Articulación Sacroiliaca/diagnóstico por imagen , Articulación Sacroiliaca/cirugía , Adolescente , Femenino , Fracturas Cerradas/diagnóstico por imagen , Humanos , Huesos Pélvicos/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
A case of chronic, nonspecific synovial inflammation presenting as a mass in the pes anserine bursa is demonstrated by MRI. The lesion was well demarcated and surrounded by a low intensity rim. On spin echo images it was homogeneous and of intermediate signal intensity, whereas on T2-weighted images it showed scattered areas of high signal producing a heterogeneous pattern. It is contrasted with a typical example of acute pes anserine bursitis, presenting as simple fluid within the bursa. The differential considerations vary accordingly between the acute and chronic forms of pes anserine bursitis, with the latter requiring differentiation from other forms of synovitis, synovial hemangioma, and synovial sarcoma. The MR features of these entities are reviewed as an aid in differential diagnosis.
Asunto(s)
Bolsa Sinovial/patología , Bursitis/diagnóstico , Rodilla/patología , Imagen por Resonancia Magnética , Bursitis/patología , Enfermedad Crónica , Diagnóstico Diferencial , Humanos , Linfocitos/patología , Masculino , Persona de Mediana Edad , Células Plasmáticas/patología , Tendones/patología , Tibia/patologíaRESUMEN
A percutaneous computed tomography (CT) guided pinning of experimentally reproduced slipped capital femoral epiphysis in five cadavers and one patient--who had bilateral pinning for moderate and severe grade chronic slip--was conducted. Prior investigations of cadavers revealed that this procedure can be performed in selected cases. The details of the technique are illustrated in this article.
Asunto(s)
Tornillos Óseos/normas , Epífisis Desprendida/cirugía , Cabeza Femoral , Radiografía Intervencional/métodos , Tomografía Computarizada por Rayos X/métodos , Adolescente , Cadáver , Epífisis Desprendida/diagnóstico por imagen , Femenino , Humanos , Radiografía Intervencional/normas , Tomografía Computarizada por Rayos X/normasRESUMEN
Images obtained from normal volunteers demonstrate highly detailed anatomy of the soft tissue and bony structures near the calcaneus and subtalar joint. Cortical bone, marrow, articular cartilage, ligaments, tendons, muscles, fibrous tissue, vascular bundles, and nerves can be identified. However, images obtained of acute calcaneal fractures were found to offer unsatisfactory depiction of bony anatomy. The presence of small fragments was obscured by a change in normal marrow signal by contusion, hemorrhage, and edema, and by the inability of magnetic resonance (MR) to image small pieces of cortical bone. Only in rare instances might MR be helpful in the acute setting when the location or displacement of tendons cannot be clearly ascertained with computed tomography (CT). MR may prove more useful in the long-term follow-up of healed fractures with persistent pain. In this setting it might be used in the diagnosis of complications such as residual or recurrent tendon displacement, tenosynovitis, heel fat integrity, and tarsal tunnel evaluation. However, this paper did not directly compare the efficacy of MR with that of CT in the long term. Therefore, the degree to which MR may eventually supplement or supplant CT is unclear and further study is required before the use of MR can be recommended in the routine clinical follow-up of calcaneal fractures.
Asunto(s)
Calcáneo/anatomía & histología , Fracturas Óseas/diagnóstico , Imagen por Resonancia Magnética , Tobillo/anatomía & histología , Tobillo/diagnóstico por imagen , Traumatismos del Tobillo , Calcáneo/diagnóstico por imagen , Calcáneo/lesiones , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico por imagen , Humanos , Osteomielitis/diagnóstico , Osteonecrosis/diagnóstico , Osteonecrosis/diagnóstico por imagen , Dolor/diagnóstico , Articulación Talocalcánea/anatomía & histología , Articulación Talocalcánea/diagnóstico por imagen , Articulación Talocalcánea/lesiones , Tendones/anatomía & histología , Tendones/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Tarsal tunnel syndrome (TTS) is an entrapment neuropathy caused by compression of the posterior tibial nerve beneath the ankle flexor retinaculum. Treatment of TTS consists of surgical release of the retinaculum. The failure rate is 10%-20%. Magnetic resonance (MR) imaging was used to evaluate a patient with an unsatisfactory response. MR imaging demonstrated incompleteness of the surgical release of the flexor retinaculum.
Asunto(s)
Síndrome del Túnel Tarsiano/diagnóstico , Calcáneo/lesiones , Fracturas Óseas/complicaciones , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Síndrome del Túnel Tarsiano/etiología , Síndrome del Túnel Tarsiano/cirugíaRESUMEN
In a retrospective study of 56 patients with surgically confirmed adenocarcinoma of the pancreas, the authors analyzed the efficacy of contrasted CT examination in the staging of tumor resectability and unresectability. Resectability was defined as strictly intrapancreatic disease; unresectability as locally invasive or metastatic disease. Of the 56 patients, 49 (88%) were found to be unresectable, and only seven (12%) were considered potentially resectable on the basis of CT evaluation. When these findings were compared to surgical findings, only one of the 49 CT unresectable patients was considered surgically resectable; all others showed advanced disease, with 30 of 49 (61%) having surgical findings comparable to CT findings, and 18 of 49 (37%) having more extensive disease at surgery than at CT. Of the 7 patients judged resectable by CT, only two (29%) were found to have local disease at surgery; three were locally invasive, one had positive nodes, and one had liver metastases. This study would suggest that CT can be very reliable in distinguishing advanced disease from confined intrapancreatic lesions (unresectability), but is not reliable for predicting locally confined disease (resectability). In particular, CT seems to be ineffective in demonstrating the full extent of pancreatic carcinoma, either unresectable or resectable, because of its inability to demonstrate microscopic local and nodal invasion and surface metastases.
Asunto(s)
Adenocarcinoma/patología , Neoplasias Pancreáticas/patología , Adenocarcinoma/diagnóstico por imagen , Humanos , Estadificación de Neoplasias , Neoplasias Pancreáticas/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
We performed a retrospective study of CT scans in 29 patients who had undergone the Whipple procedure (radical pancreaticoduodenectomy) to study the CT appearance of the postsurgical anatomy and assess the use of CT in the evaluation of early postoperative complications and recurrent tumor. In the postoperative period, the scans from 15 patients revealed seven transient fluid collections; four deep abscesses, three of which were successfully drained under CT guidance; three superficial abscesses; and five cases of ascites. In 19 patients, CT scans were obtained up to 4 years after surgery to search for recurrent tumor. The most frequent site of recurrence was the liver. CT correctly identified liver metastases in six of seven patients and was falsely positive in one. Recurrence also was found twice in retroperitoneal lymph nodes; one time each in the mesenteric root, spleen, and lung base; and twice causing afferent loop blockage. Surgical proof of recurrence was obtained in eight cases. Our experience suggests that an understanding of the normal postoperative anatomy following the Whipple procedure is essential in evaluating postoperative CT scans. Scans obtained for detection of tumor recurrence should be optimized for imaging the liver because this was the most frequent site of recurrence.
Asunto(s)
Duodeno/cirugía , Páncreas/cirugía , Radiografía Abdominal , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica , Neoplasias de los Conductos Biliares/diagnóstico por imagen , Neoplasias de los Conductos Biliares/cirugía , Neoplasias Duodenales/diagnóstico por imagen , Neoplasias Duodenales/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/cirugía , Complicaciones Posoperatorias , Estudios Retrospectivos , Tomografía Computarizada por Rayos XAsunto(s)
Neoplasias Duodenales/diagnóstico por imagen , Neurilemoma/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Anciano , Femenino , Humanos , Neoplasias Primarias Múltiples/patología , Neurofibromatosis 1/patología , Neoplasias Cutáneas/patología , Tomografía Computarizada por Rayos XRESUMEN
A case of hepatic adenoma imaged by magnetic resonance imaging (MRI) as well as with angiography, computed tomography, and radionuclide imaging is presented. Pathological correlation is also presented. Review of the literature of MRI of hepatic adenoma and related tumors is discussed.
Asunto(s)
Adenoma/diagnóstico , Neoplasias Hepáticas/diagnóstico , Hígado/patología , Imagen por Resonancia Magnética , Adulto , Diagnóstico por Imagen , Femenino , HumanosRESUMEN
Images of five cadaver ankles and three normal volunteers were obtained in an attempt to delineate magnetic resonance (MR) anatomy of the tarsal tunnel. Multiplanar T1-weighted (TE 20 msec, TR 600 msec) scans were obtained of the cadaver specimens while T1 and T2 weighted (TE 20, 80 msec, TR 2000 msec) scans were obtained of the volunteer ankles. After imaging, the cadaver ankles were frozen, sectioned, photographed, and compared to the MR images in the transverse plane. The anatomical structures seen on the MR images correlated closely with the cadaver sections. The bony and soft tissue boundaries and contents of the tarsal tunnel could be imaged with detail easily sufficient to delineate all the major structures within it, including the posterior tibial nerve and its branches.