Portal annular pancreas: the pancreatic duct ring sign on MRCP.

Portal annular pancreas is a rare pancreatic variant in which the uncinate process of the pancreas extends and fuses to the dorsal surface of the body of the pancreas by surrounding the portal vein. It is asymptomatic, but it can be mistaken for a pancreatic head mass on imaging and could also have serious consequences during pancreatic surgery, if unrecognized. We report this case of a 53-year-old female patient who was diagnosed to have portal annular pancreas on the basis of an unusual course (ring appearance) of the main pancreatic duct on magnetic resonance cholangiopancreatography, not described earlier in the radiology literature.

Neuromuscular manifestations in a patient with ehlers-danlos syndrome type IV.

We present a case of Ehlers-Danlos Syndrome (EDS) type IV with associated neuromuscular manifestations. The patient presented with nonspecific myopathic-type symptoms and later developed a spontaneous median mononeuropathy in the forearm. We believe that the case presented here complements current published neuromuscular manifestations occurring in EDS IV patients and illustrates the urgency of making the diagnosis, given the increased mortality associated with EDS IV.

MR imaging of the foot and ankle.

MR imaging provides significant anatomic detail for the evaluation of disorders of the osseous and soft tissue structures of the foot and ankle. This article describes the normal anatomy and post-traumatic conditions of the ligaments and tendons of the ankle. Other disorders of the soft tissues and osseous structures discussed include plantar fasciitis, Morton's neuroma, ganglions, plantar fibromatosis, hemangiomas and other neoplasms, fractures and stress fractures, arthritides, and osteomyelitis.

Rotator cuff: evaluation with US and MR imaging.

Magnetic resonance (MR) and ultrasound (US) imaging are currently touted for assessment of rotator cuff disease. Optimum clinical imaging techniques include use of (a) a 1.5-T MR imaging unit with small planar coils, proton-density-weighted and T2-weighted fast spin-echo sequences, and 10-12-cm fields of view (yielding 400-470 x 500-625-microm in-plane spatial resolution) and (b) a state-of-the-art commercial US unit with insonation frequencies of 9-13 MHz (yielding 200-400-microm axial and lateral resolution).

Optimal computed tomography imaging of the midfoot: an improved technique.

A new protocol for computed tomography (CT) imaging of the midfoot is described. This imaging technique places the CT cuts parallel to and perpendicular to the talus-first metatarsal axis, as viewed on the lateral CT scout image. For imaging the midfoot, this technique is an improvement over previously described hindfoot or midfoot protocols.

Detection of osteomyelitis in the neuropathic foot: nuclear medicine, MRI and conventional radiography.

The diagnostic efficacy of (1) combined three-phase bone scintigraphy and In-111 labeled WBC scintigraphy (Bone/WBC), (2) MRI, and (3) conventional radiography in detecting osteomyelitis of the neuropathic foot was compared. Conventional radiography was comparable to MRI for detection of osteomyelitis. MRI best depicted the presence of osteomyelitis in the forefoot.

MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation.

Objective: The goal of this study was to compare MR imaging with arthroscopy in evaluating triangular fibrocartilage (TFC) pathology.

Materials And Methods: The results of 178 MR imaging examinations of the wrist were independently reviewed by two musculoskeletal radiologists who were unaware of the the clinical history, including any subsequent surgery. One hundred forty-nine of these studies were obtained from symptomatic patients.

MR imaging of injuries to the small joints.

This article describes MR imaging of acute and chronic injuries of the ankle and foot, elbow, and hand and wrist. Conditions discussed include ligament and tendon injuries, fractures and bone bruises, osteochondral defects, foreign bodies, and posttraumatic ganglions. Other topics covered include fasciitis, nerve and muscle injuries about the elbow, and triangular fibrocartilage tears.

Diagnostic bone scanning in oncology.

Over the last several decades bone scanning has been used extensively in the evaluation of oncology patients to detect bone involvement. It can provide information about disease location, prognosis, and the effect of therapy. Bone scanning offers the advantages of whole body evaluation and the detection of lesions earlier than other techniques.

MR imaging of the painful wrist.

Magnetic resonance (MR) imaging is an effective method for helping determine the cause of wrist pain by demonstrating a broad spectrum of abnormalities, including those of bone, cartilage, ligaments, and tendons. MR imaging is useful in the detection, characterization, and staging of osseous injury and disease, although computed tomography provides superior detail in the depiction of bone. MR imaging may demonstrate irregular cartilage loss in noninflammatory arthropathies such as osteoarthritis, and its superior soft-tissue contrast makes it the method of choice for evaluating the synovial processes.

MR imaging of the wrist: normal findings that may simulate disease.

Twenty-six normal wrists in young adults were studied with magnetic resonance (MR) imaging. The following conclusions were drawn regarding normal anatomic features: (a) Multiple slips of the abductor pollicis longus tendon simulate longitudinal tears; (b) the extensor pollicis longus and extensor carpi ulnaris tendons normally demonstrate increased signal intensity simulating tendinitis; (c) small quantities of fluid in the extensor tendon sheaths may be normal and not indicative of tenosynovitis; (d) the triangular fibrocartilage normally demonstrates increased signal intensity simulating tears at its radial and ulnar attachment sites; (e) the volar ulnocarpal ligaments are often indistinct, thereby simulating injury; and (f) the median nerve has signal intensity equivalent to that of fat, nor of muscle as commonly believed. Awareness of these normal features is critical in making the correct interpretation of MR images of the wrist.

MR imaging interpretation of the Palmer classification of triangular fibrocartilage complex lesions.

The triangular fibrocartilage complex (TFCC) is a complex anatomic and biomechanical structure. Injury to the TFCC is a recognized cause of ulnar wrist pain. The TFCC may be injured in its horizontal portion, in its peripheral portions, or at its attachments.

Increased signal in the normal supraspinatus tendon on MR imaging: diagnostic pitfall caused by the magic-angle effect.

Objective: Increased signal intensity within the distal portion of the supraspinatus tendon during MR imaging is a frequent observation even in healthy subjects. This finding has been variously attributed to the presence of fat, muscle, connective tissue, abnormal vascularity, or degenerative changes. More recently, the effect of tendon orientation in the static magnetic field (Bo) has been implicated.

MR imaging of the major carpal stabilizing ligaments: normal anatomy and clinical examples.

The integrity of the ligamentous network of the wrist is critical, as disruption of this network may result in carpal instability and pain. The extrinsic (radiocarpal) and intrinsic (intercarpal) ligaments that maintain carpal stability can be evaluated with magnetic resonance (MR) imaging. The major extrinsic ligaments are the radioscaphocapitate, radiolunotriquetral, short radiolunate, and dorsal radiocarpal ligaments.

Ulnar collateral ligament of the thumb: MR findings in cadavers, volunteers, and patients with ligamentous injury (gamekeeper's thumb).

Objective: The ulnar collateral ligament bridges the ulnar aspect of the first metacarpal and the proximal phalanx and functions as a major stabilizer of the first metacarpophalangeal joint. Acute or chronic injury of this ligament is referred to as gamekeeper's thumb. The objectives of this study were to (1) determine the MR appearance of the ulnar collateral ligament of the thumb in cadavers and volunteers and (2) analyze the MR findings in patients with gamekeeper's thumb, especially with regard to the value of MR in detecting clinically significant displacement of the ligament (Stener lesion).

MR imaging of the ankle and foot: normal structures and anatomic variants that may simulate disease.

In the past, MR imaging of the ankle and foot has been performed by scanning both extremities simultaneously to provide a normal side for comparison. More recently, unilateral imaging with small local coils has been favored to maximize spatial resolution through use of small fields of view or large matrices. Such clarity of detail, however, demands a greater knowledge of normal anatomy and anatomic variants.

The functional significance of calcification of coronary arteries as detected on CT.

We evaluated the coronary arteries on computed tomography (CT) scans of the chest and on coronary angiograms of 27 patients who underwent both studies. We related the presence or absence of coronary artery calcification on CT to percentage stenosis on angiogram. For the left anterior descending artery (LAD), the likelihood of calcification rose proportionately with degree of stenosis; this was less true for the circumflex, and not true for the right coronary artery (RCA).