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Trabecular lines through the proximal tibia in line with the direction of the anterior cruciate ligament are visible in around two-thirds of standard knee magnetic resonance imaging (MRI) examinations. We describe their appearances and postulate that these lines may develop in response to stresses transmitted via the anterior cruciate ligament (ACL).

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Sacral edema is a widely recognized clinical sign. Hitherto there has been no method of radiological confirmation, nor has the anatomy of this sign been well described. In a prospective study of 100 patients referred for abdominopelvic computed tomography (CT), 17 showed radiological evidence of sacral edema. It was demonstrated clinically in 12 of these 17 patients, leaving five patients with apparent CT evidence of sacral edema in whom this was not demonstrated clinically. In two patients with clinical evidence of sacral edema, their tissue planes in this region appeared normal on CT. The edema fluid accumulates in an intermediate plane of fibrous tissue within the subcutaneous fatty layer of the trunk. In those 17 patients with CT evidence of edema, the center of the fluid accumulation was situated over the lumbar rather than the sacral spine, suggesting that the term "sacral" edema is something of a misnomer.

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Fibrosing alveolitis and bronchiolitis obliterans are two of the many pulmonary manifestations of the connective tissue disorders. When shortness of breath is the main complaint, it is often difficult to diagnose the individual causative lesion from the clinical examination, lung function tests, and chest radiographic findings. In such cases high resolution computed tomography, with its increased sensitivity and specificity for analysis of the pulmonary parenchyma, provides an excellent diagnostic tool for determining the presence and type of pulmonary abnormality.

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Twenty-seven cutting needle biopsies were performed on 25 children with suspected malignancy using computed tomographic (CT, 22) or ultrasound (US, 5) guidance. Anatomical sites were: retroperitoneum 6, liver 4, kidney 4, abdomen/pelvis 4, thorax 4, bowel 2, neck 1. Sixteen patients (64%) underwent subsequent open biopsy (5), marrow biopsy (2) or resection (9). There was complete concordance between the histological findings from the open or marrow biopsy and the previous needle biopsy in 12 of these 16 patients; in two patients the needle biopsy was misleading, causing inappropriate initial treatment in one. In two other patients needle biopsy was correct but lacked specific diagnostic features. Needle biopsies were performed under general, local or Ketamine anaesthesia. There were no apparent complications related to these procedures. We believe that radiologically-guided cutting needle biopsy should replace open biopsy in most children with solid malignant lesions. It can easily be performed during a single anaesthetic episode which allows radiological evaluation, biopsy, bone marrow and cerebrospinal fluid sampling. However, the potential for sampling error and histological variation within these tumours needs to be borne in mind.

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Metastatic fat necrosis is a form of lobular panniculitis which together with synovitis is an unusual complication of pancreatic disease. It can precede an attack of pancreatitis. Pancreatic disease should therefore be remembered as a cause of panniculitis. Serum amylase and abdominal ultrasonography should be considered to exclude pancreatic disease in cases of panniculitis of uncertain etiology. We describe a case of metastatic fat necrosis and discuss the appearance on magnetic resonance imaging.

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Spiral volumetric computed tomography (SVCT) has been predicted to improve vascular and organ enhancement with little effect on image quality. To see if this was the case, we studied 100 patients referred for computed tomography where we would normally have performed dynamic incremental computed tomography (DICT). Patients were randomly allocated to undergo either standard DICT or SVCT. The resulting images were analysed for overall quality, the degree of contrast medium enhancement and the extent of artefacts associated with the technique. No statistically significant difference in overall image quality between SVCT and DICT was found, apart from images of the hepatic parenchyma where the quality was significantly worse on SVCT (P < 0.05) due to the low mA permissible. Contrast enhancement was better with SVCT, although only for the thorax (P < 0.01) and the group taken as a whole (P < 0.01) did this improvement reach statistical significance. There was no statistically significant difference between the extent of artefacts observed in the two techniques. As expected, all acquisition times were shorter using SVCT. The benefits of SVCT have been well described and include the absolute contiguity of the reconstructed images and the ability to obtain many images at peak contrast enhancement. We have confirmed the latter effect. We are now also satisfied that there is no appreciable loss of overall image quality except where large volumes of solid tissue are being examined (e.g. liver).

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