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MR evidence of temporomandibular joint fluid and condyle marrow alterations: occurrence in asymptomatic volunteers and symptomatic patients.

The purpose of this study was to estimate the frequency and amount of temporomandibular joint (TMJ) fluid, as well as the frequency and type of condyle marrow alterations in asymptomatic volunteers and compare to patients with TMJ pain and dysfunction. Proton-density and T2 weighted magnetic resonance (MR) images of the TMJs of 62 asymptomatic volunteers and 58 symptomatic patients were analysed for fluid and condyle marrow alterations as well as disk position. The amount of fluid (increased T2 signal) was characterized as none, minimal, moderate or marked and related to the disk position. The differentiation between moderate and marked fluid was based on the maximum amount of fluid seen in the volunteers; more than this amount was categorized as marked fluid. The marrow of the mandibular condyle was categorized as normal, edema (increased T2 signal) or sclerosis (decreased proton-density and T2 signal) and related to fluid and disk position. In the 62 asymptomatic volunteers, 50 (81%) had none or minimal and 12 (19%) had moderate TMJ fluid. In the 58 symptomatic patients, 40 (69%) had none or minimal and 18 (31%) had moderate or marked fluid. Both in volunteers and patients, moderate fluid could be seen in joints with normal disk position, but was significantly associated with disk displacement. In the 62 volunteers, no signal abnormalities in the condyle marrow were found. In the 58 patients, six (10%) had abnormal bone marrow. These six patients had disk displacement and two had moderate or marked fluid. Marked fluid and condyle marrow abnormalities were therefore not encountered in any of the asymptomatic volunteers but in about 10% of the patients.

Adolescent↗

[Long-term radiological and clinical observations following surgery for tibio-fibular syndesmosis after fractures of the upper ankle joint (author's transl)].

Forty-two patients treated surgically for tibio-fibular syndesmosis were observed radiologically and clinically for a period of five years; the lesions followed fracture-dislocations type B, type C and following intra-articular fractures. Surgery consisted, as usual, of bone reconstruction and, where necessary, of transfixation of the syndesmosis with a horizontal screw introduced 2 cm. above the syndesmosis at a 30 degree angle to the frontal plane (15 cases). A new classification of the severity of subsequent arthrosis, as seen radiologically, was introduced and its correlation with clinical findings were determined. There was good agreement between the degree of arthrosis and functional results. The earliest signs of posttraumatic arthrosis following an incompletely treated lesion can be seen within the first year following the injury. An arthrosis of severity O due to sclerosis is of no, or only little, significance; it does not share the poor prognosis of severity grades I to III which, once they have developed, always show further deterioration.

Ankle Injuries↗

[Pathological bone structure (author's transl)].

The pathological and anatomical basis of various radiographic changes in a number of diseases of the skeleton is discussed. The conditions include abnormalities of bone formation and bone removal, including osteoporosis, fibrous dysplasia, osteomyelosclerosis, osteitis deformans, posttraumatic changes and ossifying periostitis. The form and structure of the pathological and anatomical substrate determine the radiological appearances and are essential for arriving at a diagnosis.

Adult↗

[The early radiological findings of idiopathic necrosis of the femoral head in adults (author's transl)].

Idiopathic necrosis of the femoral head in adults occurs in about 2 to 3% of all cases of degenerative hip disease. Advanced necrosis with collapse of the head offers a difficult therapeutic problem in younger patients. Early radiological diagnosis is therefore important. The typical, early radiological findings were studied in a hundred patients with idiopathic necrosis of the femoral head. They consist of an area of sclerosis at the junction of the head and neck, with a periosteal response on the inferior margin of the neck. The relationship of these changes with mechanical stress and defective blood supply is discussed. Signs of more advanced necrosis are band-like sclerosis at the point of demarkation and sub-chondral decalcification of the femoral head. Recognition of the early radiological features improves the chances of successful treatment, particularly in the lower age group.

Adult↗

Psychoneuroendocrine disturbances in a patient with a rare granulomatous disease.

Erdheim-Chester disease (ECD) and Langerhans' cell histiocytosis (LCH) are rare granulomatosis-like diseases of unknown etiology which are characterized by lipoidgranulomatous infiltrates in various organs. Contrary to LCH, endocrine and cerebral lesions were infrequently observed in ECD. We report on a patient with the clinical diagnosis of ECD displaying endocrine and cerebral manifestations and skeletal, pulmonary and soft tissue involvement. Disturbance of the endocrine system was revealed by enlargement of the pituitary, partial deficiency of growth hormone (GH), hyperprolactinemia and testosterone deficiency. Cerebral involvement included sinus vein thrombosis, pathologic acoustic evoked potentials, persistence of gadolinium enhancement after magnetic resonance imaging and hypomania. These findings emphasize the importance to assess endocrine and cerebral function in patients with rare granulomatous diseases like ECD and multiorgan involvement.

Aorta, Abdominal↗

[Value of diffusion-weighted imaging for diagnosing vertebral metastases due to prostate cancer in comparison to other primary tumors].

PURPOSE: Several publications have reported that the apparent diffusion coefficient is generally lower in metastatically affected vertebrae. Therefore, metastases are represented in diffusion-weighted images by increased signal intensity in comparison to unaffected vertebrae. However, there were indications that metastases due to prostate cancer may differ from this. Therefore, the contrast behavior of vertebral metastases due to prostate cancer or tumors with another histology are to be systematically studied using diffusion-weighted images. The present study is intended to examine whether the two groups differed and whether possible differences depended on the degree of sclerosis. MATERIALS AND METHOD: In a retrospective study the vertebral metastases of patients with prostate cancer (n = 18) were compared to those of patients with tumors of another histology (n = 20). A steady-state free precession sequence was used for the diffusion-weighted imaging. Additionally, a T1 weighted sequence before and after administration of contrast agent as well as a fat suppressed T2 weighted sequence were performed. The contrast behavior of the metastases was evaluated for all four sequences and was compared to that of the unaffected parts of the vertebra. RESULTS: In 18 patients of the tumor group, the vertebral metastases showed positive contrast in the diffusion-weighted images, and 2 had minimally negative contrast up to - 0.04. In the prostate cancer group, the contrast was positive in 9 patients and negative in 9. 6 of the metastases with negative contrast had an osteoblastic metastasization, 1 had an osteolysis, and 1 had a normal finding in the conventional X-ray image. Between the tumor group and the prostate cancer group, the medians of the contrasts were not significantly different (p = 0.054). CONCLUSION: In general, the metastatically affected vertebrae appear hyperintense in the diffusion-weighted images. This observation is only true for some vertebral metastases due to prostate cancer. The cause for this seems to be the degree of sclerosis of the metastases. Thus, it cannot be generally deduced from the hypointensity in diffusion-weighted images that a lesion is benign.

Bone Marrow↗

[Craniometaphyseal dysplasia--characteristic roentgen findings].

Craniometaphyseal dysplasia is a rare disorder of bone remodeling, which is characterized by hyperostosis or sclerosis of the skull combined with metaphyseal flaring of the long tubular bones. Diagnosis is only possible on the basis of the characteristic radiographic findings, these are shown in a case report of a 2 1/2 year old boy. There is no therapy of craniometaphyseal dysplasia.

Bone and Bones↗

Ischial tuberosity apophysitis and avulsion among athletes.

Ischial tuberosity pain in athletes may be caused by several clinical entities, which include acute and old bony or periosteal avulsions and apophysitis. We studied the natural course of these injuries based on our clinical case series of fourteen patients with apophysitis and twenty-one with avulsion of the ischial tuberosity. Only patients with the diagnosis confirmed by X-ray finding were included. The clinical diagnostic criteria by ischial apophysitis consisted of gradually increasing functional and palpatory pain at the ischial tuberosity without any major trauma at the beginning of the symptoms. Typically there was asymmetry on plain radiographs of the ischial tuberosities in apophysitis; the involved apophyseal area became sclerotic, wider than the non-symptomatic apophysis, osteoporotic patches developed and the lower margin of the ischial tuberosity became irregular. The patients with avulsion reported an acute trauma at the beginning of the symptoms and an avulsion fragment was immediately after injury or later seen in plain radiographs. The mean age of the patients with apophysitis (14.1 yrs) was lower than that of the subjects with avulsions (18.9 yrs). Apophysitis of the ischial tuberosity usually healed well without complications. Avulsions often caused more prolonged pain with referral pain to the posterior parts of the thigh which often required operative interventions. A small bony or periosteal avulsion sometimes grew to a pseudotumor calcification. We recommend conservative treatment as the primary treatment modality for both ischial tuberosity apophysitis and avulsion fractures.

Adolescent↗

[Comparative studies with quantitative computed tomography and dual-energy x-ray absorptiometry on bone density in renal osteopathy].

Measurements of bone density were carried out in 25 patients on dialysis for terminal renal insufficiency, using quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA). Unlike in subjects with normal kidneys, there was no significant correlation between these methods in this series. Ten patients showed an increase in bone density of the vertebral spongiosa on QCT measurements, which was interpreted as due to osteosclerotic bone changes in renal osteopathy. QCT showed advantages over DXA in demonstrating these changes.

Absorptiometry, Photon↗