Biomedical subjects
B H Berrey
Publications and source records attributed to B H Berrey.
Magnetic resonance appearance of fibromatosis. A report of 14 cases and review of the literature.
We reviewed retrospectively the magnetic resonance (MR) images of 14 soft-tissue lesions of fibromatosis (desmoid tumors) encountered in 11 patients. The lesions were typically inhomogeneous in texture and round to oval in configuration. Margins were well-defined in 78% of the lesions at presentation and were infiltrating in all recurrences. On T1-weighted spin echo MR images, the predominant signal intensity was either isointense or minimally hyperintense when compared with skeletal muscle. On T2-weighted MR images the predominant signal intensity was typically intermediate between skeletal muscle and subcutaneous fat or isointense to fat. Linear and curvilinear areas of decreased signal intensity were distributed throughout the lesions on both pulse sequences in 86% of cases. This pattern strongly suggested fibromatosis. Speculation concerning possible etiologies of this appearance are discussed, and the relevant literature on previously reported cases is reviewed.
Osteoid osteoma of the elbow. A review of six cases.
Six cases of osteoid osteoma of the elbow were reviewed to determine the spectrum of clinical, pathologic and radiologic findings. Since osteoid osteoma of the elbow may masquerade as a nonspecific synovitis, the diagnosis is challenging and frequently delayed. The histology is, however, indistinguishable from that of osteoid osteoma occurring in typical locations. The radiologic features of osteoid osteoma of the elbow include the following triad: (a) osteosclerosis, usually a dominant feature at initial imaging and typically enveloping the nidus; (b) joint effusion; and (c) periosteal reaction that can involve both the bone in which the osteoid osteoma arises and adjacent bones. Awareness of these features will facilitate correct diagnosis, thereby facilitating timely and appropriate treatment.
Radiologic appearance of intramuscular hemangioma with emphasis on MR imaging.
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MR imaging findings in patients with bone-chip allografts.
Increasing use of MR to evaluate primary bone neoplasms has stimulated numerous articles on the initial assessment of these lesions. However, scant MR literature has been written about the postoperative MR appearance. We studied the MR appearance of lesions treated by curettage followed by packing with cancellous bone-chip allograft. We retrospectively reviewed the MR scans of 18 consecutive patients treated in this way. Pathologic diagnoses of these lesions were confirmed according to commonly accepted criteria. The allograft sites showed a distinctive pattern of speckled bright signal on T1-weighted images in eight cases. Thirteen of 18 grafts showed a whorled or speckled pattern of increased signal on the T2-weighted images. Only four allograft regions had predominantly low signal on both T1- and T2-weighted images. Two of 18 patients had recurrent tumor proved by open biopsy. MR images in these cases showed areas of homogeneous signal that replaced areas of speckled hyperintensity on both T1- and T2-weighted images. In both these recurrences the tumor had signal intensity similar to that seen on the preoperative MR study. We conclude that knowledge of the MR appearance of cancellous bone chip allografts is important to avoid misinterpreting areas of high signal on T1- or T2-weighted images as areas of recurrence of tumor and/or hemorrhage.
Fractures of allografts. Frequency, treatment, and end-results.
One of the major complications of implantation of a massive frozen cadaveric allograft in the treatment of a tumor is fracture of the allograft. To determine the incidence, risk factors, appropriate management, and results of treatment of this complication, the records of the Orthopaedic Oncology Unit of the Massachusetts General Hospital were reviewed. Forty-three patients were identified in whom a tumor had been treated with an allograft that had subsequently fractured. The over-all incidence of fracture was almost 16 per cent. When the several risk factors (age and sex of the patient, stage and site of the lesion, and so on) for the forty-three patients who had a fracture were compared with those for the rest of the series, the only correlation was the incidence of non-union at the site of the host-donor junction, which was significantly higher in the patients who had a fracture. The mean time to fracture was 28.6 months after the operation. Three types of fractures occurred: Type I (two patients), rapid dissolution of the graft; Type II (twenty-two patients), fracture of the shaft, which was observed more frequently in male patients and which occurred a mean of 27.6 months after the operation; and Type III (nineteen patients), fragmentation of the joint, which usually occurred later (a mean of 31.6 months postoperatively) and was found more frequently in female patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Primary benign and malignant osseous neoplasms of the foot.
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Imaging of pigmented villonodular synovitis with emphasis on MR imaging.
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Soft-tissue masses: diagnosis using MR imaging.
The MR images of 112 soft-tissue masses of various causes were retrospectively reviewed. Pathologic diagnosis by biopsy was available in 96 cases. Diagnosis in the remaining 16 cases was established by characteristic radiographs, CT scans, and/or arteriograms, in conjunction with appropriate history and clinical follow-up. All masses were evaluated with both T1-weighted, 300-600/20-30 (TR/TE), and T2-weighted, 2000/80-100, images. They were reviewed to determine (1) if these images were sufficiently unique to allow a preoperative diagnosis based exclusively on the MR appearance and (2) if benignity vs malignancy could be predicted on the basis of the analysis of the MR image characteristics of the lesion. Concerning the latter, attention was directed to the margins of the lesions, to the impact of the lesion on the surrounding tissues (edema, infiltration, etc.), and to the intensity and homogeneity of the MR signal of the lesion. MR images were sufficiently characteristic to allow a specific diagnosis in 27 (24%) of the 112 cases (10 lipomas, eight hemangiomas, six pigmented villonodular synovitis, two hematomas, and one arteriovenous malformation). MR was incapable of reliably distinguishing between benign and malignant soft-tissue tumors.
The treacherous biopsy.
The biopsy is a critical step in the evaluation of patients with suspected malignancies. The surgical approach in performing the biopsy can significantly affect the patient's future treatment options and prognosis. From July 1985 to July 1986, 63 patients were referred for evaluation by the Orthopaedic Oncology Service at Walter Reed Army Medical Center. Seven patients with primary musculoskeletal malignancies had biopsy or surgery prior to referral. In six patients this had an adverse impact on their treatment, resulting in amputation. Careful consideration of masses as potential malignancies should be undertaken prior to biopsy, and should the surgeon or the hospital be unable to provide definitive care for the patient, consideration should be given to early referral before biopsy.
Diagnosis of infection by preoperative scintigraphy with indium-labeled white blood cells.
Scintigraphy with indium-labeled white blood cells has been reported to be sensitive and specific in the diagnosis of low-grade sepsis of the musculoskeletal system. We reviewed the records of fifty patients who had suspected osteomyelitis or suspected infection about a total joint prosthesis and who underwent scintigraphy with technetium-99m methylene diphosphonate and scintigraphy with indium-111 oxine-labeled white blood cells before an open surgical procedure. Any patient who received preoperative antibiotics was not included in the study. For all of the patients, gram-stain examination of smears, evaluation of a culture of material from the operative site, and histological examination were done. The patients were divided into two groups. Group I was composed of twenty-four patients, each of whom had a prosthesis in place and complained of pain. Group II was composed of twenty-six patients for whom a diagnosis of chronic osteomyelitis had to be considered. With the indium scans alone, there was only one false-negative result (in Group II), but there were eighteen false-positive results (eight patients in Group II and ten patients in Group I). Although scintigraphy with indium-labeled white blood cells is quite sensitive, it is not specific in detecting chronic osteomyelitis; a negative scan should be considered highly suggestive that osteomyelitis is not present. Specificity can be increased by interpreting the indium scan in conjunction with the technetium scan.
MR appearance of fibroxanthoma.
Magnetic resonance images of nine patients with 10 fibroxanthomas of bone were retrospectively reviewed. Eight of 10 lesions were characterized by a markedly decreased signal of both T1- and T2-weighted pulse sequences. This pattern of decreased signal intensities, when present, proved distinctive and has not been observed in other nonossified primary bone lesions. Possible etiologies for this observation are discussed.
Intramuscular myxoma: MR features.
Intramuscular myxoma is a benign mesenchymal lesion consisting of bland spindled cells embedded in an avascular myxoid stroma. On CT, intramuscular myxoma presents as a well-demarcated, homogeneous, low density mass situated within skeletal muscle. The attenuation of the lesion is slightly greater than water but less than that of the surrounding normal muscle, with typical values between +10 and +60 HU. There is scant magnetic resonance (MR) literature on the appearance of intramuscular myxoma; the few MR spin echo images that have been published characterize it as a homogeneous mass with signal intensity less than or equal to skeletal muscle on T1-weighted and brighter than fat on T2-weighted pulse sequences. We present two cases of intramuscular myxoma with imaging characteristics that differ from those previously reported.
MR appearance of fibrous dysplasia.
Magnetic resonance (MR) imaging is utilized in diverse clinical circumstances for evaluation of the musculoskeletal system. Consequently, common benign skeletal lesions may be detected incidentally following MR scan obtained for unrelated reasons. The spectrum of MR appearances of fibrous dysplasia has not been previously reported. We retrospectively reviewed all radiologic images (including the MR scans) of 11 sites of fibrous dysplasia encountered in seven patients. On MR, the fibrous dysplastic lesion causes an "expanded" bony contour and is characterized by decreased signal on T1-weighted image. The signal on T2-weighted MR scan is variable, however. Since fibrous dysplasia is a (relatively) common skeletal lesion that can be encountered incidentally, all radiologists should be familiar with its MR appearance. Furthermore, in the unlikely possibility of surgical intervention, MR is useful in determining the extent of disease within the affected bone and planning the preoperative strategy.