Biomedical subjects

D B Finlay

Publications and source records attributed to D B Finlay.

At least 19 recordsLinked to original sources

PubMed1997

An audit of knee radiographs performed for general practitioners.

The Royal College of Radiologists (RCR) has published guidelines concerning indications for imaging investigations. These include plain radiography of the knee, the indications for which are locking or signs of restricted movement. This audit consisted of 1153 knee radiographs in a 9 month period, results of a questionnaire sent to general practitioners (GPs), analysis of radiological reports and returned questionnaires (55% of cases), and subsequent comments from the GPs on receiving these results. Only 50% of cases fall within RCR guidelines, 90% of radiographs were normal or showed degenerative change. In 42% of cases, knee radiographs were requested to confirm previously expected degenerative change, and in 30% patient pressure was a significant factor. Most knee radiographs (87%) result in no significant change in management apart from continuation of symptomatic measures. Application of current guidelines, however, would miss some important diagnoses manifest clinically by persistent pain or effusion, for example loose body or Brodie's abscess. In cases of locking, where a radiograph may miss significant soft tissue abnormality, there was concern that reassurance was often gained by a normal examination. This audit shows that many knee radiographs are unnecessary. The guidelines appear appropriate with the proviso that persistent pain and effusion should be included as indications for investigation. Many GPs report medico-legal considerations as important reasons for unnecessary referrals, although the application of guidelines should be protection against this. The referral rate for knee radiographs before and after the communication of these results has not altered.

Adolescent↗

PubMed1997

Knee tumours--duration and nature of symptoms prior to investigation.

The incidence of most musculoskeletal neoplasms is highest around the knee. Royal College of Radiologists Guidelines for diagnostic imaging state that plain radiographs are not routinely indicated for knee pain without restriction of movement or symptoms of locking. The notes of 19 patients with knee tumours presenting over a 5 year period were analysed. Irrespective of age or the grade of malignancy the majority of patients had symptoms for around 6 months prior to the initial radiograph. Only four patients had symptoms which would have merited radiological investigation under the present Guidelines. Even in these patients the symptoms prior to either pathological fracture or locking would not have come under the Guidelines. There is a case for regarding persistent, unilateral knee pain for longer than 6 weeks as an indication for imaging.

Adolescent↗

PubMed1997

The value of indium-111-labelled leucocyte imaging and ultrasonography in the investigation of pyrexia of unknown origin.

The aim of this study was to assess indium-111 leucocyte imaging and ultrasound in the investigation of pyrexia of unknown origin (PUO), as well as the predictive value of available clinical information on the radiological outcome. 256 111In leucocyte scans performed over a 5 year period were reviewed. There were 59 scans in 58 patients who fulfilled recognized criteria for true PUO; 47 of these patients had ultrasound. In 15 patients the fever settled and no diagnosis was made; the source of PUO was infective in 20 and non-infective in 24. In the group as a whole, the sensitivities of leucocyte scan and ultrasound were 25% and 23% with specificities of 100% and 83%, respectively. In infective cases of PUO, the sensitivities were 20% for both modalities. There was no correlation between leucocyte count or differential, C reactive protein or the presence or absence of antibiotics. In the cases where the leucocyte scan led to the diagnosis of infection, the scan was performed within 4 weeks of the onset of symptoms. The results show that an infective cause for PUO is established in less than 50% of cases. The leucocyte scan is specific and although not very sensitive can often be a guide to subsequent cross-sectional imaging. If an infective cause for the PUO is strongly suspected, 111In leucocyte scanning may be more sensitive if performed in the first few weeks of fever.

Fever of Unknown Origin↗

PubMed1996

Hypertrophic osteoarthropathy in staging skeletal scintigraphy for lung cancer.

AIM: To assess the prognostic significance of hypertropic osteoarthropathy (HOA) discovered on routine staging bone scintigraphy in patients with lung cancer. PATIENTS AND METHODS: Between 1989 and 1992 all 99mTc-MDP bone scintigrams performed for the staging of bronchogenic carcinoma were reviewed. HOA was diagnosed by the observation of cortical/periosteal increased uptake in the extremities of the long bones. Follow-up and confirmation of the diagnosis was obtained by hospital computer, histology records, operative records, patient notes and radiological data where available. RESULTS: 164 staging scintigrams for lung cancer were identified. Twenty-eight patients (17%) were observed to have HOA. Patients with and without HOA were well matched for age and sex. There was little difference in the distribution of cell type but the HOA groups has a greater incidence of peripheral tumours. There was no significance in survival between the two groups. Two of three long-term survivors had clinically overt HOA and one presented with arthralgia. CONCLUSION: HOA is often seen on skeletal scintigraphy for staging of lung cancer and has no prognostic significance. The data also support current teaching that a high index of suspicion for HOA, as a cause of arthralgia may lead to early diagnosis of a potentially resectable lung carcinoma.

Aged↗

PubMed1996

The correlation of bone scintigraphy and histological findings in patellar tendinitis.

Patellar tendinitis is a chronic overuse injury causing pain and tenderness over the proximal insertion of the patellar tendon. Its management is usually conservative, but in intractable cases surgery is effective. Bone scintigraphy has been suggested as a useful investigation in these patients, although we are aware of no large series supporting this. Thirty-four patients with intractable symptoms of patellar tendinitis were treated surgically. The operative specimens were graded histologically and compared with preoperative radionuclide bone scans. The histological findings confirmed tendon and or tendon sheath abnormalities in all the samples. The predominant abnormalities were increased vascularity, fibroblast proliferation, acid mucopolysaccharide and haemosiderin deposition. Bone scintigraphy showed 24 (71%) patients to have abnormalities on the delayed images, 8 with diffusely increased activity in the patella and 16 with increased activity localized to the lower pole. Patients with abnormal bone scans had significantly more severe histological changes in their tendons. These findings support the use of radionuclide bone scans in the pre-operative assessment of patellar tendinitis correlating well with histopathological severity of the disease process. The 10 false-negative cases (29%), however, suggest that bone scans are unhelpful in the routine diagnosis and management of this condition.

Adolescent↗

PubMed1996

Multifocal skeletal tuberculosis: bone scan appearances.

Bone scans are not generally required in the investigation of tuberculosis. The most common reason for the request is bone pain, which may precede the diagnosis of tuberculosis. The finding of multifocal areas of increased uptake on a bone scan may be due to a number of causes, the most common of which is metastatic bone disease. Therefore, there is a risk that those caused by tuberculosis may be misdiagnosed. We report six such bone scans occurring over 5 years which were found to be due to skeletal tuberculosis. Five patients were of Asian descent, four of whom had had bone biopsies confirming the presence of mycobacterium tuberculosis. The sixth patient, a Caucasian, had a bone biopsy which isolated mycobacterium bovis. Although skeletal tuberculosis is generally secondary to a primary pulmonary focus, all six patients had a normal chest X-ray.

Adult↗

PubMed1995

A study of metatarsal fractures in children.

The purpose of our study was to document the sites and distribution of mid-foot and fore-foot fractures in children, relating them to the pattern of injury with particular reference to the first metatarsal. The clinical records and radiographs of 388 children with foot injuries were examined. A total of 62 metatarsal and seven tarsal fractures were identified in 60 children. The commonest fracture was of the fifth metatarsal, 45 per cent overall; 90 per cent of these children were over 10 years old. In children under 5 years old, first metatarsal fractures accounted for 73 per cent, but in children over 5 years old, these fractures accounted for only 12 per cent of the total. In all, 6.5 per cent of all fractures and 20 per cent of first metatarsal fractures went unrecognized at the initial attendance.

Adolescent↗

PubMed1995

Childhood ossification of the anterior longitudinal ligament of the cervical spine.

Two paediatric cases of acquired ossification of the cervical anterior longitudinal ligament are described. This has not been previously reported in childhood. The first was associated with corrosive ingestion requiring oesophagectomy and colonic interposition and the second with acute lymphoblastic leukaemia initially presenting as idiopathic hypereosinophilic syndrome. Possible mechanisms are discussed.

Cervical Vertebrae↗

PubMed1995

Direct and indirect MRI findings in ganglion cysts of the common peroneal nerve.

MRI findings in three cases of ganglion cyst of the common peroneal nerve are presented. In each case the cyst was imaged as an oval structure in transverse section section adjacent to the fibular neck. The cyst extended in a tubular fashion over several slices with an inferior extension towards the superior tibiofibular joint. Signal intensity was intermediate on T1- and high on T2-weighted images. In addition, increased signal on both T1- and T2-weighted images was noted throughout the peroneal compartment and was associated with clinical and EMG evidence of denervation. This has not been previously described but may be an important indirect sign which, when seen, should prompt a careful search in the region of the fibular neck for an underlying ganglion cyst of the common peroneal nerve.

Adolescent↗

PubMed1995

The aetiology and distinguishing features of solitary spinal hot spots on planar bone scans.

PURPOSE: To determine the aetiology of solitary spinal hot spots on planar bone scans and to determine which radiographic and scintigraphic features aid in distinguishing benign from malignant lesions. MATERIALS AND METHODS: 81 bone scans showing a solitary hot spot in the spine were identified. Aetiology was determined in 73 based on imaging and clinical findings, including clinical follow-up. The location of the hot spot was classified as paravertebral (related to the lateral spinal margin), panvertebral (diffuse uptake confined within a vertebra), hemivertebral (uptake confined between the midline and lateral spinal margin) or complex (all others). RESULTS: The aetiology of the spinal hot spot was benign in 55 patients and malignant in 18. The latter all belonged to the subgroup of 42 patients with a known malignancy. Only eight of the 18 malignant cases had suggestive plain radiographic findings. There was no significant relationship between aetiology and age. The spinal level of the hot spot was cervical in three (all benign), thoracic in 16 (eight benign) and lumbar in 54 (44 benign). The hot spot was paravertebral in 21 (all benign), panvertebral in 24 (20 benign), hemivertebral in 13 (10 benign) and complex in 15 (only four benign). CONCLUSIONS: Most (75%) solitary spinal hot spots are benign, and even in patients with known malignancy just over half (57%) are benign. Malignant lesions are often (56%) radiographically occult. Thoracic or complex hot spots are more likely to be malignant while paravertebral hot spots are characteristically benign. These features may be helpful in distinguishing benign and malignant lesions in patients with a known malignancy and unremarkable radiographs. Other scintigraphic features are unhelpful in distinguishing benign from malignant lesions.

Adolescent↗

PubMed1995

The value of 99Tcm-MDP bone scans in young patients with exercise-induced lower leg pain.

This study compares the bone scan appearances in 32 patients with medial tibial syndrome (MTS) with the appearance in 28 patients with confirmed chronic compartment syndrome (CCS). A distinctive pattern of uptake was seen in 30 patients, 24 of whom had MTS and 6 of whom had CCS. Of the patients with normal scans, only 4 had MTS, the remaining 15 had CCS. Both of these findings are statistically significant and confirm that bone scans are a useful diagnostic tool in the differential diagnosis of exercise-induced lower leg pain.

Adult↗

PubMed1995

The aetiology of solitary hot spots in the ribs on planar bone scans.

The aim of this study was to determine the aetiology of solitary hot spots in the ribs found at bone scintigraphy in patients with known extraskeletal malignancy. A group of 34 patients whose bone scans showed a solitary hot spot in a rib were identified retrospectively over a 4-year period. They all had a known extraskeletal malignancy. Aetiology of the rib hot spot was established in 26 patients based on a review of clinical features, radiographic findings and clinical follow-up. In eight cases it remained indeterminate. In 14 (41%) cases, the rib lesion was malignant in origin, 9 were due to metastasis and 5 due to direct spread from intrapulmonary malignancy. In 12 (35%) cases, it was benign. In the remaining 8 (24%) cases, the aetiology was indeterminate. In the subgroup of 14 hot spots confined to the anterior rib end, 5 (36%) were due to malignancy, 4 (28%) were benign and 5 (36%) were indeterminate. We conclude that solitary hot spots in the ribs of patients with known extraskeletal malignancy undergoing bone scintigraphy are frequently (41%) malignant in origin. This also applies when the hot spot is in the anterior rib end (36% malignant). Thus, such hot spots are far more sinister than previously reported and require careful clinical and radiographic evaluation.

Adult↗

PubMed1995

Isotope bone scans in patients with painful knee replacements: do they alter management?

A retrospective review of the scintigraphic appearances, clinical findings and outcome in 12 patients presenting with painful knee replacements was made. Three patients required revision surgery; symptoms in the remaining nine patients settled without operative management. Three examinations failed to identify prostheses proven to be infected by aspiration and four were falsely positive for infection without supportive clinical evidence. Four examinations demonstrated loosening and in one patient the bone scan was normal but the prostheses was loose at revision surgery. There were no specific features to predict which prostheses required surgical revision and the ability to diagnose or exclude infection was limited. It is concluded that the results of three phase 99Tcm bone scans in symptomatic knee prostheses are of little assistance in guiding clinical management and that a period of conservative management should be considered prior to operative intervention.

Humans↗

PubMed1995

Single-photon-emission computerised tomography compared with planar bone scan to assess femoral head vascularity.

We performed single-photon-emission CT (SPECT) and planar bone scans to assess femoral head vascularity in ten patients with displaced intracapsular hip fracture. The heads were labelled with tetracycline and after excision at hemiarthroplasty were assessed for tetracycline uptake distribution by fluorescence under UV light. The four which had the greatest tetracycline uptake were normal on SPECT and planar imaging. In two cases the planar bone scans were normal although SPECT suggested avascularity thus giving false-negative results. Surgeons should be aware of this; SPECT may prove to be a more accurate method of assessing vascularity of the femoral head in fractures of the femoral neck.

Arthroplasty↗

PubMed1994

Ultrasonography of the tibialis posterior tendon in rheumatoid arthritis.

This work was carried out to assess the frequency of frank rupture of the tibialis posterior tendon (TPT) in RA and to determine if other pathology in the tendon can be correlated with foot deformity. Clinical, radiographic and ultrasonographic signs of TPT pathology were assessed bilaterally in 28 patients with RA and hindfoot involvement. The degree of hindfoot pain, the single-heel-rise test and the tibiocalcaneal angle were assessed clinically. The talometatarsal angle was measured on lateral weight-bearing radiographs. Tendon continuity and thickness were noted on sonography, both in the study group and in a control group of 14 patients. The TPT was significantly thinner in those rheumatoid patients with an abnormal single-heel-rise test when compared to those patients with a normal test (P < 0.001) and to the control group (P < 0.001). The mean thickness in patients with an abnormal test was 1.6 mm, in patients with a normal test it was 2.3 mm and in the controls it was 1.9 mm. In the rheumatoid group thinning of the tendon was significantly correlated (r = -0.33, P < 0.05) with heel valgus as assessed by the tibiocalcaneal angle. It was also significantly correlated (r = 0.31, P < 0.05) with pes planus as assessed by the talometatarsal angle. Only one case of frank rupture of the TPT was identified. There were also significant correlations between TPT thickness and patient age, disease duration and steroid therapy, such that tendon attenuation was associated with increasing age, longer disease and steroid usage. There was no association between TPT thickness and the degree of hindfoot pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

An audit of paediatric technetium-99m methylene diphosphonate bone scans.

Eighty-nine Technetium-99m-MDP scans performed between January 1987 and June 1990 at the Leicester Royal Infirmary were reviewed with regard to the indication, patient outcome and value of the scans in the patients' management. The significant finding was the value of a normal scan in the management of children with chronic pain.

Acute Disease↗

PubMed1994

Knee effusions, radiology and acute knee trauma.

Sixty patients with acute knee trauma were examined radiographically at presentation and subsequently examined under anaesthetic, when arthroscopy was performed. The aim was to assess whether a normal radiograph at presentation excluded significant knee pathology. Nine patients with significant pathology (25%) had normal radiographs at presentation.

Acute Disease↗

PubMed1993

Recurrent anterior glenohumeral joint dislocation and torsion of the humerus.

Two computerized axial tomographic sections, one taken just below the coracoid process and the other about 2.5 cm proximal to the interepicondylar line, were used to determine glenoid version and humeral torsion in 19 patients with recurrent anterior glenohumeral joint dislocation and in 23 controls. Analysis of interobserver variation revealed the method to be reliable. There was no difference in glenoid version between the two groups. However, humeral torsion was greater in patients (153 degrees) than in controls (144 degrees). It appears that increased humeral torsion may predispose to glenohumeral joint dislocation.

Adolescent↗