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M D Murphey

Publications and source records attributed to M D Murphey.

At least 19 recordsLinked to original sources
PubMed1999

Muscle infarction in patients with diabetes mellitus: MR imaging findings.

PURPOSE: To describe the magnetic resonance (MR) imaging findings in diabetic patients with muscle infarction and to describe commonly associated clinical features. MATERIALS AND METHODS: The MR imaging studies of 21 patients with diabetic muscle infarction were reviewed retrospectively. Of the 21 patients, 12 were women, and nine were men; the mean age was 48 years (range, 30-77 years). RESULTS: Eight patients had bilateral lower-extremity involvement; six had involvement confined to the right lower extremity and seven to the left. The thigh was involved in 17 patients (81%). One or more of the musculi vastus, the most frequently affected muscle group, were affected in 16 patients (76%). Four patients (19%) had isolated calf involvement. MR imaging studies showed diffuse enlargement of involved muscle groups and partial loss of normal fatty intermuscular septa. MR imaging also allowed identification of areas of subfascial fluid in 16 patients (76%) and subcutaneous edema in 19 patients (90%). MR imaging showed involved muscle groups best with T2-weighted, inversion-recovery, and gadolinium-enhanced sequences, where the infarcted muscles appeared diffusely hyperintense compared with adjacent muscles. Comparison of T2-weighted and gadolinium-enhanced MR images of nine patients showed enlarged, enhancing muscles in all patients and small, focal, rim-enhancing fluid collections in six of nine patients (66%). CONCLUSION: Diabetic muscle infarction is suggested in diabetic patients with sudden onset of severe pain in the thigh or calf muscles who have MR imaging findings of diffuse edema and swelling of multiple thigh and calf muscles (often in more than one compartment).

Diabetes Mellitus, Type 1↗
PubMed1998

Subcutaneous granuloma annulare: radiologic appearance.

OBJECTIVE: Granuloma annulare is an uncommon benign inflammatory dermatosis characterized by the formation of dermal papules with a tendency to form rings. There are several clinically distinct forms. The subcutaneous form is the most frequently encountered by radiologists, with the lesion presenting as a superficial mass. There are only a few scattered reports of the imaging appearance of this entity in the literature. We report the radiologic appearance of five cases of subcutaneous granuloma annulare. DESIGN AND PATIENTS: The radiologic images of five patients (three male, two female) with subcutaneous granuloma annulare were retrospectively studied. Mean patient age was 6.4 years (range, 2-13 years). The lesions occurred in the lower leg (two), foot, forearm, and hand. MR images were available for all lesions, gadolinium-enhanced imaging in three cases, radiographs in four, and bone scintigraphy in one. RESULTS: Radiographs showed unmineralized nodular masses localized to the subcutaneous adipose tissue. The size range, in greatest dimension on imaging studies, was 1-4 cm. MR images show a mass with relatively decreased signal intensity on all pulse sequences, with variable but generally relatively well defined margins. There was extensive diffuse enhancement following gadolinium administration. CONCLUSION: The radiologic appearance of subcutaneous granuloma annulare is characteristic, typically demonstrating a nodular soft-tissue mass involving the subcutaneous adipose tissue. MR images show a mass with relatively decreased signal intensity on all pulse sequences and variable but generally well defined margins. There is extensive diffuse enhancement following gadolinium administration. Radiographs show a soft-tissue mass or soft-tissue swelling without evidence of bone involvement or mineralization. This radiologic appearance in a young individual is highly suggestive of subcutaneous granuloma annulare.

Adipose Tissue↗
PubMed1998

Osteoblastoma of the foot and ankle.

A total of 329 patients with osteoblastoma were retrospectively reviewed from the archives of the Armed Forces Institute of Pathology, of which 41 (12.5%) presented with tumors in the foot and ankle. This was the third most common site of disease after the spine and femur. Overall, the mean age was 22.5 years, which was the same for the foot and ankle subset of patients; however, there was a significant male predominance in foot and ankle patients compared with the whole group. The majority of patients were skeletally mature (85.4%). Clinically, most patients presented with pain (97.2%), although one-third of the total related a history of antecedent trauma. The interval between the onset of symptoms and biopsy was 84 days (range, 0-572 days). Radiographically, the majority of lesions were in the hindfoot (N = 18; 44%) of which 16 of 18 tumors (89%) were in the talus. Of these, one-half were subperiosteal and dorsally based and were associated with osseous tumor matrix and a soft tissue mass. Two osteoblastomas, both in the metatarsals, transitioned into sarcomas; the rest were histologically benign. For diagnostic purposes, it was essential to obtain clinical, radiographic, and histologic correlation.

Adolescent↗
PubMed1997

Computed radiography in musculoskeletal imaging.

In conclusion, CR offers many advantages in comparison with conventional radiography. Musculoskeletal radiology particularly benefits from the wide dynamic range and image-processing capabilities of CR. Most studies have not shown a statistically significant difference in observer performance (diagnostic accuracy) of CR in comparison with conventional radiography in musculoskeletal applications. In addition, dose reduction in the range of 25% to 50% is possible with many musculoskeletal images. However, disadvantages are also apparent and include reduced spatial resolution, increased noise, and change in image size and format. Overall, the advantages of CR and digital technology outweigh its limitations and for these reasons continue to promote the conversion from conventional radiography.

Adult↗
PubMed1997

The use of gadolinium in the MR evaluation of soft tissue tumors.

MRI has emerged as the preferred modality for the imaging evaluation of musculoskeletal tumors. Although there is general agreement on the value of MR in detection, diagnosis and staging, the use of intravenous contrast in the evaluation of soft-tissue tumors and tumor-like masses remains controversial. The purpose of this review is to highlight these controversies, to put them in perspective, and to make recommendations for the use of gadolinium-enhanced imaging. The following specific areas will be addressed: (1) general considerations in the evaluation of soft tissue tumors, (2) added specificity in diagnosis, (3) response to chemotherapy, (4) evaluation for local recurrence after surgery and/or radiation therapy, and (5) selection of biopsy site.

Adolescent↗
PubMed1997

Chondroblastoma of the foot.

A total of 322 cases of chondroblastoma were referred to the Armed Forces Institute of Pathology between 1960 and 1990. Ten additional cases of chondroblastoma were treated at Walter Reed Army Medical Center between 1985 and 1993. Forty-two of these involved the foot, two of which were treated at Walter Reed Army Medical Center. Patients with chondroblastoma of the foot were male in 35 (81%) cases, with a mean age of 25.5 years, which was significantly different from the mean age of 17.3 years in patients with chondroblastoma of the long bones (P < 0.0001). Chondroblastoma of the foot is most commonly found in the posterior subchondral areas of the talus and calcaneus as well as in the calcaneal apophysis. Radiographically, the lesion was associated with an articular surface or apophyseal area in all cases and appeared radiolucent, with little to no matrix production. The margins were generally well defined. Cystic features were noted grossly and histologically in 24 (57%) specimens, a feature seen in only 21% of all chondroblastomas overall. Treatment consists of thorough curetting and bone grafting with good oncologic and functional results.

Adolescent↗
PubMed1996

From the archives of the AFIP. Primary tumors of the spine: radiologic pathologic correlation.

Primary tumors of the spine are relatively infrequent lesions compared with metastatic disease, multiple myeloma, and lymphoma. However, when a solitary lesion of the spine occurs, these neoplasms represent an important group of entities for diagnostic consideration. A wide variety of benign neoplasms can involve the spine, including osteoid osteoma, osteoblastoma, aneurysmal bone cyst, giant cell tumor, enostosis, and osteochondroma. Common primary nonlymphoproliferative malignant neoplasms of the spine include chordoma, chondrosarcoma, Ewing sarcoma or primitive neuroectodermal tumor, and osteosarcoma. The imaging features of these lesions of the spine are often characteristic. These changes include a small sclerotic focus with irregular thorny margins in the vertebral body (enostosis), a small radiolucent nidus with central calcification in the posterior elements of the vertebral body (osteoid osteoma), a large expansile lesion with multiple fluid-fluid levels (aneurysmal bone cyst), and an aggressive mineralized mass (chondroid or osteoid) with osseous and soft-tissue involvement (chondrosarcoma or osteosarcoma). Radiologists should be aware of the appearance of these unusual neoplasms in order to provide a complete differential diagnosis and to guide clinical colleagues in patient treatment.

Adolescent↗
PubMed1996

Parosteal osteosarcoma: value of MR imaging and CT in the prediction of histologic grade.

PURPOSE: To evaluate the use of magnetic resonance (MR) imaging and computed tomography (CT) for predicting the histologic grade of parosteal osteosarcomas. MATERIALS AND METHODS: Sixty parosteal osteosarcomas were analyzed for tumor size and location, presence of a cleavage plane, intramedullary extension, soft-tissue mass (distinct from ossified mass), and the presence and pattern of ossification. Axial and longitudinal views were evaluated for specific osseous sites within the bone. Tumors were classified as low grade (grade 1) or high grade (grades 2-3). RESULTS: There were 32 low-grade lesions and 28 high-grade lesions. Average maximal lengths of low- and high-grade tumors were 7.7 and 15.0 cm, respectively. A cleavage plane was present in 20 (62%) low-grade and 19 (68%) high-grade lesions. On cross-sectional images, intramedullary extension was present in 13 (41%) low-grade and 14 (50%) high-grade lesions. A focal soft-tissue mass distinct from the ossific matrix was identified in 25 (89%) high-grade lesions and in only two (6%) low-grade lesions. All 17 high-grade lesions evaluated with MR imaging were of predominantly high signal intensity on T2-weighted images. CONCLUSION: A poorly defined soft-tissue component distinct from the ossific matrix is the most distinctive feature of high-grade parosteal osteosarcoma and may be an optimal site for biopsy.

Adolescent↗
PubMed1995

Measurement of radiographic changes in adjuvant-induced arthritis in rats by quantitative image analysis.

OBJECTIVE: To apply quantitative analytical methods to the evaluation of radiographic images in experimental arthritis. METHODS: Adjuvant was used to induce arthritis in rats. Arthritis progression was followed by conventional methods. In addition, digitized images of radiographs of the calcaneus were examined for changes in the mean and in the distribution pattern of gray values. Periosteal new bone formation was measured as an increase in image area of the calcaneus. RESULTS: Significant changes in the gray value profile and increases in periosteal bone formation occurred in arthritic rats. More extensive changes occurred in Lewis rats than in Sprague-Dawley rats. Analysis of serial radiographs revealed an initial decrease in the density of juxtaarticular bone, followed by progressive increases in gray value variation due to concurrent bone loss and bone formation. Eventually, bone formation in arthritic rats resulted in increased gray values above those in nonarthritic rats. CONCLUSION: Image analysis represents a sensitive, quantitative method for detecting radiographic changes in experimental arthritis.

Animals↗
PubMed1995

From the archives of the AFIP. Musculoskeletal angiomatous lesions: radiologic-pathologic correlation.

Vascular lesions of bone and soft tissue are relatively common musculoskeletal neoplasms. Hemangioma is the most frequently encountered angiomatous lesion. Osseous hemangioma commonly involves the spine and calvaria and often has a characteristic radiographic appearance, with either coarsened trabeculae lying adjacent to the vascular channels or multifocal lytic areas creating a honeycomb pattern. Soft-tissue hemangioma is the most frequent soft-tissue neoplasm of infancy and childhood. Radiography and computed tomography (CT) may show phleboliths in cavernous soft-tissue hemangioma. The magnetic resonance (MR) imaging appearance, however, is often more distinctive, because fat overgrowth and serpentine vascular channels can be seen. Lymphangioma usually occurs in the neck and axillae of young children as a soft-tissue mass composed of large cavernous spaces and is well evaluated with CT, ultrasound, or MR imaging. Vascular lesions can also diffusely involve both bone and soft tissue in angiomatosis. A group of more aggressive vascular neoplasms, including hemangioendothelioma, hemangiopericytoma, and angiosarcoma, may have a nonspecific imaging appearance; however, the vascular pattern can be recognized in some cases, allowing radiologic diagnosis. Imaging is important throughout the evaluation of angiomatous lesions for detection, diagnosis, preoperative assessment, and treatment.

Adolescent↗
PubMed1995

Gas bubbles in the hip joint on CT: an indication of recent dislocation.

OBJECTIVE: The purpose of this study was to determine if gas bubbles in the hip joint seen on CT scans after trauma are reliable indicators of recent (< 48 hr) hip dislocation. We believe that the gas seen in the hip joint represents intracapsular nitrogen bubbles that result from the vacuum created by forcible distraction associated with traumatic dislocation. MATERIALS AND METHODS: CT scans of 79 consecutive patients with pelvic injury were reviewed retrospectively. We noted the number and position of intracapsular gas bubbles, presence of joint effusion, soft-tissue injury, and associated fractures or dislocations. Intracapsular gas bubbles were defined as round areas of low attenuation, in an intracapsular position, that on visual inspection were equivalent to air. Seventy-three of 79 patients were imaged within 48 hr of injury. Most patients had been involved in a motor vehicle collision or were pedestrians struck by a motor vehicle. Fifteen patients had hip dislocation, including one patient with bilateral dislocation. Fifty-five patients had pelvic fractures without hip dislocation, and nine patients had soft-tissue injury without fracture or dislocation. Fourteen of 16 dislocations had been reduced at the time of scanning. RESULTS: Gas bubbles were seen in the hip joint on CT scans in 13 (81%) of the 16 dislocated hips, including 12 (92%) of 13 dislocations in patients scanned within 4 hr of admission. Bubbles were present in 11 (79%) of 14 hip joints that had dislocations reduced at the time of scanning and in both hip joints that remained dislocated. Most bubbles were located anterior to the femoral neck; however, bubbles were also seen posteriorly. Bubble size (1-3 mm) and number (1-7) varied. Only two (3%) of 64 patients without dislocation had intracapsular gas bubbles; one had been shot and the other had extensive soft-tissue emphysema. CONCLUSION: In the absence of penetrating trauma, intracapsular gas bubbles on CT are reliable indicators of recent hip dislocation and may be the only objective finding of this injury.

Accidents, Traffic↗
PubMed1995

MR imaging of musculoskeletal tumors of the hand and wrist.

Musculoskeletal tumors of the hand and wrist are relatively uncommon. Yet, despite their overall rarity, certain bone and soft-tissue lesions have a predilection for this location. This article reviews the common musculoskeletal tumors of the hand and wrist. It is not intended as a comprehensive review but as an overview, emphasizing the use of MR imaging in the evaluation of these lesions and highlighting those diagnoses that may be suggested by MR imaging.

Adult↗
PubMed1994

Cysteine proteinase inhibitors decrease articular cartilage and bone destruction in chronic inflammatory arthritis.

OBJECTIVE: To determine the effects of peptidyl fluoromethyl ketones on the in vitro activity of purified cathepsins B and L, on tissue cysteine proteinase activity, and on cartilage and bone destruction in experimental arthritis. METHODS: The effects of the fluoroketones on cathepsins B and L in vitro and the effects of oral administration of fluoroketones on ex vivo cysteine proteinase activity in tissue homogenates were determined by measuring the inhibition of fluorogenic substrate cleavage. To determine the effects on arthritis, animals were injected with adjuvant or type II collagen, treated orally with the fluoroketones, and the severity of arthritis was assessed by clinical, histologic, and radiologic methods. RESULTS: All of the fluoroketones tested were potent inhibitors of purified cathepsins B and L activity. Oral administration of the fluoroketones reduced tissue cysteine proteinase activity by up to 77%. In addition, fluoroketone treatment significantly reduced the severity of clinical joint disease and decreased the destruction of articular cartilage and bone. Quantitative analysis of radiographic images indicated that treatment significantly reduced soft tissue changes, periosteal proliferation, and bone erosion, but only partially reduced juxtaarticular osteoporosis. CONCLUSION: These studies suggest that cysteine proteinase inhibitors may limit tissue destruction in diseases such as rheumatoid arthritis.

Animals↗
PubMed1994

From the archives of the AFIP. Musculoskeletal malignant fibrous histiocytoma: radiologic-pathologic correlation.

Malignant fibrous histiocytoma (MFH) is a pleomorphic sarcoma, occurring most frequently in the deep soft tissues of the extremities. Primary osseous MFH is less common. MFH is the most common soft-tissue sarcoma of late adult life. Although its imaging appearance is often nonspecific, any deep-seated invasive intramuscular mass in a patient over 50 years of age is most likely an MFH. Cortical involvement by soft-tissue MFH is common, and identification of this finding increases the likelihood of MFH. Prominent fluid components with peripheral nodular enhancement after contrast material administration and lack of adipose elements are suggestive of a specific histologic subtype, myxoid MFH. Osseous MFH shows aggressive bone destruction with cortical involvement and a soft-tissue mass and is located in the diaphysis or metaepiphysis. Lesions in the metaepiphysis may have a less aggressive appearance and do not extend to subchondral bone. Computed tomography and magnetic resonance imaging are vital for preoperative staging and surgical planning and in detecting early recurrence postoperatively.

Aged↗
PubMed1994

Distal chevron osteotomy with lateral release for treatment of hallux valgus deformity.

From 1986 to 1990, 42 feet in 30 patients had a combined chevron osteotomy and lateral release to correct their painful bunion deformity. Seventeen patients, 23 feet, were available for follow-up. The purpose of this study was to evaluate the outcome of this procedure and to determine the incidence of avascular necrosis. The patients were examined by an independent examiner, radiographs obtained, and questionnaires filled out. Avascular necrosis was determined using plain films read by a musculoskeletal radiologist who did not know the outcomes. The average age was 45 years at the time of the procedure. Average follow-up was 50 months. The preoperative intermetatarsal angle averaged 13 degrees and the hallux valgus angle averaged 31 degrees. At study follow-up, the intermetatarsal angle averaged 8 degrees and the hallux valgus angle averaged 17.5 degrees. The results were graded by the Mayo Clinic Forefoot Scoring System (75-point scale) and a subjective scoring system. Average postoperative Mayo Clinic score was 67. Fifteen feet were subjectively rated as excellent, six as good, and two as fair. Complications occurred in four feet. Hallux varus occurred in two feet, extension contracture in one foot, and an infection in one foot. None of the feet developed definite radiographic evidence of avascular necrosis. Distal chevron osteotomy combined with a lateral release for corrective bunion surgery has come under scrutiny, because of the risk of avascular necrosis of the first metatarsal head. However, our study showed no evidence of avascular necrosis on radiographs. In addition, 91% of patients had good to excellent results at an average 50-month follow-up.

Adult↗
PubMed1994

Parosteal lipoma: MR imaging characteristics.

OBJECTIVE: The purpose of this study was to determine the characteristics of parosteal lipomas on MR imaging. MATERIALS AND METHODS: We retrospectively reviewed the images and medical records of eight patients with surgically and pathologically confirmed parosteal lipomas. Radiologic studies performed included conventional radiography and MR imaging (n = 8), CT (n = 7), conventional tomography (n = 2), and scintigraphy (n = 5). RESULTS: Osseous reaction was present in all cases, manifesting as either mild cortical thickening best seen on magnification radiographs or larger osseous excrescences seen on all radiologic images. These osseous reactions were surrounded by the lipomatous component of the neoplasm and created a firm attachment of the neoplasm to the underlying bone. The lipomatous component showed typical features of adipose tissue on all images and was usually seen on radiographs (n = 7). However, CT or MR imaging was needed to determine the anatomic location and relationship to surrounding structures before surgery. MR imaging was considered superior to CT for preoperative assessment, primarily because of its multiplanar imaging capability. In addition, cartilage and fibrous tissue (n = 3) were identified adjacent to larger osseous excrescences. Associated muscle atrophy in three cases was caused by nerve impingement. These manifestations of parosteal lipoma were also better assessed with MR images because of improved contrast resolution. The distribution of muscle atrophy could be used to determine the site of nerve involvement preoperatively. CONCLUSION: We conclude that MR imaging is the most useful adjunct to conventional radiography in the presurgical evaluation of parosteal lipomas because of its multiplanar imaging capabilities and improved contrast resolution for detecting muscle atrophy and site of nerve involvement when present. These factors are important for preoperative assessment to help guide surgical intervention.

Adolescent↗
PubMed1994

Subcapital fractures of the femoral neck: prevalence and cause of radiographic appearance simulating pathologic fracture.

OBJECTIVE: Subcapital fractures of the femoral neck are common in elderly persons who have osteoporosis. Occasionally, radiographs of the hip in these patients show a radiolucency in the superolateral, subcapital region of the femoral neck that mimics the features of a pathologic fracture. Our purpose was to determine the prevalence of this finding and the anatomic variations of fracture alignment that cause this appearance. MATERIALS AND METHODS: All subcapital nonpathologic hip fractures (n = 111) that occurred at our institution during a 5-year period were reviewed. Radiographs were available in 100 of these cases. Review of intraoperative biopsy specimens, available in 69 patients, revealed no evidence of neoplasm in any case. In the other patients, follow-up radiographs, clinical evaluation, and pathology reports were used to exclude neoplastic involvement. Preoperative radiographs were analyzed for the presence of findings suggesting a pathologic fracture. Fracture configuration was classified by using the Garden staging system. Cadaveric femurs (n = 6) were fractured and studied radiographically. RESULTS: Seventeen (17%) of the 100 subcapital fractures had a radiographic appearance similar to that of a pathologic fracture. This finding occurred only with Garden stage III fractures (n = 7, 32% of Garden stage III fractures) or Garden stage IV fractures (n = 10, 24% of Garden stage IV fractures). Study of the cadaveric femoral specimens showed that the radiographic appearance simulating a pathologic fracture was primarily caused by external rotation of the distal fracture fragment and was accentuated by displacement between fracture fragments. CONCLUSION: The radiographic appearance of subcapital fractures of the femoral neck unrelated to neoplasm is often similar to that of pathologic fractures. This appearance is caused primarily by rotation of the fracture fragments, and the finding is accentuated by displacement. Recognition of the appearance of subcapital hip fractures mimicking pathologic fractures and knowledge of the cause of this finding are important for prescribing appropriate treatment.

Adolescent↗