[CME Rheumatology 26: Bone Marrow Edema of the Sacro-Iliac Joint = Spondyloarthritis? What the General Practicioner Should Know].

CME Rheumatology 26: Bone Marrow Edema of the Sacro-Iliac Joint = Spondyloarthritis? What the General Practicioner Should Know Axial spondyloarthritis is a chronic inflammatory joint disease mainly involving the sacroiliac joints (ISG) and the spine. The diagnosis can be made early due to acute inflammatory changes in the ISG on magnetic resonance imaging (MRI). Radiographs of the ISG do not help in early diagnosis because structural damage is not apparent on radiographs until an advanced stage.

[CME Rheumatology 24/Answers: DISH of the Hand and Undifferentiated Polyarthritis].

CME Rheumatology 24/Answers: DISH of the Hand and Undifferentiated Polyarthritis We present a case with undifferentiated, unclassified polyarthritis and with peripheral diffuse idiopathic skeletal hyperostosis (DISH). We discuss the differential diagnoses of "seronegative" polyarthritis and explain the radiographic findings of the little-known peripheral aspects of DISH.

[CME Rheumatology 24: DISH of the Hand and Undifferentiated Polyarthritis].

CME Rheumatology 24: DISH of the Hand and Undifferentiated Polyarthritis We present a case with undifferentiated, unclassified polyarthritis and with peripheral diffuse idiopathic skeletal hyperostosis (DISH). We discuss the differential diagnoses of "seronegative" polyarthritis and explain the radiographic findings of the little-known peripheral aspects of DISH.

Dose-optimized computed tomography of the cervical spine in patients with shoulder pull-down: Is image quality comparable with a standard dose protocol in an emergency setting?

Purpose: Superimposing soft tissue and bony structures in computed tomography (CT) of the cervical spine (C-spine) is a limiting factor in optimizing radiation exposure maintaining an acceptable image quality. Therefore, we assessed image quality of dose-optimized (DO) C-spine CT in patients capable of shoulder pull-down in an emergency setting.

Methods And Materials: DO-CT (105mAs/120 kVp) of the C-spine in trauma settings was performed in patients with shoulder pull-down if C5 was not superimposed by soft tissue on the lateral topogram, otherwise standard-dose (SD)-CT (195 mAs/120 kVp) was performed.

Do Patients With Skin Psoriasis Show Subclinical Axial Inflammation on Magnetic Resonance Imaging of the Sacroiliac Joints and Entire Spine?

Objective: To explore potential subclinical involvement of the axial skeleton by magnetic resonance imaging (MRI) of the sacroiliac (SI) joints and the entire spine in patients with skin psoriasis without clinical evidence of peripheral or axial inflammation.

Methods: Twenty patients with skin psoriasis but no clinical evidence of peripheral or axial inflammation and 22 healthy controls underwent standardized dermatologic and rheumatologic clinical examination and unenhanced 1.5T MRI of the SI joint and the entire spine.

The medial border of the tibial tuberosity as an auxiliary tool for tibial component rotational alignment during total knee arthroplasty (TKA).

Purpose: The objective of this study was to quantify the amount of ensuing internal rotation of the tibial component when positioned along the medial border of the tibial tubercle, thus establishing a reproducible intraoperative reference for tibial component rotational alignment during total knee arthroplasty (TKA).

Methods: The angle formed from the tibial geometric centre to the intersection of both lines from the middle of the tibial tuberosity and its medial border was measured in 50 patients. The geometric centre was determined on an axial CT slice at 10 mm below the lateral tibial plateau and transposed to a slice at the level of the most prominent part of the tibial tuberosity.

[Imaging findings of cristal deposit disorders].

Cristal deposit disorders are characterised by cristal deposits in hyaline and fibrocartilage, in synovium, capsule, ligaments and tendons and periarticular soft tissue. Calciumpyrophosphatedihydrate (CPPD), hydroxyapatite (calcific tendinitis) and uric acid arthropathies are the most common cristal deposit diseases. Radiography is still the number one image modality for initial imaging and the identification of cristal-induced inflammatory arthropathies.

Increased Osseous (99m)Tc-DPD Uptake in End-Stage Ankle Osteoarthritis: Correlation Between SPECT-CT Imaging and Histologic Findings.

Background: We analyzed the histopathologic findings in end-stage osteoarthritic ankle joint tissue that display increased uptake of bone-seeking radiotracer in single-photon emission computed tomography-computed tomography (SPECT-CT) imaging.

Methods: Six consecutive patients with end-stage osteoarthritis undergoing total ankle replacement received preoperative SPECT-CT imaging using (99m)Technetium dicarboxypropane diphosphonate ((99m)Tc-DPD). Using imaging data for stratification, osteochondral tissue sections were prepared from SPECT-positive (+) and -negative (-) areas of tibial and talar resection specimens.

Generation and characterization of osteochondral grafts with human nasal chondrocytes.

We investigated whether nasal chondrocytes (NC) can be used to generate composite constructs with properties necessary for the repair of osteochondral (OC) lesions, namely maturation, integration and capacity to recover from inflammatory burst. OC grafts were fabricated by combining engineered cartilage tissues (generated by culturing NC or articular chondrocytes - AC - onto Chondro-Gide® matrices) with devitalized spongiosa cylinders (Tutobone®). OC tissues were then exposed to IL-1β for three days and cultured for additional 2 weeks in the absence of IL-1β.

Radiographic diagnosis and differentiation of an aggressive angiomyxoma in a male patient.

Aggressive angiomyxoma is a rare soft-tissue tumor which usually occurs in female patients of reproductive age. Its occurrence in men is even more unusual and as illustrated in this case the difference between pathology suggested by a physical examination and its actual extent can be quite striking. We present a case report of an 81-year-old man with the typical MRI appearances of a pelvic aggressive angiomyxoma, describe imaging and histopathologic features of this rarely seen locally infiltrative neoplasm and also discuss therapeutic options for patients with an aggressive angiomyxoma.

Long-term outcomes of muscle volume and Achilles tendon length after Achilles tendon ruptures.

Purpose: The best treatment for Achilles tendon (AT) ruptures remains controversial. Long-term follow-up with radiological and clinical measurements is needed.

Methods: In this retrospective multicentre cohort study, patients (n = 52) were assessed at a mean of 91 months follow-up after unilateral AT rupture treated by open, percutaneous or conservative (non-surgical) treatment.

Quantitative MRI can detect subclinical disease progression in muscular dystrophy.

Oculopharyngeal muscular dystrophy (OPMD) is a rare autosomal dominant muscular dystrophy with late onset and slow progression. The aim of this study was to compare different methods of quantitative MRI in the follow-up of OPMD to semiquantitative evaluation of MRI images and to functional parameters. We examined 8 patients with genetically confirmed OPMD and 5 healthy volunteers twice at an interval of 13 months.

Long-term treatment with infliximab in patients with sarcoidosis.

Background: Long-term benefit and safety of infliximab treatment in patients with chronic sarcoidosis remain unclear.

Objectives: It was the aim of this study to assess the clinical benefit and safety of long-term infliximab treatment in patients with chronic steroid-resistant sarcoidosis.

Methods: We conducted a retrospective chart review of all patients with chronic steroid-resistant sarcoidosis who received infliximab between January 2003 and November 2010.

A novel imaging method for osteochondral lesions of the talus--comparison of SPECT-CT with MRI.

Background: Magnetic resonance imaging (MRI) is the current standard in noninvasive diagnostics of osteochondral lesions (OCLs) of the talus. Single-photon emission computed tomography-computed tomography (SPECT-CT) is a new technique that displays different imaging qualities. The influence of the aforementioned diagnostic information on treatment decision making in talar OCLs is not known.

Impact of motion on T1 mapping acquired with inversion recovery fast spin echo and rapid spoiled gradient recalled-echo pulse sequences for delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) in volunteers.

Purpose: To evaluate the impact of motion on T1 values acquired by using either inversion-recovery fast spin echo (IR-FSE) or three-dimensional (3D) spoiled gradient recalled-echo (SPGR) sequences for delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) in volunteers.

Materials And Methods: Single-slice IR-FSE and 3D SPGR sequences were applied to perform dGEMRIC in five healthy volunteers. A mutual information-based approach was used to correct for image misregistration.

Anterior cruciate ligament reconstruction by using bioabsorbable femoral cross pins: MR imaging findings at follow-up and comparison with clinical findings.

Purpose: To determine the frequency of imaging findings and complications related to bioabsorbable femoral cross pins at follow-up magnetic resonance (MR) imaging studies after anterior cruciate ligament (ACL) reconstruction and compare these MR imaging findings with clinical evaluation findings.

Materials And Methods: The institutional review board approved this retrospective study, and informed consent was waived. Follow-up MR imaging studies (average, 26 months after surgery) in 218 patients with prior ACL reconstruction were retrospectively reviewed.

Feasibility study of simultaneous physical examination and dynamic MR imaging of medial collateral ligament knee injuries in a 1.5-T large-bore magnet.

Objective: To determine the feasibility of evaluating medial knee joint laxity with dynamic magnetic resonance (MR) imaging and simultaneous physical joint examination in a large-bore 1.5-T system.

Materials And Methods: The study included 10 patients (5 women, 5 men; mean age 35 years) with clinically diagnosed and categorized acute injuries of the medial collateral ligament (MCL).

MR arthrography of the hip: differentiation between an anterior sublabral recess as a normal variant and a labral tear.

Purpose: To retrospectively evaluate imaging characteristics of surgically proved sublabral recesses and labral tears in the anterior portion of the acetabulum at magnetic resonance (MR) arthrography.

Materials And Methods: Institutional review board approval was obtained; informed consent was waived. The study included 57 patients (36 women [mean age, 37 years], 21 men [mean age, 32 years]) who underwent MR arthrography and either surgery or arthroscopy as reference standard.

Multicenter trial: comparison of two different formulations and application systems of low-dose nasal midazolam for routine magnetic resonance imaging of claustrophobic patients.

Purpose: To prospectively assess and compare two formulations and methods of administration of low-dose nasal midazolam for the treatment of claustrophobic patients undergoing magnetic resonance imaging (MRI) as part of a multicenter Phase III trial.

Materials And Methods: In all, 108 consecutive adult claustrophobic patients were randomly assigned to one of two treatment groups (multidose group: MDG, unit-dose group: UDG). MDG encompassed 55 patients who received intranasally a 0.

Abnormalities of the lesser tuberosity on radiography and MRI: association with subscapularis tendon lesions.

Objective: The objective of our study was to retrospectively evaluate the association between abnormalities of the lesser tuberosity and subscapularis tendon lesions.

Materials And Methods: Cortical irregularities and cysts of the lesser tuberosity were evaluated on radiographs and MR images in 70 patients: 31 with normal subscapularis tendons and 39 with subscapularis tendon tears. These imaging findings were correlated with subscapularis tendon tears diagnosed during arthroscopy and with fatty atrophy of the subscapularis muscle seen on MR images.

Accuracy of chest radiographs in the emergency diagnosis of heart failure.

The purpose of this study was to determine the diagnostic accuracy of chest radiographic findings of heart failure (HF) in current patients presenting with dyspnea in the emergency department. In a secondary analysis of the BASEL study, initial chest radiographs of 277 patients with acute dyspnea were evaluated by two radiologists blinded to the adjudicated diagnosis (56% had the final diagnosis of HF). Predefined radiographic criteria of HF were used.

Fibrosis and adventitious bursae in plantar fat pad of forefoot: MR imaging findings in asymptomatic volunteers and MR imaging-histologic comparison.

Purpose: To retrospectively evaluate plantar fat pad (PFP) signal intensity alterations in magnetic resonance (MR) imaging studies of asymptomatic volunteers and to compare PFP alterations with histopathologic findings in cadavers and patients.

Materials And Methods: After appropriate institutional review board approval and any required informed consent were obtained, MR imaging studies of 70 asymptomatic volunteers (35 women, 35 men; mean age, 45 years; range, 21-69 years) obtained for another investigation were retrospectively analyzed by two musculoskeletal radiologists in consensus. The location, signal intensity, margin, extent, and size of PFP alterations were determined.

Image quality from high-resolution CT of the lung: comparison of axial scans and of sections reconstructed from volumetric data acquired using MDCT.

Objective: Our objective was to compare the image quality of reconstructed thin sections obtained from a 16-MDCT scanner with that of axial high-resolution CT scans of the same patient.

Subjects And Methods: Fifty consecutive patients referred for CT of the chest underwent 16-MDCT and, subsequently, axial high-resolution CT. The volumetric raw data from the MDCT scans were reconstructed into slices 2-mm thick using a high-spatial-frequency reconstruction algorithm.