Radiographically occult fracture of the tibial epiphysis: sonographic findings with CT correlation.

We report the case of a radiographically occult tibial fracture diagnosed sonographically and confirmed with CT. Ultrasound signs of cortical discontinuity and a three-layered fluid accumulation in the deep infrapatellar bursa were demonstrated.

Sacral insufficiency fractures.

Purpose: To highlight difficulties in the diagnostic process and the validity of imaging techniques for sacral insufficiency fractures.

Methods: Records of 25 women aged 68 to 95 years with sacral insufficiency fractures were reviewed. Baseline blood biochemistry and haematology test results were obtained.

Multislice CT in imaging of trauma of the spine, pelvis and complex foot injuries.

Multislice CT (MSCT) has greatly enhanced the performance of CT scanners and has vastly improved imaging of musculoskeletal trauma. Fast, high resolution scanning is now possible. In our institution, MSCT is an essential part of the imaging of the traumatized patient.

Clinical and radiological effects of anakinra in patients with rheumatoid arthritis.

Interleukin-1 (IL-1) is a proinflammatory cytokine that plays a pivotal role in the pathophysiology of rheumatoid arthritis (RA). Inhibiting the activities of IL-1 at the receptor level with the recombinant human IL-1 receptor antagonist anakinra (Kineret; Amgen Inc., Thousand Oaks, CA) is a new therapeutic option for the management of patients with RA.

Treatment of rheumatoid arthritis patients with interleukin-1 receptor antagonist: radiologic assessment.

Objectives: The radiologic findings of a placebo-controlled, dose-ranging, multicenter, multinational trial have been reported previously. Radiographs were evaluated using the Larsen scoring method and Erosion Joint Count. After completion of the study, a subset of the films was read again using a modified Sharp score.

A multicenter, double-blind, dose-ranging, randomized, placebo-controlled study of recombinant human interleukin-1 receptor antagonist in patients with rheumatoid arthritis: radiologic progression and correlation of Genant and Larsen scores.

Objective: To evaluate radiographic progression and the relationship of radiologic scores obtained by the Genant and Larsen methods in a clinical trial of recombinant human interleukin-1 receptor antagonist (IL-1Ra).

Methods: Patients with rheumatoid arthritis (RA) were randomized into 4 groups: placebo (n = 121) or IL-1Ra at a daily dosage of 30 mg (n = 119), 75 mg (n = 116), or 150 mg (n = 116). Hand radiographs obtained at baseline, 24 weeks, and 48 weeks were scored using both methods.

Ultrasound imaging of forearm fractures in children: a viable alternative?

Objective: A pilot study to investigate whether ultrasonography can be reliably used to demonstrate uncomplicated greenstick and torus fractures in children.

Method: Children between the ages of 2 and 14 years with a high clinical suspicion of a non-articular, undisplaced forearm fracture were included. Ultrasound imaging of the injury was performed by a consultant radiologist who gave an immediate report.

Treatment of rheumatoid arthritis with recombinant human interleukin-1 receptor antagonist.

Objective: To evaluate the efficacy and safety of interleukin-1 receptor antagonist (IL-1Ra) in patients with rheumatoid arthritis (RA).

Methods: Patients with active and severe RA (disease duration <8 years) were recruited into a 24-week, double-blind, randomized, placebo-controlled, multicenter study. Doses of nonsteroidal antiinflammatory drugs and/or oral corticosteroids (< or =10 mg prednisolone daily) remained constant throughout the study.

Interactive image-guided surgery of the spine--use of the ISG/Elekta Viewing Wand to aid intraoperative localization of a sacral osteoblastoma.

The intraoperative localization of small osteoid osteomas and osteoblastomas of the spine is often difficult. The authors report a patient with a small sacral osteoblastoma in whom the experimental use of an Interactive Image-Guidance Stereotactic system, to aid localization, is described. The Elekta Viewing Wand is a spatial localization device primarily designed for intracranial procedures.

Routine post-traumatic radiographic screening of midfacial injuries: is one view sufficient?

Midfacial injuries are a common reason for attendance at Accident and Emergency (A&E) departments. A&E staff find these injuries difficult to assess due to limited undergraduate training in maxillofacial examination and early tissue oedema which may mask asymmetry. Patients are therefore referred for 'facial views' radiographs and commonly three views (OM15, OM30, lateral face) are taken for screening.

Cervical spine imaging in trauma patients: a simple scheme of rationalising arm traction using zonal divisions of the vertebral bodies.

Objective: To evaluate the effectiveness of arm traction for cervical spine imaging in trauma patients and devise a scheme to predict the probability of visualising the C7/T1 level in trauma patients.

Methods: 98 trauma patients were studied. Each vertebral body was divided into three equal horizontal zones, the disc space between vertebral bodies being equivalent to one zone.

Magnetic resonance imaging of acute tendon injury in the finger.

Accurate assessment of flexor tendon function in a digit with an acute, non-penetrating injury is difficult. MR imaging can negate the need for surgical exploration and the associated morbidity.

Extensive infiltration of bone with marrow necrosis in a case of hairy cell leukaemia.

This 32-year-old patient with hairy cell leukaemia demonstrated extensive bony involvement in a pattern not previously described. Although the disease continued to progress during interferon treatment, a change to a regime of deoxycoformycin resulted in an excellent response.

Computer-aided diagnosis: detection and characterization of hyperparathyroidism in digital hand radiographs.

An automated method is developed for the detection and staging of skeletal changes due to hyperparathyroidism on digitized hand radiographs. Subperiosteal bony resorption, particularly along the radial margins of the middle and proximal phalanges, is among the earliest manifestations of secondary hyperparathyroidism. In order to quantify the severity of bone resorption in these regions, the computer method analyzes the roughness of the phalangeal margins, as projected on the radiograph.

The deep lateral femoral notch: an indirect sign of a torn anterior cruciate ligament.

Magnetic resonance (MR) imaging has shown that tears of the anterior cruciate ligament (ACL) are frequently accompanied by meniscal and osseous injuries. Abnormalities of the cartilage overlying the lateral femoral condylopatellar sulcus (notch) also have been noted during arthrotomy of ACL-deficient knees. In this study, the appearance of this sulcus on MR images and the depth of the sulcus on conventional radiographs are compared in patients with normal and torn ACLs to determine whether a deep sulcus is a useful indirect sign of a torn ACL.

Some commonly unrecognized manifestations of metabolic arthropathies.

The metabolic arthropathies are characterized by the deposition of abnormal substances in or around joints. Certain features of some of these arthropathies and their significance have only recently been recognized and others have been insufficiently emphasized. An important group of conditions are the arthropathies related to renal failure and its treatment, namely, aluminum toxicity, periarticular calcification and crystal deposition, hyperparathyroidism, and dialysis-related amyloidosis.

Dialysis-related amyloid arthropathy: MR findings in four patients.

Dialysis-related amyloidosis is a recently recognized complication of long-term hemodialysis. It is caused by the deposition of a unique form of amyloid derived from circulating beta 2-microglobulin. This study describes the MR imaging characteristics in five articular sites of four symptomatic patients with biopsy-proved (three patients) or clinically and radiographically suspected (one patient) dialysis-related amyloidosis.

Comparison of transrectal ultrasound and magnetic resonance imaging in the staging of prostate cancer.

A group of 32 patients with a histological diagnosis of prostate cancer underwent transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) to stage the disease. TRUS was more sensitive in the detection of tumour and in the detection of direct extracapsular spread. MRI was more sensitive in the detection of tumour involvement of the seminal vesicles and bladder base.

Erosive osteoarthritis: is it a separate disease entity?

Erosive osteoarthritis (EOA) characteristically involves the hands of middle-aged women. The diagnosis is essentially radiological and depends upon the presence of articular surface erosions. This study investigates whether this radiological feature is a marker of a specific clinical entity.

Magnetic resonance imaging, computed tomography and endosonography in the local staging of carcinoma of the cervix.

Thirty-seven patients with carcinoma of the cervix were prospectively staged by examination under anaesthesia (EUA), transvaginal and transrectal ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). Pathological correlation was available for 20 patients. In the pathologically staged patients, EUA agreed with the staging in 17, understaging three patients.

CT appearances of relapse of lymphoma in the lung.

The patterns of pulmonary relapse were studied in 15 patients with Hodgkin's disease and one patient with Non-Hodgkin's lymphoma. All the patients with Hodgkin's disease had mediastinal lymphadenopathy at initial diagnosis. For those patients with no prior episodes of relapse the mean time to pulmonary involvement was 2 years 11 months compared to over 8 years for those who first relapsed elsewhere.