Case report 743: Urographic opacification following arthrography of the hip.
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Adult↗
Biomedical subjects
M K Dalinka
Publications and source records attributed to M K Dalinka.
Magnetic resonance imaging of the foot and ankle.
Technical considerations for the magnetic resonance imaging of the foot and ankle are discussed, including the selection of the appropriate surface coil, the importance of stabilizing the anatomic region, and the principles guiding the choice of pulse sequences. The anatomy of the foot and ankle are reviewed, and the normal appearance and important variations of the different structures on magnetic resonance images are discussed. Pathology of the foot and ankle are then discussed. Topics covered include osteochondral and radiographically occult fractures, tears and inflammation of the Achilles and posterior tibial tendons, tears of the lateral collateral ligaments and sinus tarsi syndrome, primary tumors (in particular, those of the foot), synovial diseases such as pigmented villonodular synovitis, congenital abnormalities, and disorders such as tarsal tunnel syndrome and plantar fasciitis.
Ankle Joint↗
MRI appearance of femoral head osteonecrosis following core decompression and bone grafting.
We used magnetic resonance imaging (MRI) to evaluate retrospectively 32 hips with avascular necrosis of the femoral head before and after core decompression and bone grafting. At a median follow-up time of 15 months, 4 of 9 large lesions had undergone femoral head collapse; 2 small lesions had decreased in size; and 14 small, 6 moderate, and 5 large lesions were unchanged. One hip with biopsy-proven avascular necrosis had diffuse marrow edema which resolved after surgery. The signal pattern within the lesions was analyzed in 17 hips. Fifteen lesions were unchanged, while one fat-like lesion became fibrous-like and one edema-like lesion resolved. Analysis of the femoral neck marrow signal in one patient revealed that premature fatty marrow conversion had reverted to hemopoietic marrow 2 years after surgery. Most lesions that appeared stable on MRI were clinically stable or improved. MRI can demonstrated changes in size and signal characteristics as well as femoral head collapse after core decompression and bone grafting. Changes in the surrounding marrow signal, including resolution of marrow edema and reconversion from fatty to hemopoietic marrow, can also be detected.
Adult↗
Hand injuries in adults.
The radiologist plays an important role in the evaluation of hand injuries. Although the detection of fractures is important, recognition and delineation of soft tissue damage is equally vital. If only soft tissue injuries exist, plain film findings are often nonspecific. Nevertheless, they can give helpful clues in evaluating ligaments and tendons. It is especially important for the radiologist to be knowledgeable of these soft tissue injuries because, in an emergency room setting, the radiologist may be the physician most familiar with the spectrum of injuries and possible complications.
Adult↗
Biceps tendon dislocation: evaluation with MR imaging.
The magnetic resonance (MR) images from six patients with biceps tendon dislocation--two in whom it was surgically proved and four in whom it was suspected--were retrospectively evaluated. The dislocated tendon can be identified medial to the bicipital groove, best seen on the axial and oblique coronal and sagittal images. Associated abnormalities of the biceps tendon include thickening (n = 3), high signal intensity (n = 3), and surrounding fluid (n = 4). The factors thought to contribute to dislocation can also be well seen on MR images. These include abnormal shape of the bicipital groove (n = 2), disruption of the coracohumeral ligament (n = 6), disruption (n = 4) and thinning (n = 1) of the subscapularis tendon, and supraspinatus tendon tear (n = 4). Since MR imaging is becoming the modality of choice for the evaluation of shoulder derangements, familiarity with the appearance of biceps tendon dislocation on MR images is important.
Adult↗
Magnetic resonance imaging of the hip with emphasis on avascular necrosis.
The hip has a primary role in weight bearing and gait. It is frequently involved in mechanical and inflammatory processes, leading to a painful joint. The pain is often nonspecific, requiring imaging studies for evaluation and diagnosis. Standard radiographs usually are the initial and often the only study required. Routine radiographs are insensitive to changes in the soft tissues and may not reveal changes in the medullary canal. The multiplanar capabilities and high contrast resolution of magnetic resonance imaging make it an ideal method for imaging the hip following standard radiography. Magnetic resonance imaging may be used to detect abnormalities in patients who have had normal radiographs or it can be used to evaluate the complications or stages of disease in patients who have had abnormal radiographs.
Arthritis↗
Magnetic resonance imaging of the shoulder. Sensitivity, specificity, and predictive value.
The sensitivity, specificity, and predictive value of magnetic resonance imaging in the diagnosis of lesions of the rotator cuff, glenohumeral capsule, and glenoid labrum were evaluated in ninety-one patients and fifteen asymptomatic volunteers. Magnetic resonance imaging demonstrated 100 per cent sensitivity and 95 per cent specificity in the diagnosis of complete tears, and it consistently predicted the size of the tear of the rotator cuff. There was a definite correlation between atrophy of the supraspinatus muscle and the size of a complete, chronic tear of the rotator cuff. The sensitivity and specificity of magnetic resonance imaging in the differentiation of tendinitis from degeneration of the cuff were 82 and 85 per cent, and in the differentiation of a normal tendon from one affected by tendinitis with signs of impingement the sensitivity and specificity were 93 and 87 per cent. The formation of spurs around the acromion and acromiocalvicular joint correlated highly with increased age of the patient and with chronic disease of the rotator cuff. The sensitivity and specificity of magnetic resonance imaging in the diagnosis of labral tears associated with glenohumeral instability were 88 and 93 per cent. The study showed that high-resolution magnetic-resonance imaging is an excellent non-invasive tool in the diagnosis of lesions of the rotator cuff and glenohumeral instability.
Acromioclavicular Joint↗
Magnetic resonance imaging of the wrist.
Magnetic resonance imaging is one of the newest diagnostic techniques for evaluating the complex anatomy of the wrist. It is the only diagnostic modality that can directly depict abnormalities within the ligaments of the wrist and the TFC complex. Pathologic processes involving bone and soft tissue can also be demonstrated.
Bone and Bones↗
Acute muscle injury complicating sickle cell crisis.
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Acute Disease↗
Fluid-fluid level: a nonspecific finding in tumors of bone and soft tissue.
Fluid-fluid levels have commonly been reported to occur in aneurysmal bone cysts but have also been seen in telangiectatic osteosarcoma, chondroblastoma, and giant cell tumor of bone. The authors reviewed their experience with nine bone and three soft-tissue tumors that showed fluid-fluid levels on computed tomographic or magnetic resonance images. The bone tumors included fibrous dysplasia, simple bone cyst, recurrent malignant fibrous histiocytoma of bone, two classical osteosarcomas, and four aneurysmal bone cysts. The soft-tissue tumors included soft-tissue hemangioma and two synovial sarcomas. Except for aneurysmal bone cysts, these types of tumors have not been reported to be associated with fluid-fluid levels. Radiologic-pathologic correlation was available in seven patients; in all seven, the fluid-fluid levels indicated prior hemorrhage. The authors conclude that the presence of fluid-fluid levels in bone or soft-tissue tumors cannot be considered diagnostic of any particular tumor.
Adolescent↗
Imaging of the knee.
MR imaging has become the primary imaging modality of the knee. Its advantages include its noninvasive nature, multiplanar imaging capability, excellent soft-tissue contrast, and high resolution. The need for multiple imaging modalities is obviated, as the menisci, cruciate ligaments, synovium, articular cartilage, marrow, and periarticular soft tissues can be simultaneously evaluated. Other imaging modalities may occasionally be helpful in the evaluation of specific problems including CT in tibial plateau fractures, real-time ultrasound for the confirmation of a popliteal cyst or popliteal artery aneurysm, and arthrography for the detection of prosthetic joint loosening.
Diagnostic Imaging↗
Magnetic resonance imaging of the shoulder.
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Humans↗
Magnetic resonance imaging of the shoulder.
The shoulder is now accessible to MRI owing to recent technical advances. The major advantages of this modality include its noninvasive nature, lack of ionizing radiation, excellent contrast and anatomic resolution, multiplanar imaging capability, and ability as a single imaging modality to evaluate simultaneously for a wide variety of pathologic processes. It is proving its utility particularly in the evaluation of the painful shoulder and the diagnosis of glenohumeral instability, rotator cuff impingement, tendinitis, and tear. We believe that with greater experience and large comparative studies, MRI will clearly demonstrate its superiority in evaluation of the shoulder and will almost entirely replace arthrography, as has occurred with the knee.
Humans↗
Advances in spinal imaging.
Considerable technical advances in spinal imaging have been made that have greatly aided diagnosis, surgical planning, treatment, and posttreatment follow-up of patients with spinal disorders. This article presents an update on the recent advances in magnetic resonance, digital, and radionuclide imaging techniques, three-dimensional computed tomography, and sonography of the spine.
Humans↗
The use of magnetic resonance imaging in the evaluation of bone and soft-tissue tumors.
We believe that MR imaging should follow plain films in the imaging analysis of soft-tissue tumors and bone tumors suspected of malignancy. MR imaging is primarily useful in tumor staging, although it may aid in diagnosis and the detection of recurrent or residual disease. Gd-DTPA and MR spectroscopy are currently being evaluated in many medical centers; their utility in the work-up and management of tumors of bone and soft tissue has yet to be determined.
Bone Neoplasms↗
Soft tissue osteochondroma. A report of three cases.
Three cases of benign soft tissue osteochondroma, a lesion of uncertain pathogenesis, are reported. Two cases were located in the subcutaneous tissues beneath the calcaneus. The other was located in the soft tissues near the left ankle joint. The diagnosis of soft tissue osteochondroma should be considered when a well-defined osseous mass is located in the soft tissues. The differential diagnosis includes myositis ossificans, tumoral calcinosis, synovial chondromatosis, and soft tissue osteosarcoma.
Adolescent↗
Rotator cuff tears: diagnostic performance of MR imaging.
To determine the diagnostic performance of magnetic resonance (MR) imaging in the evaluation of suspected rotator cuff tears, eight asymptomatic volunteers and 32 patients with rotator cuff tendonopathy who underwent surgery were examined with MR imaging. Twenty-four of these patients also underwent contrast arthrography. The ability of MR imaging to depict the size of cuff tears and the quality of torn tendon edges was also evaluated. The MR imaging and arthrographic studies were reviewed without knowledge of surgical results or of the other studies. A scoring system was developed and a score assigned to each patient's MR study. The sensitivity of MR imaging for all tears (partial and full thickness) was 0.91, and the specificity was 0.88; whereas the sensitivity and specificity of arthrography were each 0.71. The scoring system improved the sensitivity to 1.0 and the specificity to 0.92. Linear regression analysis showed excellent correlation between preoperative assessment of the size of rotator cuff tears and measurement at surgery (r = .95).
Humans↗
Paget disease: MR imaging findings.
Magnetic resonance (MR) images of 13 patients with Paget disease were reviewed, and findings were correlated with those from computed tomographic (CT) scans, radiographs, and, in two patients, surgical biopsy. MR imaging findings correlated with CT and radiographic findings of cortical thickening, increased size of bone, and coarse thickened trabeculae. Focal or diffuse decreased signal intensity, representing dense bone, was seen on images obtained with short and long repetition times (TRs) and echo times (TEs); high-signal foci, representing fat collections, were seen on short TR/TE images; and high-signal foci, representing fibrovascular marrow in active Paget disease, were seen on long TR/TE images. Complications of Paget disease-including basilar invagination, spinal stenosis, and sarcoma--were well identified on MR images. Although MR imaging is not generally used in diagnosis of Paget disease, the disease will be encountered more frequently as more MR imaging examinations are performed. An awareness of the range of findings in Paget disease is useful in evaluating MR images of the musculoskeletal and other systems.
Aged↗