Biomedical subjects
Publications and source records attributed to S Eustace.
MR Imaging has altered radically the detection, characterization, and the staging of bone tumors. This article reviews MR imaging techniques and appearances of benign and malignant bone tumors that are encountered in the cervical spine.
OBJECTIVE: This study was undertaken to determine the contribution of meniscal extrusion and cartilage loss to joint space narrowing on conventional radiographs by correlation with magnetic resonance imaging (MRI). SUBJECTS AND METHODS: Sixty-two consecutive patients, 32 patients with osteoarthritis and 30 without osteoarthritis, over the age of 60 years that were referred for both radiographic and MRI of the knee were included in the study. In each case, relative joint space narrowing on conventional AP radiographs was assessed utilizing the Kellgren-Lawrence scoring system. Subsequently, the degree of meniscal extrusion and the integrity of articular cartilage were evaluated from MR in the same patients. RESULTS: Each of 30 patients with normal joint space (Kellgren Grade 0) were noted to have normal articular cartilage, grade 1 meniscal extrusion was identified in only three of these patients. In comparison, meniscal extrusion was identified in all 32 patients with joint space narrowing (Kellgren Grades 1-4). Definite thinning or loss of articular cartilage was identified in only 15 of the 32 cases. In 17 patients with radiographic joint space narrowing (Kellgren Grades 1-3) and meniscal extrusion, no loss of articular cartilage was observed. A statistically significant correlation (P<0.001) was observed between Kellgren Grade and degree of meniscal extrusion and cartilage thinning on MRI. CONCLUSION: Conventional radiographs are an unreliable method of evaluating for articular cartilage loss in patients with early osteoarthritis. Initial joint space narrowing on conventional radiographs is secondary to meniscal extrusion rather than thinning of articular cartilage in most cases.
Fast MR imaging protocols pave the way for more widespread use of MR imaging to evaluate emergency room trauma patients. This article reviews technical developments and protocols facilitating rapid imaging, conventional applications of MR imaging to evaluate soft tissue injuries, and newer applications in which MR imaging is used to image both axial and appendicular fractures.
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Explore the source record for details and available documents.
STUDY DESIGN: The authors assessed degenerative lumbar displacement in a population-based cohort of 217 men and 400 women who had lateral lumbar radiographs performed at the mean age of 54 years and again at 79 years, and who had completed interviews on back symptoms and functional performance in connection with the follow-up examination. OBJECTIVES: To assess the prevalence and incidence of degenerative slippage and its association with back pain and physical disability. SUMMARY OF BACKGROUND DATA: Degenerative displacement of lumbar vertebrae may cause instability, nerve root compression, and spinal stenosis. Its incidence in the older population and association with back pain and disability are unknown. METHODS: The authors assessed the prevalence and incidence of degenerative slippage from lateral lumbar radiographs performed 25 years apart and its association with back pain and physical disability from interviews performed in connection with the follow-up examination. RESULTS: At the follow-up examination, 23 (12%) men and 100 (25%) women had developed degenerative slippage exceeding 3 mm; two of them had this already at the baseline. A forward displacement was found in 8 men and 76 women (P < 0.0001 for difference between the genders) and a backward one in 16 men and 35 women. On average, forward slip was 18% +/- 5.5, and backward slip, 15% +/- 4.0 of the anteroposterior diameter of the vertebra below. At the time of the second lumbar radiograph, 39 (32%) of the subjects with slippage, compared with 90 (19%) of the controls, had pain, aching, or stiffness in their back on most days (P = 0.001). After adjustment for endplate sclerosis, which was also related to pain (P = 0.015), slippage still had association with daily back symptoms (P = 0.009). However, subjects with slippage had not experienced more back symptoms during the preceding year or in earlier ages of life, and they did not report more disability than the controls. CONCLUSIONS: Degenerative displacement of lumbar vertebrae is common in an older population and is associated with increased prevalence of daily back symptoms. However, two thirds of the subjects with degenerative displacement do not report ongoing back symptoms, and the disorder is also unrelated to long-term back pain and physical disability.
The bicipito-radial bursa, which lies at the biceps tendon insertion on the radial tuberosity, is a rare site of chronic bursitis. We describe the clinical, radiological, and pathological findings in a case complicated by multiple rice body formation. In so doing, we describe MR appearances that allow discrimination of this entity from both synovial chondromatosis and pigmented villonodular synovitis.
OBJECTIVE: To compare the evaluation of fractures of the distal radius with MRI and conventional radiographs. To demonstrate the ability of MRI to detect unsuspected soft tissue derangement accompanying this common injury. DESIGN AND PATIENTS: Twenty-one consecutive inpatients admitted following fracture of the distal radius underwent preoperative evaluation with both conventional radiographs and MRI. In each case, analysis was made of both the osseous and soft tissue injury. MRI findings were compared with those identified on conventional radiographs and at subsequent surgical fixation. RESULTS: Of 21 patients with fractures of the distal radius, 20 had extension to the radiocarpal articulation, 14 had distal radio-ulnar joint extension and 5 had avulsion of the ulnar styloid. Occult carpal bone fractures accompanying fracture of the distal radius were identified in two patients: one of the capitate and the other of the second metacarpal base. Ten patients (48%) had associated soft tissue injury: six patients had scapholunate ligament rupture, two patients had disruption of the triangular fibrocartilage, one patient had extensor carpi ulnaris tenosynovitis and one patient had a tear of a dorsal radiocarpal ligament. Of five patients with ulnar styloid avulsions, none had evidence of triangular fibrocartilage tears. CONCLUSION: MRI affords better evaluation of osseous injury accompanying distal radial fractures than conventional radiographs. Intra-articular soft tissue injury accompanies distal radial fractures in almost 50% of cases. Scapholunate ligament disruption commonly accompanies intraarticular fracture through the lunate facet of the distal radius. Fracture of the ulnar styloid is infrequently associated with tear of the triangular fibrocartilage.
PURPOSE: To evaluate pediatric growth plate injuries with conventional radiographs and magnetic resonance imaging (MRI). To review potential clinical impact of MRI on subsequent patient management and outcome. METHODS: Fourteen patients with known or suspected growth plate injury were studied. Each patient underwent imaging by conventional radiography and MRI within 2 weeks of injury. Findings on conventional radiographs and on MR images were compared and then correlated with subsequent management and outcome at a mean of 12 months. RESULTS: Direct visualization of cartilage afforded by MRI improved evaluation of growth plate injury in each case. MRI changed Salter Harris classification or staging in 2 of 9 patients with fractures visualized on conventional radiographs, allowed the detection of radiographically occult fractures in 5 of 14 cases, and resulted in a physical change in management in 5 of the 14 patients studied. CONCLUSION: MRI has an important role in the evaluation of acute pediatric growth plate injury, particularly when diagnostic uncertainty persists following the evaluation of conventional radiographs. MRI allows detection of occult fractures, may alter Salter Harris staging, and in the reported study it frequently resulted in a change in patient management.
This study was undertaken to describe 'isolated' osteoarthritis of the scaphotrapeziotrapezoid articulation in six patients with chronic scapholunate ligament disruption. Each patient included for study had scapholunate ligament disruption with secondary dorsal intercalated segmental instability. Secondary volar tilt of the scaphoid appeared to be limited in each case by impaction and development of osteoarthritis at the scaphotrapeziotrapezoid articulation. Isolated osteoarthritis at the scaphotrapeziotrapezoid articulation may accompany chronic scapholunate ligament disruption, its identification should trigger a search for associated scapholunate ligament disruption in the absence of a known systemic arthropathy.
We describe computed tomography (CT)-guided percutaneous anterior cruciate ligament (ACL) ganglion cyst aspiration in three patients. In so doing, we review clinical technique, patient outcomes and discuss advantages of radiologically guided intervention relative to traditional surgical incision and drainage.
This article reviews contemporary evaluation of hip prostheses, emphasizing both the accepted use of conventional radiographs, arthrograms, and scintigraphy, as well as the evolving use of CT and MR imaging in evaluating suspected complications. Developments in CT postprocessing and MR pulse sequence design now allow successful imaging of soft tissues adjacent to hardware components.
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We present a patient with a distinctive lesion of the skull base, which, at imaging, showed expansile destruction of the sphenoid bone, hemorrhage with fluid-fluid levels, and contrast enhancement of a solid portion. These features ordinarily suggest either giant cell tumor or aneurysmal bone cyst; however, pathologic examination confirmed instead a rare variant of osteosarcoma of the telangiectatic type. Although imaging findings can indicate any of these possibilities, biopsy is an essential step in arriving at the diagnosis.
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This article demonstrates and compares imaging of orthopaedic hardware (fixation plates, screws, Kischner wire and prostheses) using gradient-echo, spin-echo and fast spin-echo sequences. It describes simple techniques which minimize susceptibility artefact induced by these components at magnetic resonance (MR) imaging, allowing visualization of adjacent soft tissues. The article emphasizes the importance of selecting the appropriate imaging plane in order to avoid hardware distortion of slice select gradients, emphasizes the importance of selecting frequency encoding gradient axes in order to orientate the long axis of the artefact away from the tissue of interest and, finally, compares the marked susceptibility artefact observed adjacent to hardware using gradient-echo with the artefact reduction achieved by using fast spin-echo sequences.