Biomedical subjects

A Saifuddin

Publications and source records attributed to A Saifuddin.

At least 19 recordsLinked to original sources

PubMed2007

Non-neoplastic conditions presenting as soft-tissue tumours.

Review of referrals to our unit over the last 7 years showed that of approximately 750 cases referred as soft-tissue tumours, 132 were subsequently diagnosed as non-neoplastic lesions. The imaging characteristics of these lesions are presented to differentiate them from neoplasms. The most common diagnoses were myositis ossificans, ganglion cyst, abscess/infection, bursitis and synovitis. The imaging features of other rarer conditions will also be discussed.

Abscess↗

PubMed2007

Epithelioid sarcoma of the median nerve mimicking a peripheral nerve sheath tumour.

We describe a case of epithelioid sarcoma of the median nerve in a 57-year-old woman presenting with symptoms and signs of carpal tunnel syndrome for 2 years. The clinical examination was suggestive of a wrist ganglion compressing the median nerve. Magnetic resonance imaging (MRI) showed a 5 cm x 3 cm mass involving the median nerve in the carpal tunnel and appearances mimicked a benign peripheral nerve sheath tumour. This report illustrates a rare tumour presenting in a rare location and emphasizes the atypical clinical and MRI features that should alert the radiologist to the possibility of a rare sarcoma mimicking a benign peripheral nerve sheath tumour.

Diagnosis, Differential↗

PubMed2006

Primary atypical sacral meningioma--not always benign.

We present a case of an atypical recurrent meningioma of the sacrum with pulmonary metastasis in a 31-year-old man. He presented with deep-seated buttock pain and urinary hesitancy for 3 months. MRI revealed a lesion occupying the central and left side of the sacral canal at the S1-S2 level. Surgical excision of the lesion via a posterior approach was undertaken, and the patient became symptom-free post-operatively. Histology confirmed atypical meningioma. Eight months later he re-presented with similar symptoms, and MRI confirmed local recurrence. The patient underwent left hemisacrectomy. Six months later he again presented with low back pain and MRI confirmed a second local recurrence. A CT scan of the chest showed multiple lung metastases. The patient died of a severe chest infection 18 months later.

Adult↗

PubMed2006

Ganglion cysts at the gastrocnemius origin: a series of ten cases.

OBJECTIVE: To describe ganglion cysts arising close to the origin of the medial and lateral head of gastrocnemius as identified on magnetic resonance (MR) imaging. DESIGN AND PATIENTS: We present a series of ten cases of ganglion cysts arising close to the gastrocnemius origin from the medial and lateral femoral condyles. These were collected over a 6-year period from our imaging database. All patients attended for routine MR imaging of the knee with a variety of clinical presentations. Data collected included patient demographics, ganglion size, ganglion site, clinical presentation and ancillary MR imaging findings. The ten patients in this series consisted of seven males and three females, five right and five left knees, age range 27-68 years, mean age 40.6 years. RESULTS: The mean maximal dimension of the ganglion cysts was 26 mm, range 15-40 mm. The medial gastrocnemius origin was involved in eight patients and the lateral origin in two patients. The MR imaging findings consisted of both uni- and multi-loculated cysts, often containing numerous septations with fluid signal characteristics. The cysts were extra-capsular with no clear communication with the joint. One patient presented with a popliteal soft tissue mass and none of the cases required surgical intervention for cyst removal. CONCLUSIONS: MR imaging may identify ganglion cysts arising in an intra- or extra-articular site around the knee. This series documents the MR imaging characteristics of ganglion cysts arising close to the gastrocnemius origin and discusses the relevance of this imaging finding.

Adult↗

PubMed2006

MR imaging of autologous chondrocyte implantation of the knee.

Autologous chondrocyte implantation (ACI) is a surgical technique that is increasingly being used in the treatment of full-thickness defects of articular cartilage in the knee. It involves the arthroscopic harvesting and in vitro culture of chondrocytes that are subsequently implanted into a previously identified chondral defect. The aim is to produce a repair tissue that closely resembles hyaline articular cartilage that gradually becomes incorporated, restoring joint congruity. Over the long term, it is hoped that this will prevent the progression of full-thickness articular cartilage defects to osteoarthritis. This article reviews the indications and operative procedure performed in ACI. Magnetic resonance imaging (MRI) sequences that provide optimal visualization of articular cartilage in the post-operative period are discussed. Normal appearances of ACI on MRI are presented along with common complications that are encountered with this technique.

Cartilage Diseases↗

PubMed2006

Imaging of the posterolateral corner of the knee.

The structures of the posterolateral corner of the knee are increasingly recognized as fulfilling an important role in maintaining knee stability. The posterolateral aspect of the knee is stabilized by a complex anatomy of osseous, myotendinous and ligamentous structures. Unrecognized injuries to this part of the knee are a cause of failure of cruciate ligament reconstruction. This review focuses on the anatomy and common injury patterns involving the posterolateral corner of the knee, with emphasis on magnetic resonance imaging.

Fractures, Bone↗

PubMed2006

Benign primary tumours of the ribs.

Benign primary tumours of the ribs are rare and may be identified during the investigation of a clinically suspected abnormality or as an incidental finding. This review describes the spectrum of benign tumours that can involve the rib and illustrates the radiographic, computed tomography (CT) and magnetic resonance (MR) imaging appearances that may facilitate diagnosis.

Bone Cysts, Aneurysmal↗

PubMed2006

Hibernoma: MRI features in eight consecutive cases.

AIM: To describe the preoperative magnetic resonance imaging findings of eight histologically-proven cases of hibernoma. MATERIALS AND METHODS: The site, size, and signal characteristics of eight consecutive hibernomas were retrospectively assessed on T1-weighted spin-echo and short T1 inversion recovery (STIR)/fat-saturated T2-weighted fast spin echo magnetic resonance images. Four patients also had gadolinium-enhanced fat-saturated T1-weighted spin echo imaging. Patient age and sex, and duration of symptoms were recorded. RESULTS: Three female and five male patients with an average age 36 years (range 16-53 years) were included. Seven lesions occurred in the thigh, four in the anterior compartment and three in the posterior compartment. One lesion occurred superficial to the scapula. All cases demonstrated common magnetic resonance imaging findings of a well-defined, heterogeneous mass, slightly or clearly hypo-intense to subcutaneous fat on T1-weighted spin-echo images, with prominent thin low signal bands throughout the tumour. The lesions failed to fully suppress on STIR or fat-saturated T2-weighted images. Only one of the four contrast-enhanced studies demonstrated increased vascularity in the tumour. CONCLUSION: The MRI findings of a lesion that is diffusely slightly hypointense to surrounding subcutaneous fat, should prompt the operator to consider hibernoma in the differential diagnosis.

Adipocytes, Brown↗

PubMed2006

MRI of bone marrow oedema associated with focal bone lesions.

AIM: To quantify the volume of bone marrow oedema surrounding focal bone lesions and to identify its relevance relative to diagnosis. METHODS: Three hundred and eighty-eight of 1456 patients included in the orthopaedic oncology database who underwent magnetic resonance imaging (MRI) demonstrated bone marrow oedema and were included in the study. There were 225 males and 163 females, age range 1-87 years (mean 29 years). MRI images were retrospectively reviewed and assessed for the extent of bone marrow oedema. The amount of oedema was graded: grade 1: oedema present but smaller than the lesion size; grade 2: oedema equivalent to the lesion size; grade 3: oedema greater than the lesion size. RESULTS: There were 190 grade 1 lesions: 56% malignant, 33% benign, 11% non-neoplastic; 74 grade 2 lesions: 19% malignant, 50% benign, 31% non-neoplastic; and 124 grade 3 lesions: 10% malignant, 46% benign, 44% non-neoplastic. There was a significant relationship between oedema grade (i.e., volume of oedema) and final diagnosis (p<0.0005). CONCLUSION: Bone marrow oedema may be associated with a wide range of focal bony lesions, including malignant, benign and non-neoplastic causes. As the volume of bone marrow oedema increases relative to the size of the underlying lesion, the probability that the underlying lesion is benign is increased.

Adolescent↗

PubMed2005

Injuries of the posterior cruciate ligament and posterolateral corner of the knee.

Injuries of the posterior cruciate ligament (PCL) and posterolateral corner (PLC) of the knee are less common than those of the anterior cruciate ligament (ACL) and their significance is often under-appreciated in the acute setting. Even when recognised, knowledge of the natural history and outcome of treatment has lagged behind that of the ACL and has led to confusion over the indications for operative treatment. Recent developments in the understanding of the anatomy and biomechanics of this area of the knee have led to improvements in management and a renewed interest in these potentially disabling injuries. The aim of this review is to bring the trauma generalist abreast of these recent developments and to improve diagnosis through a heightened index of suspicion and use of appropriate special investigations. The principles of management of both isolated and combined injuries to the PCL and PLC, in the acute and chronic settings, are described.

Acute Disease↗

PubMed2005

Progressive non-infectious anterior vertebral fusion (Copenhagen Syndrome) in three children: features on radiographs and MR imaging.

Progressive non-infectious anterior vertebral fusion is a rare childhood disease of unknown aetiology. It commonly presents with kyphosis associated with progressive fusion in the thoracolumbar spine. MR imaging features have not previously been described to our knowledge. Three cases presenting to our institution are described. All three children had other congenital or developmental problems. Plain radiographs showed typical features with narrowing and irregularity of the anterior endplates and developing anterior vertebral fusion. MR imaging was available in all (in one case sequentially at ages 1 and 12 years), and features demonstrated were anterior disc narrowing and anterior endplate irregularity progressing to fusion. Associated bone oedema or fatty replacement was seen in the endplates, and was most marked at the anterior corners.

Abnormalities, Multiple↗

PubMed2005

Adhesive capsulitis: sonographic changes in the rotator cuff interval with arthroscopic correlation.

OBJECTIVE: To evaluate the sonographic findings of the rotator interval in patients with clinical evidence of adhesive capsulitis immediately prior to arthroscopy. DESIGN AND PATIENTS: We prospectively compared 30 patients with clinically diagnosed adhesive capsulitis (20 females, 10 males, mean age 50 years) with a control population of 10 normal volunteers and 100 patients with a clinical suspicion of rotator cuff tears. Grey-scale and colour Doppler sonography of the rotator interval were used. RESULTS: Twenty-six patients (87%) demonstrated hypoechoic echotexture and increased vascularity within the rotator interval, all of whom had had symptoms for less than 1 year. Three patients had hypoechoic echotexture but no increase in vascularity, and one patient had a normal sonographic appearance. All patients were shown to have fibrovascular inflammatory soft-tissue changes in the rotator interval at arthroscopy commensurate with adhesive capsulitis. None of the volunteers or the patients with a clinical diagnosis of rotator cuff tear showed such changes. CONCLUSIONS: Sonography can provide an early accurate diagnosis of adhesive capsulitis by assessing the rotator interval for hypoechoic vascular soft tissue.

Adult↗

PubMed2005

Pes anserine bursitis: incidence in symptomatic knees and clinical presentation.

OBJECTIVE: To determine the prevalence and associated clinical symptoms of pes anserine bursitis in symptomatic adult knees. MATERIALS AND METHODS: A retrospective review was performed of the reports of 509 knee MRI studies obtained from July 1998 to June 2004 on 488 patients presenting to an orthopaedic clinic with knee pain suspected to be due to internal derangement. The MRI studies and case histories of all patients reported to have pes anserine bursitis were reviewed. The management of these patients was also noted. RESULTS AND CONCLUSIONS: The prevalence of pes anserine bursitis as detected on MRI is 2.5%. The commonest clinical presentation was pain along the medial joint line mimicking a medial meniscal tear. We suggest that an accurate diagnosis of pes anserine bursitis on MRI will help prevent unnecessary arthroscopy and possibly initiate early treatment of the condition. Axial imaging is important in these cases to differentiate the bursa from other medial fluid collections.

Adult↗

PubMed2005

Spinal cord infarction following therapeutic computed tomography-guided left L2 nerve root injection.

STUDY DESIGN: Case report. OBJECTIVES: To report a rare case of spinal cord infarction following therapeutic computed tomography-guided nerve root injection. SUMMARY OF BACKGROUND DATA: Diagnostic and therapeutic image-guided nerve root injection is commonly performed in the management of low back pain and sciatica. The severe complication of spinal cord infarction has been reported in only 3 cases previously. METHODS: Retrospective review of case records and imaging. RESULTS: A 71-year-old woman presented with symptoms and signs of left L2 nerve root compression. She was managed with computed tomography-guided left L2 nerve root injection using bupivacaine and triamcinolone and developed immediate bilateral sensory loss and paraplegia. Magnetic resonance imaging demonstrated diffuse hyperintensity within the distal thoracic cord and conus on T2-weighted images, consistent with spinal cord infarction. CONCLUSIONS: We report the fourth case of spinal cord infarction following nerve root injection. The severity of this complication warrants that it should be considered during patient consent for this procedure.

Aged↗

PubMed2005

CT guided diagnostic foot injections.

AIM: To describe a CT technique for guiding diagnostic and therapeutic injections in the hind- and mid-foot. MATERIALS AND METHODS: Over a period of 50 months, 28 individuals were referred for diagnostic and therapeutic hind- and mid-foot injections before possible arthrodesis. A CT technique was developed that allowed entry into the various joints using a vertical approach. Numbers of joints injected were as follows: posterior subtalar, 21; talonavicular, 4; calcaneonavicular, calcaneocuboid, navicular-cuneiform and 5th metatarsocuboid joints, 1 each. RESULTS: All injections but one were technically successful. Significant relief of symptoms was noted by 16 participants, whereas for 9 there was no improvement and for 3 a partial response was achieved. CONCLUSION: CT is a simple and safe alternative to fluoroscopy for guiding diagnostic and therapeutic foot injections, and may be the technique of choice in cases of disordered anatomy.

Adult↗

PubMed2005

The imaging of lumbar spondylolisthesis.

Lumbar spondylolisthesis is a common finding on plain radiographs. The condition has a variety of causes which can be differentiated on the basis of imaging findings. As the treatment is dependent upon the type of spondylolisthesis, it is important for the radiologist to be aware of these features. We present a pictorial review of the imaging features of lumbar spondylolisthesis and explain the differentiating points between different groups of this disorder. The relative merits of the different imaging techniques in assessing lumbar spondylolisthesis are discussed.

Humans↗

PubMed2005

Imaging of periosteal reactions associated with focal lesions of bone.

Periosteal reaction (PR) is the response of cortical bone to an underlying insult. It is manifest in a limited number of histological and radiological patterns. Although not specific for a particular diagnosis, the appearance of PR aids the radiological characterization of bone lesions. Once ossified, PR is demonstrated well on plain radiography but can also be visualized on ultrasound, CT, MRI and bone scintigraphy, particularly in the early stage. This article provides a pictorial review of the patterns of PR with particular reference to bone tumours.

Bone Neoplasms↗

PubMed2004

The prevalence and diagnostic significance of fluid-fluid levels in focal lesions of bone.

OBJECTIVE: To determine the prevalence and diagnostic significance of fluid-fluid levels (FFLs) in focal bone lesions. DESIGN AND PATIENTS: Clinical and radiological details of 738 consecutive patients referred with focal lesions of bone and who had undergone MRI were reviewed. FFLs were identified in 83 (11.2%). The proportion of the lesion occupied by FFLs was estimated, based on imaging in all available planes, as <1/3, 1/3-2/3, >2/3 but not the entire lesion, and complete. The degree of FFL change in each lesion was correlated with the final diagnosis, which was either histological (n=80) or clinicoradiological (n=3). There were 31 female and 52 male patients, mean age 25.5 years (range 5-83 years). RESULTS: Histology revealed 46 benign, 32 malignant and 2 non-neoplastic lesions. A clinicoradiological diagnosis was made in the 3 lesions without histology: 2 were benign (simple bone cyst and intraosseous lipoma) and 1 malignant (a metastasis). Malignant neoplasms commonly showed FFLs which occupied <1/3 of the entire lesion (n=22/32, 68.8%), and 50% of all the lesions in this group were conventional intramedullary osteosarcomas (n=16). With increasing FFL change, malignancy became less frequent: with >2/3 (but incomplete) FFL change, 81% (n=13/16) of tumours were benign. If the entire tumour showed FFL change, the histology was benign in 100% (n=11). CONCLUSIONS: The extent of FFLs within a focal bone lesion appears to be inversely related to the degree of malignancy. If at least 2/3 of the lesion shows FFL change, 89% of diagnoses are benign.

Adolescent↗