Biomedical subjects
Publications and source records attributed to R G Stiles.
The authors present a case of atypical heel pain masquerading as plantar fasciitis. The patient was subsequently diagnosed with hyperparathyroidism-induced stress fracture of the calcaneus. The clinical entity of hyperparathyroidism and its manifestations in the skeletal system are presented, as well as a review of stress fractures and pertinent imaging studies.
The authors present a case of breast cancer metastasizing to the calcaneus that was confirmed by bone biopsy. The patient's complaint of heel pain provided the initial evidence of skeletal metastasis. Metastatic spread of cancer to the hand or foot (acrometastasis) is considered rare. However, the possibility of acrometastasis should be considered in any patient with a history of cancer presenting with skeletal pain, especially if the symptoms do not respond to therapy.
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PURPOSE: To describe the clinical, histologic, and radiologic findings in patients with diabetic muscular infarction (DMI). MATERIALS AND METHODS: Descriptive case series of 3 patients with DMI and 22 previously reported cases (MEDLINE data base search) in the English literature are presented. RESULTS: Diabetic muscular infarction is usually seen in patients with long-standing insulin-dependent diabetes and multiple end-organ microvascular complications. Two-thirds of patients with DMI are women, with a mean age at presentation of 39 +/- 12 years. The typical clinical presentation includes abrupt onset of thigh pain and tenderness. There is a palpable, painful mass, with swelling and induration of the surrounding tissue without systemic symptoms or signs. The painful lesion persists for weeks, occasionally with exacerbations of symptoms, then spontaneously resolves over several weeks to months. Recurrent episodes are reported in half of the patients. Muscles commonly affected are the vastus lateralis, thigh adductors, and biceps femoris; but calf muscles may be involved as well. Active pathologic changes in the muscle are more sensitively evaluated with T2-weighted sequences on magnetic resonance (MR) imaging, which shows high intensity in involved muscle. Histologic features of DMI consist of large areas of muscle necrosis and edema. Regenerating muscle fibers and lymphocytic interstitial infiltration may be present. CONCLUSION: Diabetic muscular infarction is a rare complication of diabetes mellitus. In most patients, the diagnosis can be made when the characteristic clinical presentation is combined with a typical MR imaging results. Muscle biopsy can be helpful in establishing the diagnosis of DMI, but histologic findings are not specific. Awareness of this syndrome plus MR imaging as the first diagnostic test should lead to the correct diagnosis and shorter hospitalization.
OBJECTIVE: To evaluate the accuracy of direct magnetic resonance imaging (MRI) signs of tears of the anterior cruciate ligament. PATIENTS AND METHODS: Over the period April 1991 to February 1994, 92 consecutive MRI studies of the knee were obtained for which arthroscopic data were also available. The MRI studies were retrospectively evaluated for course, continuity, signal intensity, morphologic features, contour and visualization of the anterior cruciate ligament. Arthroscopic findings were correlated with individual primary signs and the overall MRI diagnosis. RESULTS: Among the cases studied were 4 partial and 32 complete tears of the anterior cruciate ligament (as determined by arthroscopy). Because of the low number of partial tears, it was not possible to draw any meaningful conclusions about the MRI diagnosis of this type of tear. For complete tears, the criteria with the highest accuracy were abnormal course of the ligament (96.0%) and high signal intensity (89.3%). The overall diagnostic accuracy of MRI was 98.8%. CONCLUSIONS: The most accurate direct MRI finding in patients with a complete tear of the anterior cruciate ligament was abnormal course of the ligament, followed by abnormally high signal intensity.
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An alternative method of presenting and evaluating unenhanced and contrast-enhanced MR images is illustrated. We used a desktop computer and commercially available software to combine unenhanced and contrast-enhanced images to produce a color map of contrast enhancement superimposed on a gray-scale image. The color-enhanced images increased the conspicuousness of the areas of contrast enhancement, which is particularly important if the enhancing structures are small or adjacent to fatty tissues. The process has advantages over standard subtraction techniques in that gray scale is preserved while areas of subtle contrast enhancement are readily seen as areas of color. Although applied to MR imaging, this method may also be applicable to other studies that use contrast enhancement.
The technique of hip arthroplasty is at least 30 years old and currently is performed 120,000 times per year in the United States [1]. Changes in materials and surgical techniques have markedly decreased the prevalence of infection and aseptic loosening. At the same time, other complications such as stress shielding and aggressive granulomatosis have become increasingly important complications of joint replacement [2]. All four of these entities manifest radiographically as periprosthetic lucency (Fig. 1.). The purpose of this essay is to illustrate the plain film findings of each of these complications.
OBJECTIVE: The purpose of this study was to evaluate the spectrum of plain radiographic findings in patients with septic hip prostheses. MATERIALS AND METHODS: Radiographs of 20 confirmed infected hip prostheses were examined for the presence or absence of lucency, type of lucency (focal or nonfocal), rapidity of radiographic change, periostitis, subsidence, and cement fracture. RESULTS: Findings were normal in 10 prostheses, but nonfocal lucencies mimicking mechanical loosening were seen in four cases. Two cases showed focal bone loss, indistinguishable from aggressive granulomatosis. A variety of findings, including subsidence and periostitis, were seen in the remaining four prostheses. CONCLUSION: Plain radiographs of septic hip prostheses often show normal findings but can show focal bone loss that mimics aggressive granulomatosis.
Aggressive granulomatosis is a potentially devastating complication of joint-replacement surgery. This condition likely represents a foreign body reaction to particulate metal, methylmethacrylate or polyethylene. The authors describe a 51-year-old woman in whom aggressive granulomatosis developed after total knee arthroplasty. Plain radiographs over a 3-year period showed progressively expanding focal areas of bone loss. Revision arthroplasty was necessary to prevent pathologic fracture.
Myocutaneous sclerosis is a known complication of intramuscular and subcutaneous injection of narcotics. We have described the MRI findings of this entity with superimposed infection in a patient addicted to intramuscular and subcutaneously administered nalbuphine. The clinical and imaging features of this disorder are sufficiently characteristic to allow confident diagnosis. This is the first report of this disorder due to nalbuphine.
PURPOSE: The accuracy of fluoroscopy-guided hip aspiration in the diagnosis of infection in hip prostheses was evaluated. MATERIALS AND METHODS: Results from 147 preoperative aspiration cultures were compared with results of operative cultures. The relative costs of aspiration and nuclear medicine studies were also compared. RESULTS: With the operative culture results as the standard, sensitivity of hip aspiration was 92.8% and specificity was 91.7%. The negative and positive predictive values were 99.2% and 54.2%, respectively. Aspiration arthrography costs approximately 20% as much as complementary technetium sulfur colloid-indium-111 granulocyte scans, the most accurate nuclear medicine study used to evaluate potentially infected hip prostheses. CONCLUSION: Hip aspiration is an accurate and cost-effective method of evaluating the potentially infected hip prosthesis.
Fibrous lesions of bone include entities with a wide range of radiographic appearance and clinical behavior. Many benign fibrous lesions, such as medial supracondylar defects, fibrous cortical defects, and nonossifying fibromas have typical radiographic appearances and usually are self-limited. Desmoplastic fibromas and benign fibrous histiocytomas are less common, behave more aggressively, and usually require biopsy and surgical management. Fibrous dysplasia varies from solitary clinically unimportant lesions to wide-spread, deforming skeletal involvement that can lead to severe functional impairment and, rarely, even to death. Malignant fibrous lesions, including malignant fibrous histiocytomas and fibrosarcoma, produce aggressive lytic lesions, which require careful anatomic staging, accurate biopsy, and aggressive and appropriate treatment.
Radiology literature indexes were searched for articles concerning socioeconomic and political issues published during two 21-year periods: 1920-1940 and 1970-1990. Of 200 articles found, 96 were considered appropriate for study, 40 from 1920-1940 and 56 from 1970-1990. All except two of the articles were from Radiology or the American Journal of Roentgenology. The articles were organized into 16 categories. By quantifying the number of times these socioeconomic and political issues appeared and comparing quotations from the articles, the authors demonstrated many common issues in the two periods, despite drastic differences in radiology practice. Analysis of historical literature provides perspective on current socioeconomic and political issues and may help formulate solutions to current problems. Documentation of such issues facilitates historical analysis and is an important function of the radiology literature.
Aneurysmal bone cysts (ABCs) have been reported in essentially every bone of the human skeleton. This case report documents a very unusual clinical appearance for this entity: a superior mediastinal mass. Also, the patient underwent multiple imaging studies that demonstrated both common (absence of septations) and unusual (extensive involvement of vertebral body with little involvement of posterior elements) characteristics of ABCs.
Magnetic resonance imaging (MRI) is accurate in evaluating meniscal tears using spin echo pulse sequences. The purpose of this study was to systematically compare T1-weighted pulse sequences to two echo proton density/T2 (2eT2)-weighted sequences. Menisci were separated into four grades based on signal characteristics. In addition, all menisci were graded as positive or negative for tear. Twenty-three patients (46 menisci) were studied with both pulse sequences and the results were compared with arthroscopic findings. Using T1 sequences, 14 of 18 torn menisci and 26 of 28 untorn menisci were identified. Using 2eT2 sequences, 13 of 18 torn menisci and 26 of 28 untorn menisci were correctly identified. There was high correlation between T1 and 2eT2 sequences for torn versus untorn menisci and for grade of injury (P = .99). There is very little difference between T1- and 2eT2-weighted pulse sequences in evaluation of meniscal tears.
In order to define the anatomy of the calcar femorale, a radiologic and surgical study was done on ten paired cadaver femurs. After radiography and computed tomographic (CT) scans, the specimens were subjected to medullary reaming by an experienced orthopedist, simulating total hip arthroplasty procedures. The imaging studies were repeated and compared with the prereaming studies. The calcar femorale was dissected from surrounding medullary bone, and sections of this structure were examined histologically. The calcar femorale is a condensation of cancellous bone. It is not affected by the reaming procedure but may play a role in guiding the reamer. This structure is separate from the calcar area described in relation to bone resorption after hip arthroplasty.