Radiologic case study. Patellar dislocation: medial retinacular tears, avulsion fractures, and osteochondral fragments.
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Biomedical subjects
Publications and source records attributed to H J Griffiths.
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Macrodystrophia lipomatosa is a rare form of gigantism involving an extremity consisting of predominately fibroadipose tissue. Radiographically, it appears as hypertrophy of soft tissues and bone. CT and MR scanning delineate the tissues involved and are virtually diagnostic, demonstrating the predominantly adipose component as well as the overgrowth of the bones, nerves, and vessels also involved.
Magnetic resonance (MR) images of 16 peripheral nerve tumors (14 patients) were correlated with histopathologic appearance. Thirteen patients had surgically proved neuro-fibromatosis. There were 10 neurofibromas, four schwannomas, and two neurofibrosarcomas. Seven of the 10 neurofibromas showed a target pattern of increased peripheral signal intensity and decreased central signal intensity on T2-weighted images. This pattern appeared to correspond to a distinctive zonal histologic appearance that was found only in the neurofibromas. This pattern was not seen on MR images of the other peripheral tumors.
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Fourteen patients with various synovial diseases were imaged using conventional radiographic techniques and MRI. We had five patients with synovial tumors, including two each with PVNS and synovial osteochondromatosis. We had five patients with infections and four patients with various other forms of arthritis. Although MRI was found to be a useful means to visualize the synovium, the findings were nonspecific except in the case of PVNS.
A review of Paget's disease produces few surprises; however, several good articles have recently been published on its appearance, on MR imaging, sarcomatous degeneration, and the disease-related occurrence of multicentric giant-cell tumors. One recent paper illustrated the possible progression of fibrous dysplasia occurring in the skull after adolescence, a finding that does not occur elsewhere. An excellent review article on the normal and abnormal calcaneus is reviewed, and two brief reports on skeletal angiomatosis are discussed. Condensing osteitis of the clavicle is well described in one article that proves it to be an entity distinct from chronic recurrent multifocal osteomyelitis of the clavicle seen in children. Finally, a number of articles on congenital spinal anomalies are reviewed.
Three patients with solitary osteochondromas which were increasing in size have been recently examined. Plain films were available on all patients; two patients had MR studies, and two had CT scans. In all three cases, malignant transformation of the osteochondroma was suspected from the cross-sectional imaging studies, but pathologic examination proved that these patients all had bursa formation without any evidence of malignancy. The incidence of this rare complication of solitary osteochondroma is discussed. Ultrasound is also recommended for the evaluation of enlarging solitary osteochondromas.
There are two theories concerning the origin of multifocal osteogenic sarcoma: In one, the lesions all arise synchronously as multiple, simultaneously appearing, primary tumors, and in the other, there appears to be one dominant site with early and rapidly progressive metastatic disease. We believe that our patient fits into the second group with a primary right (distal-end) femoral osteogenic sarcoma with early and rapid metastasis. Bone scan, chest CT, and MRI examinations played an essential role in the initial evaluation and follow-up of this patient with osteosarcomatosis. The multiple modalities also offered a greater sensitivity in the detection and for the surveillance of the progression of the condition.
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Interest continues in total joint replacement and its complications. Now that noncemented arthroplasties have been introduced, further radiographic signs are being elucidated. The roles of bone scanning and aspiration arthrography are also being reevaluated. Ultrasonography has become the imaging modality of choice in congenital hip dysplasia and is being used increasingly in the evaluation of other musculoskeletal conditions. The ilizarov distraction osteogenesis technique is also discussed and there has been increasing interest in anterior cruciate ligament reconstruction and its sequelae.
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The pelvic radiographs of 312 patients aged 18 to 92 years were reviewed to determine if the Singh index was valid or not. The cortical thickness of the lower part of the femoral calcar, the stress index (body weight, physical activity, and femoral neck angle), and the Singh Index (trabecular pattern of the femoral neck) were measured in each patient and correlated with each other and with the patient's age, sex, and dominant side. It was found that the Singh index correlates well with age but not with the cortical thickness or stress index. Thus, the Singh index is an unreliable measure of osteopenia, and we conclude that other methods should be used for screening patients with osteoporosis.
The scintigraphic findings of a patient with characteristic clinical, laboratory, and radiographic features of congenital lipodystrophy were studied. Bone scan showed uniform increased bone uptake of Tc-99m MDP with markedly enhanced peri-articular activity and very prominent renal activity. Liver-spleen scan showed marked hepatosplenomegaly. This combination of scintigraphic abnormalities is unique in congenital lipodystrophy and constitutes a very interesting constellation of findings. Observed scintigraphic findings are compatible with previously described radiographic findings.
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Arm muscle plus bone (M + B) cross-sectional area of the arm estimated from area circumference and skinfold thickness was compared with that estimated from CAT scans. The anthropometric technique overestimated M + B area, and the degree of overestimation varied directly with arm adiposity.