The other arthritides. Roentgenologic features of osteoarthritis, erosive osteoarthritis, ankylosing spondylitis, psoriatic arthritis, Reiter's disease, multicentric reticulohistiocytosis, and progressive systemic sclerosis.

Osteoarthritis may be divided into primary generalized and secondary forms. Primary generalized osteoarthritis is characterized by narrowing of cartilage, marginal osteophytes, and absence of erosions. The most common sites of involvement are the distal interphalangeal joints of the fingers and the first carpometacarpal joint.

Shoulder instability: evaluation with MR imaging.

Instability of the glenohumeral joint is a common cause of chronic shoulder pain and disability. One or more episodes of subluxation or dislocation may result in a tear, detachment, or attenuation of the glenoid labrum, stripping of the joint capsule from the scapula, or trauma to the tendons or muscles of the rotator cuff. A series of 27 shoulders examined with magnetic resonance (MR) imaging showed changes of glenohumeral instability, which were confirmed with open or arthroscopic surgery.

The use of MRI to assist in diagnosis of pigmented villonodular synovitis of the knee joint.

Pigmented villonodular synovitis (PVNS) of the knee joint remains a difficult and elusive entity to define and characterize. This entity most often appears in the young adult knee with nonspecific clinical features, including a painful range of motion and perhaps a sensation of locking. Detection and diagnosis of this localized soft-tissue mass are difficult because plain roentgenograms may be totally within normal limits.

Focal spot size measurements with pinhole and slit for microfocus mammography units.

Many mammography units now have microfocal spots ranging in size from 0.09 to 0.4 mm for magnification radiography.

Results of core decompression for femoral head osteonecrosis.

The progression of femoral head osteonecrosis (FHON) culminates in destruction of the hip joint, a devastating consequence for young people who are predominantly affected. Core decompression, as a means of ameliorating the disease, was evaluated in 45 hips in 33 patients with nontraumatic FHON. The mean clinical and roentgenographic follow-up period was three years (range, 1-7 years).

Spinal neuroarthropathy after traumatic paraplegia.

Spinal neuroarthropathy is a little-known complication of traumatic paraplegia. Four cases of this syndrome are described, with emphasis on the characteristic radiographic findings of severe juxta-articular bone destruction, dense appositional new bone formation, large osteophytosis, and soft-tissue bony debris. The factors predisposing patients to develop a neuropathic joint are diminished pain and proprioceptive sensations with maintained mobility.

High frequency breast ultrasound. Hand-held versus automated units; examination for palpable mass versus screening.

Four hundred forty-five patients had one or more breast ultrasound examinations with equipment from six manufacturers, operating at 5, 7.5, or 10 MHz. Two hundred seven patients were examined by both automated and hand-held units.

Shoulder impingement syndrome: MR findings in 53 shoulders.

The shoulder impingement syndrome refers to a condition in which the supraspinatus tendon and subacromial bursa are chronically entrapped between the humeral head inferiorly and either the anterior acromion itself, spurs of the anterior acromion or acromioclavicular joint, or the coracoacromial ligament superiorly. As a result, the space for the bursa and tendon is reduced, and repeated trauma to these structures leads to bursitis and rotator cuff injury. Although pain and limitation of motion are common early findings, the diagnosis is often delayed until a complete tear of the rotator cuff has occurred.

Musculoskeletal infection of the extremities: evaluation with MR imaging.

Magnetic resonance (MR) imaging was performed in 17 patients, 11-84 years of age, referred for evaluation of possible osteomyelitis involving the appendicular skeleton. MR imaging permitted successful identification of osteomyelitis in ten patients (four acute, two subacute with Brodie abscess, two chronic, and two acute with septic arthritis) and of cellulitis in the absence of osteomyelitis in four patients, including one with a soft-tissue abscess. Active osteomyelitis was excluded in three patients.

Ultrasound artifacts affecting the diagnosis of breast masses.

An investigation of the outcome of over 1600 breast ultrasound examinations revealed a number of scanning artifacts. Artifactual echoes in cysts resulted from inappropriate scanning factors, including focal zone placement, gain, TGC, and gray scale, and from partial volume effect. The absence of a sign suspicious for carcinoma, posterior shadowing to a solid mass, resulted from faulty focal zone placement, or from the mass resting on chest wall tissue.

Ultrasound breast examination of asymptomatic patients with normal but radiodense mammograms.

Of 1757 consecutive women patients examined with ultrasound (US) between 1983-1986, 796 patients were asymptomatic, had no masses on their mammograms, and were scanned with whole breast US because their breasts were radiodense on mammography. Combinations of automated and real-time hand-held equipment, ranging in frequency from 3.9 MHz to 10 MHz.

Survey of mammography practices.

Of the 319 radiologists who responded to a survey concerning mammography practices, 50% were employed in a private hospital and 26% in a private office. Film-screen mammography was used most often (54%) followed by xeromammography (30%) and a combination of film-screen and xeromammography (16%). Of the respondents, 62% had changed their method of performing mammography in the last 10 years.

Elbow joint: normal anatomy on MR images.

The normal anatomy of the elbow joint in axial, sagittal, and coronal planes was evaluated by comparing 30 magnetic resonance (MR) images of eight healthy volunteers with microtomed cryosections prepared from six cadaver elbows. MR images provided depiction of muscles and tendons, bone marrow, articular cartilage, and neurovascular structures. Cross-referencing of MR images from one plane to another was useful in the evaluation of complicated, obliquely oriented muscle bundles and other soft tissues.

Evaluation of radiation dose, focal spot, and automatic exposure of newer film-screen mammography units.

Fifteen recently introduced mammographic units representing eight different models and manufacturers were evaluated to see whether the equipment performance equaled claims made by the manufacturers. Focal-spot size was measured by pinhole and slit methods. Eight automatic exposure control systems on five models were tested by measuring the optical density produced by imaging at 28 and 30 kVp, with and without a grid and with test objects of varying thicknesses of BR12 epoxy material.

Mammographic dual-screen-dual-emulsion-film combination: visibility of simulated microcalcifications and effect on image contrast.

Three test objects simulating different mammographic problems were imaged with a new low-dose dual-screen-dual-emulsion-film combination and a standard screen film combination, with and without a moving grid, at 28 and 32 kVp, and with 0.3- and 0.5-mm focal spots.

Ischemic necrosis of the femoral head. Correlation of magnetic resonance imaging and histologic sections.

Magnetic resonance (MR) images were correlated with matched histologic sections of a resected ischemic necrotic femoral head and neck. Preoperative radiographs had revealed Stage 3 ischemic necrosis. Preoperative MR images disclosed foci of abnormally low signal intensity alternating with normal-appearing foci of high signal intensity.

Breast cancer detection: one versus two views.

Mammographic examinations of 169 patients with 172 biopsy-proved carcinomas, and of 194 healthy subjects, were interpreted independently and retrospectively by three experienced mammographers, initially as single-view oblique examinations and 6 months later as two-view oblique-cephalocaudal examinations. For the single-view examinations of the cancer patients, 67% of the cancers were correctly recommended for biopsy, additional views were requested for 23%, and a "negative" interpretation was made for 10%. For the single-view examinations of healthy subjects, biopsy was recommended for 7% and additional views were recommended for 32%.

Rheumatic manifestations of Wegener's granulomatosis.

Wegener's granulomatosis is a necrotizing granulomatous vasculitis with multisystem involvement. We reviewed the rheumatic manifestations among 50 patients with Wegener's granulomatosis. Arthralgia, myalgia and/or arthritis occurred in 2/3 of patients and 28% had nonerosive and nondeforming polyarthritis.

Automated and hand-held breast US: effect on patient management.

Breast ultrasound (US) was performed, with either an automated or a hand-held unit or both, on 1,212 patients. Of 612 asymptomatic patients, 118 (19.3%) had solitary cysts; ten (1.

Mammography screening: successes and problems in implementing widespread use in the United States.

Deterrents to the use of screening mammography include perceived risks of radiation, perceived "unnecessary" biopsies and overdiagnosis, and high cost. In addition, physicians and patients have attitudinal barriers that do not reflect objective realities. Professional and public education efforts are needed to enable women and their physicians to develop a more sophisticated understanding of the usefulness of screening mammography and the role played by the radiologist.