Biomedical subjects
Publications and source records attributed to S Eustace.
This article reviews technique and clinical applications of whole body MR imaging as a diagnostic tool in cancer staging. In particular the article reviews its role as an alternative to scintigraphy (bone scan and PET) in staging skeletal spread of disease, its role in assessing total tumour burden, its role in multiple myeloma and finally its evolving non oncologic role predominantly assessing total body composition.
Bertolotti's syndrome is characterised by anomalous enlargement of the transverse process(es) of the most caudal lumbar vertebra which may articulate or fuse with the sacrum or ilium and cause isolated L4/5 disc disease. We analysed the elective MR scans of the lumbosacral spine of 769 consecutive patients with low back pain taken between July 2003 and November 2004. Of these 568 showed disc degeneration. Bertolotti's syndrome was present in 35 patients with a mean age of 32.7 years (15 to 60). This was a younger age than that of patients with multiple disc degeneration, single-level disease and isolated disc degeneration at the L4/5 level (p </= 0.05). The overall incidence of Bertolotti's syndrome in our study was 4.6% (35 of 769). It was present in 11.4% (20 patients) of the under-30 age group. Our findings suggest that Bertolotti's syndrome must form part of a list of differential diagnoses in the investigation of low back pain in young people.
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We report a patient with calf pain induced by sport and exercise, initially thought to represent compartment syndrome, in whom MRI and duplex ultrasound ultimately revealed cystic adventitial disease of the popliteal artery. Surgical de-roofing of the popliteal artery resulted in complete resolution of symptoms with return to sporting activities.
This study was undertaken to qualitatively and quantitatively compare fast MRI of hips with and without parallel imaging using SENSE (sensitivity encoding). 27 patients underwent MRI of the hips with coronal T1 turbo spin echo (TSE) (repetition time (TR) 500 ms, effective echo time (TEeff) 15 ms, Turbo Factor 4), coronal IR-TSE (TR 2000 ms, TEeff 30 ms, inversion time (TI) 160 ms, Turbo Factor 20) and axial T2 TSE (TR 3000 ms, TEeff 80 ms, Turbo Factor 20) weighted images acquired with and without SENSE with a reduction factor of 2. Conventional imaging was performed in 8 min and 36 s. Images acquired with SENSE were acquired in 5 min and 31 s without a discernible reduction in image quality or a significant quantitative reduction in image signal to noise ratio, contrast to noise ratio or edge enhancement.
PURPOSE: To describe magnetic resonance imaging (MRI) findings in patients with suspected Parsonage Turner syndrome and to emphasize the value of an additional whole body MR scan to improve specificity of this diagnosis. MATERIAL AND METHODS: Three patients with proven Parsonage Turner syndrome referred for conventional MRI of the shoulder girdle and additional whole body turboSTIR MRI were included for study. RESULTS: In each case, imaging revealed edema in the muscles of the shoulder girdle. Whole body turboSTIR MRI scan confirmed localized unilateral changes in each case improving specificity and confidence in the diagnosis of Parsonage Turner syndrome in each case. CONCLUSION: Whole body turboSTIR MR imaging is a useful diagnostic tool in the evaluation of patients with suspected Parsonage Turner syndrome. Inclusion of the brain, neck, brachial plexus, and extremity musculature at whole body imaging allows differentiation from polymyositis and elimination of additional causes of shoulder girdle pain and weakness including gross lesions in the brain, neck, and brachial plexus by a single non-invasive study.
The vascularity of the acetabular free fragment in Ganz osteotomies has remained a concern. This study aims to assess the role of MR imaging in the postoperative evaluation of Ganz osteotomies. Twenty patients (19 females, 1 male), average age 24 years (range, 12-36 years), had sequential magnetic resonance imaging studies of the pelvis at 6 weeks and 6 months following Ganz osteotomies. Normal healing with no evidence of periosteotomy edema was seen in 17 patients at 6 weeks. Three patients showed evidence of reduced vascularity. In two of these, there were focal changes suggestive of subclinical ischemia. The other had gross signal changes in the osteotomy fragment suggestive of diffuse ischemia. The patients with focal changes were asymptomatic and had normal 6-month scans. The patient with diffuse changes complained of persistent groin pain, which resolved after 4 months. The 6-month scan showed some persistent vascular changes. The scan at 1 year showed complete resolution. The study suggests that Ganz osteotomy has minimal effect on the vascularity of the acetabular free fragment.
The development of malignant lesions in the acetabulum can lead to painful and disabling bone destruction. Lytic metastases of the acetabulum are frequent, causing pathologic fractures, pain and disability. The literature is sparse in relation to the exact indications and technique for this procedure. Percutaneous injection of methylmethacrylate or ethanol may provide marked pain relief or bone strengthening in patients, with malignant acetabular destruction, who are unable to tolerate surgery. Injection of methylmethacrylate is usually indicated when the weight-bearing part of the acetabulum is involved. The goals of treatment are pain relief and mechanical strengthening of the acetabulum. Radiography and computed tomography must be performed prior to therapeutic percutaneous injection to assess the location and extent of the lytic process, the presence of cortical destruction or fracture, and the presence of soft-tissue involvement. We report a case of a 39-year-old woman with a secondary acetabular lesion, which was treated successfully with percutaneous acetabular cementoplasty. We describe a novel technique used to inject cement into the lesion, allowing for greater cement volume and pressurisation within the lesion.
PURPOSE: To determine whether a commercially available automated MR myelogram sequence improves the interpretation and diagnostic yield at MRI of the lumbar spine. MATERIAL AND METHODS: A total of 207 consecutive patients referred for MR examination of the lumbar spine for evaluation of low back pain or spinal radicular symptoms were included for study. All patients had initial imaging with sagittal T1-W and T2-W scans, followed by axial T2-W images. Subsequently an MR myelogram was acquired in each case in coronal, sagittal and oblique planes. MR myelogram images were evaluated initially and a diagnosis was established and recorded. Subsequently, a diagnosis was established by review of conventional images of the lumbar spine in sagittal and axial planes, in conjunction with the MR myelogram. The utility of the MR myelogram in establishing the diagnosis was graded on a 4-point scale, where grade 0 indicated that it contributed no additional information and grade 3 indicated that it was essential for diagnosis. Analysis of the additional value of myelography in patients with multilevel disease was made. RESULTS: Primary diagnoses were disc herniation in 69 cases (33%), degenerative disc disease in 51 cases (26%), spinal stenosis in 19 cases (9%), isolated lateral recess stenosis in 5 cases (2%), or other diagnoses, including facet degeneration in 48 cases (23%). Scans were normal in 15 cases (7%). MR myelography was graded as grade 0 in 151 cases (73%), grade 1 in 44 cases (21%) and grade 2 in 12 cases (6%). In no case was MR myelography essential for diagnosis (grade 3). In patients with multilevel disease (n=27), in 17 cases MR myelography was graded as grade 1 (63%) and in 8 cases grade 2 (30%). CONCLUSION: MR myelography when employed in routine practice was of limited value, assisting in establishing a diagnosis in a minority of cases (6%). The technique was of limited additional value in patients with multilevel pathology and to a lesser extent in patients with scoliosis, where it helped to establish the level most likely to account for pathology.
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Osteopathia striata is an asymptomatic autosomal dominant or sporadically inherited disorder that causes dense striations at sites of endochondral bone formation, with a predilection for the metaphyses of long bones. Melorheostosis is a mixed sclerosing dysplasia with disturbance of both endochondral and intramembranous ossification, in which disordered intramembranous ossification dominates. It presents typical radiological changes of cortical hyperostosis distributed along a sclerotome with variable associated cutaneous and clinical features. Overlap syndromes including one or more of these diseases are described. We report a 44-year-old man with both melorheostosis and osteopathia striata who presented with pain secondary to superimposed osteosarcoma. In reporting this case we discuss the relationship between sclerosing dysplasia and either coexisting or complicating sarcoma.
The purpose of this study was to evaluate whole-body magnetic resonance imaging (MRI) of cadavers as an adjunct to autopsy. Eight consecutive patients underwent both whole-body MRI and autopsy [either conventional (six), limited (one), or percutaneous (one)] within 24 hours of death. Comparison was made of major and minor abnormalities and predicted cause of death recorded by independent readers at both MRI and autopsy. Major discrepancies between the recorded primary cause of death at imaging and autopsy occurred in five (5) patients. These included a myocardial infarction found at autopsy alone, bowel infarction and portal venous gas found at MRI alone, and aortic dissection and occipital infarct found at MRI alone in a patient on whom only limited autopsy was performed. Postmortem MRI may represent a useful adjunct to autopsy, particularly in patients in whom autopsy is limited due to patient/family consent, inoculation risks, and ethnic doctrines.
Widespread use of MRI now allows the routine identification of previously unevaluated traumatic bone marrow oedema and haemorrhage. Similar marrow oedema is identified in patients with tumours, hyperaemia and medullary congestion. Patterns and extent of traumatic bone marrow oedema and haemorrhage are dictated by mechanism. Diffusion techniques may allow precise evaluation of severity of injury. Illustrative examples and discussion are presented. Eustace, S. (2001). Clinical Radiology56, 4-12.
STUDY DESIGN: Case report. OBJECTIVES: To report on the diagnosis and current treatment of a rare tumor about the cervical spine. SUMMARY OF BACKGROUND DATA: Extraskeletal Ewing's sarcoma (EES) is rare and has not been previously described about the cervical spine. We present a case of a 24-year-old man with a large mass in the posterior triangle of the neck extending through the vertebral foramens of the cervical vertebrae. This was identified as an extraskeletal Ewing's sarcoma. Traditional treatment paradigms have been associated with a poor prognosis. Since the recommendations of the Intergroup Rhabdomyosarcoma Study II study of multimodal chemotherapy and radiotherapy, this tumor has a significantly better prognosis. METHOD: Surgical debulking of the tumor was necessary to relieve cord compression. Histologic analysis was used to confirm both magnetic resonance imaging and computed tomography diagnosis. A chemoradiation therapy program was commenced in accordance with Intergroup Rhabdomyosarcoma Study II recommendations. RESULTS: Computed tomography and magnetic resonance imaging demonstrated a large lobulated mass extending through the exit foramens of C2/C3 and C3/C4. The mass was entirely extraskeletal and extradural. Histologic examination of the excised mass showed microscopy consistent with extraskeletal Ewing's sarcoma. After surgical debulking and chemoradiation, the patient made a complete recovery. CONCLUSION: A review of the literature confirms that extraskeletal Ewing's sarcoma is a rare tumor and particularly so in the region of the cervical spine. Early diagnosis and surgical debulking combined with current multimodality chemoradiation programs can produce a favorable outcome.
This study was undertaken to assess the utility of whole-body turbo short tau inversion recovery (STIR) magnetic resonance imaging (MRI) to detect metastases to liver, brain, and bone as a single examination in women with breast cancer. Seventeen patients with biopsy-proven breast cancer and suspected metastatic disease attending over a 12-month period referred for both conventional imaging and whole-body MRI were included in the study. Three patients were found to be free of metastases at both conventional and MR imaging. Appendicular or axial skeletal metastases were identified in 11 of 17 patients, with correlation between findings at whole-body MRI and scintigraphy in 15 of the 17 patients. Five patients had evidence of hepatic metastases on whole-body MRI, of which metastases were identified in only three patients at CT despite contrast enhancement. Four patients had brain abnormalities (metastases in three patients, meningioma in one patient) detected on both whole-body and dedicated brain MRI. Preliminary clinical experience suggests that turbo STIR whole-body MRI may represent a convenient and cost-effective method of total body screening for metastases in patients with breast carcinoma.
OBJECTIVE: This study was undertaken to analyse the diffusion characteristics of synovial fluid in degenerative and inflammatory arthropathies. DESIGN AND PATIENTS: Ten in vitro specimens of synovial fluid from patients with both degenerative and inflammatory arthropathy were studied at body temperature with a navigator-corrected spin echo diffusion sequence (B values 0-512 s/mm2), on a Philips 1.5-T Gyroscan. Subsequently synovial fluid from knee joint effusions of 25 patients (10 patients with osteoarthritis, 10 patients with effusions following trauma and 5 patients with effusions secondary to inflammatory arthritis) was evaluated with the same navigator-corrected spin echo diffusion sequence. RESULTS: Both in vitro and in vivo study demonstrated decreased diffusion in patients with effusions secondary to degenerative joint disease (less than 2.40 x 10(-5) cm2/s) relative to patients with effusions accompanying knee trauma (greater than 2.75 x 10(-5) cm2/s) and inflammatory arthritis (in vitro and in vivo greater than 3.00 x 10(-5) cm2/s). CONCLUSION: Synovial fluid in degenerative arthritis shows less diffusion or free water movement than synovial fluid in inflammatory arthritis. Diffusion characteristics of synovial fluid may be used to predict the nature of the underlying form of arthritis in patients presenting with knee joint effusions.
The ulnar nerve can be injured in the arm, forearm, and wrist. This report describes a 79-year-old woman who presented to the emergency department with acute lower extremity weakness and vertigo. Her medical history was significant for moderate to severe aortic stenosis, hypertension, and a remote intravascular thrombosis in the right forearm. The patient was diagnosed with a transient ischemic attack and was treated with anticoagulants. Three days after beginning anticoagulation therapy, she developed a diffuse intramuscular hemorrhage in the arm, which compromised predominantly ulnar fibers. The clinical, radiologic, and electrodiagnostic abnormalities are reviewed, and the possible etiologies of ulnar neuropathy are discussed. To our knowledge, this is the first report of ulnar neuropathy secondary to diffuse hemorrhage into the muscles of the arm.
OBJECTIVE: This study was undertaken to analyze diffusion characteristics of normal and posttraumatic bone marrow. MATERIALS AND METHODS: Fifty consecutive patients with knee pain underwent both conventional and diffusion-weighted MR imaging (b values, 0-980 sec/mm2). Diffusion maps derived from source data were analyzed on a workstation using region-of-interest techniques. Apparent diffusion values recorded in normal marrow were compared with values recorded in abnormal posttraumatic bone marrow (square centimeters per second). RESULTS: Normal bone marrow identified in 35 patients showed minimal diffusion, with a mean value of 0.15x10(-5) cm2/sec. Bone marrow in 15 patients sustaining direct traumatic injury (21 bone bruises) showed markedly increased diffusion, with a mean value of 0.8x10(-5) cm2/sec (range, 0.4-1.3 cm2/sec). CONCLUSION: Marrow injury after trauma with trabecular damage allows increased movement or diffusion of interstitial water relative to normal marrow. The magnitude of diffusion change appears to reflect the severity of marrow injury.