Biomedical subjects
Publications and source records attributed to P L Munk.
Candida osteomyelitis is an uncommon complication of immunosuppressive therapy. Its radiographic manifestations are similar to those of other relatively indolent infectious agents. We report the CT and MR findings in a patient who developed this condition following treatment for acute myelogenous leukemia, and review the imaging literature covering similar cases.
OBJECTIVE: To determine whether enchondromas and chondrosarcomas can be differentiated on the basis of peritumoral MR signal abnormality. DESIGN: STIR and T2-weighted MRI images were retrospectively assessed for the presence and extent of abnormal peritumoral marrow and soft-tissue signal. The cause of the peritumoral signal abnormality was determined by histologic correlation with resection specimens. The presence or absence of bone destruction was noted. PATIENTS: Twenty-three patients were studied: ten with enchondromas (three men, seven women; ages 33-73 years) and 13 with chondrosarcomas (seven men, six women; ages 25-88 years). RESULTS: Abnormal peritumoral marrow signal was present on STIR images around none of 10 enchondromas and all of 13 chondrosarcomas (P < 0.0001). The marrow signal abnormality corresponded histologically to fine marrow fibrosis in all cases. Adjacent abnormal soft-tissue signal was present on STIR images around none of ten enchondromas and eight (62%) of 13 chondrosarcomas (P = 0.0026). Abnormal soft-tissue signal was more common around high-grade than low-grade chondrosarcomas (100% vs 38%, P = 0.028), and was more extensive (mean extent 28 mm vs 8 mm; P > 0.04). In the subset of tumors without bone destruction, peritumoral marrow signal abnormality was present around none of ten enchondromas and all of five chondrosarcomas (P = 0.0003); abnormal soft-tissue signal was present around none of ten enchondromas and two of five chondrosarcomas (P > 0.05). CONCLUSION: Abnormal marrow or soft-tissue signal around a chondroid tumor is suggestive of chondrosarcoma, even in the absence of bone destruction. STIR images are necessary for adequate detection of peritumoral signal abnormalities.
The authors report a case of metastatic breast carcinoma that on investigation was shown to have a negative bone scan in spite of multiple densely sclerotic metastases on radiography and CT and a positive bone biopsy. The literature is reviewed with regard to the subject of negative bone scans in this situation.
This report describes and discusses the clinical, MRI, and pathologic findings in a case of synovial sarcoma arising within a peripheral nerve. Intraneural origin of synovial sarcoma is very unusual, and the MR imaging appearance of this condition has not been previously reported. MR imaging was valuable, as it showed the intraneural location and extent of the tumor, but it did not allow a specific histologic diagnosis.
Extraskeletal osteosarcomas are rare tumors, and the telangiectatic variety is the least common histological variety in this group. This report describes the clinical and MR imaging findings in two cases arising in the pretibial soft tissues. Both tumors demonstrated marked inhomogeneity with T2-weighted spin echo and STIR sequences. One of the tumors revealed numerous fluid levels within the lesion. A review of the MRI features of these tumors is provided. Osteosarcoma with telangiectatic features should be considered in the differential diagnosis of a soft tissue mass with fluid-fluid levels in patients 40 years of age or older.
Many techniques and pulse sequences have been devised for the assessment of the anterior cruclate ligament. The present study compares fast spin echo (FSE) imaging to conventional spin echo imaging at a field strength of 1.5 T in an effort to determine if these sequences are diagnostically equivalent. Where available, arthroscopy was also done. A total of 52 patients were imaged using both FSE and conventional spin echo sequences. Eight volunteers were used as controls. Arthroscopy was performed on 10 patients. The anterior cruciate ligament was assessed in a blinded fashion by three radiologists. The Kappa statistic was then used to determine the percentage agreement between FSE and conventional spin echo imaging. Fast spin echo sequencing demonstrated a sensitivity of 100%, a specificity of 94.8% and an accuracy of 96.3% when compared to arthroscopy. Conventional spin echo imaging and arthroscopy had a sensitivity of 100%, specificity of 84.6% and an accuracy of 88.9%. The remaining 34 patients who did not undergo arthroscopy were followed clinically because clinical and imaging findings were not suggestive of ACL tears. These demonstrated 72% agreement between FSE and conventional spin echo imaging using the Kappa statistic, with regards to calling ACL normal or having only a low-grade partial tear. Fast spin echo imaging produces images of the anterior cruciate ligament that have similar diagnostic accuracy to conventional spin echo images (P < 0.05) within a much shorter scan time. These results however, require further validation in a larger group, preferably with arthroscopic correlation.
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Long-term gastrostomy tubes have a well-accepted role in providing nutritional support. Traditionally they have been placed by surgeons and by endoscopists. In the last decade, radiologists have come to play a major role in the placement of gastrostomy and gastrojejunostomy devices, and can usually do so as effectively and at lesser expense. A technique for placement is outlined, with a discussion of patient selection and complications. A review of the literature is provided.
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Chondroid lipoma is a recently described benign tumor of adipose origin which, pathologically, mimics myxoid liposarcoma and myxoid chondrosarcoma. This tumor typically presents as a well-defined mass in the superficial tissues of the extremities. In this report, we present the magnetic resonance imaging (MRI) appearances of a pathologically proven chondroid lipoma. To our knowledge, this is the first report of any imaging findings associated with this tumor.
Osteosarcomas arising in irradiated tissues are uncommon but important complications of radiotherapy. Radiation-induced osteosarcomas generally occur 3-30 years after exposure and are most common after radiotherapy for cervical or breast carcinoma. These tumors are usually rapidly growing, extremely painful, and histologically high grade. In this paper, we report two cases of high-grade post-radiation osteosarcoma of the scapula. Despite being almost identical radiologically and pathologically, one case had a typical clinical presentation whereas the second case had two unusual features, being non-painful and arising in a field initially irradiated for bronchogenic carcinoma.
The authors describe a 66 year old woman with small-cell carcinoma of the oesophagus who developed a perforation following chemotherapy. Small-cell carcinoma of the oesophagus is a rare neoplasm, varying in appearance from a small mucosal lesion to a larger fungating mass, which in our patient presented as a bulky soft-tissue mass causing stricture. Pleural fluid collections which developed via a spontaneous oesophageal-pleural fistula were subsequently drained using percutaneously placed catheters. Radiologic management of this condition provided a successful and cost-effective means of patient care.
OBJECTIVE: The purpose of this study was to design and use an algorithm for selection of the most appropriate biopsy technique. MATERIALS AND METHODS: An algorithm was designed to maximize the tissue sampling and diagnostic accuracy of musculoskeletal tumor biopsy. We used fine-needle aspiration to sample small ( < 3 cm) soft-tissue masses, an 18-gauge automated Biopty Gun to sample large ( > 3 cm) soft-tissue masses, a bone-cutting core biopsy needle to sample sclerotic bone tumors, and a combination technique to sample lytic bone tumors with an intact bony shell. We reviewed the results of 46 consecutive biopsies obtained with this algorithm. RESULTS: The overall diagnostic accuracy was 96%, with one inadequate biopsy and one inaccurate biopsy. The diagnostic accuracies within subgroups of tumor types were: primary malignant tumors (n = 15), 93%; primary benign tumors (n = 9), 100%; secondary malignant tumors (n = 11), 100%; secondary benign tumors (n = 8), 88%; and infections (n = 3), 100%. CONCLUSION: This algorithm allows selection of the biopsy procedure most likely to safely provide adequate and accurate biopsy samples.
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