Biomedical subjects
Tudor Hughes
Publications and source records attributed to Tudor Hughes.
MR imaging of the finger tendons: normal anatomy and commonly encountered pathology.
MR imaging has emerged as a powerful tool in the evaluation of soft tissue structures such as the tendons of the hand and finger due to its excellent soft tissue contrast and multiplanar imaging capabilities. In the finger and hand, perhaps more than in any other location in the body, a detailed and intimate understanding of anatomy is crucial for lesion localization, directing clinical management and predicting long-term prognosis. These issues are of paramount importance to both the clinician and imager, both faced with the challenge of the complex anatomy and pathology associated with these delicate structures. The anatomy of the finger including intrinsic and extrinsic muscles, retinacular structures, and tendons will be discussed. The MR imaging features of common lesions of the tendons of the hand and finger will be reviewed.
MR arthrography of the knee: how, why, when.
MR arthrography combines the techniques of arthrography with MR imaging to benefit from the added imaging information afforded by intra-articular distention. This article reviews technical considerations for MR arthrography, potential complications, indications, pitfalls in imaging diagnosis, and commonly encountered pathology. It is an elegant study that can offer precise diagnostic information in the appropriate clinical setting.
Meniscal tears: role of axial MRI alone and in combination with other imaging planes.
OBJECTIVE: The purpose of this study was to determine the reliability of standard axial MR images alone in the diagnosis of meniscal tears of the knee and in combination with other imaging planes. MATERIALS AND METHODS: Sixty-two patients (55 men, seven women; age range, 23-68 years) with a prior MRI examination who underwent arthroscopic surgery of the knee during a 1-year period were included in the study group. Images were independently reviewed for identification of meniscal tears by two musculoskeletal radiologists blinded to arthroscopic findings. Sequences for meniscal evaluation included axial fat-saturated fast spin-echo proton density, coronal fat-saturated fast spin-echo proton density, and sagittal fast spin-echo proton density with 4- to 5-mm slice thicknesses. Imaging groups for evaluation were axial, coronal, sagittal, axial and sagittal, axial and coronal, and coronal and sagittal. Observers reported a confidence level for the presence or absence of meniscal tear in all imaging groups based on a 5-point scale. Statistical analysis considered medial and lateral menisci separately. RESULTS: Forty patients had medial meniscal tears, and 16 had lateral meniscal tears at arthroscopy. For medial and lateral meniscal tears, the accuracy (79% and 71%, respectively) of imaging in the axial plane was comparable to other imaging groups but the mean confidence levels (2.82 and 3.00, respectively) were low. In one patient, the axial plane alone correctly showed that no tear was present. No statistically significant difference was observed between imaging plane groups of both menisci in the diagnosis of meniscal tears (p > 0.05). The axial plane increased the accuracy of sagittal and coronal planes of lateral meniscus when combined. CONCLUSION: In standard knee MRI examinations, the axial imaging plane may be valuable for the detection and characterization of meniscal tears.
MR imaging of the musculoskeletal soft tissue mass: is heterogeneity a sign of malignancy?
BACKGROUND: Magnetic resonance (MR) is considered the imaging modality of choice to evaluate soft tissue lesions. Whether MR imaging can be used to differentiate benign from malignant soft tissue lesions is still controversial. To elucidate this controversy, MR images of 37 patients with soft tissue masses of the musculoskeletal system were reviewed at Christchurch Hospital, New Zealand. METHODS: There were 19 benign and 18 malignant lesions. MR images were evaluated with regard to lesion size, border definition, homogeneity, changes in pattern of homogeneity, signal characteristic (signal intensity on T1-weighted, T2-weighted), and demonstration of relation to neurovascular bundle and bone as well as edema in or around the lesion. RESULTS: Statistically significant imaging features favoring a diagnosis of malignancy included inhomogeneity at T2-weighted images (p = 0.002) and a change in pattern from homogeneity on T1-weighted images to inhomogeneity at T2-weighted images (p = 0.003). Malignant tumors also had neurovascular or bone involvement in 28% of cases, which was not seen in their benign counterparts. Size, border definition, and edema of surrounding tissues were generally not helpful in distinguishing benign from malignant soft tissue masses. CONCLUSIONS: The inhomogeneity of lesions on T2, the change from homogeneity on T1 to inhomogeneity on T2 sequence, and involvement of bone or neurovascular structures are features that may be helpful in differentiating benign from malignant soft tissue masses.