Malignant round cell tumours of bone: atypical clinical and imaging features

Objective.To describe the clinical, radiological and MRI features of six atypical cases of histologically proven appendicular Ewing sarcoma/ primitive neuroectodermal tumour (PNET). Design. Retrospective review of case notes and available imaging was carried out. Patients. Six patients (4 male, 2 female; mean age 27years, range 19–44 years), presenting over a 77-month period, were identified from the Bone Tumour Register. All had unusual clinical and imaging features for Ewing sarcoma/PNET. Results and conclusions. Four tumours were centred on the distal femoral metaphysis, one in the proximal tibial metaphysis and one in the distal tibial metaphysis. Plain radiographs were available in four cases and showed minor cortical changes. MRI demonstrated a relatively small, eccentrically located intraosseous component with a large, eccentric extraosseous component. Extension into the epiphysis was seen in three cases and into the adjacent joint in two cases. Intraosseous ”skip” metastases were present in three cases. The clinical and imaging features were atypical for conventional intraosseous Ewing sarcoma/PNET and the exact site of origin (intraosseous, periosteal or soft-tissue) was unclear. Received: 6 December 1999 Revision requested: 7 February 2000 Revision received: 20 July 2000 Accepted: 4 August 2000     

Imaging of blunt chest trauma

In western European countries most blunt chest traumas are associated with motor vehicle and sport-related accidents. In Switzerland, 39 of 10,000 inhabitants were involved and severely injured in road accidents in 1998. Fifty two percent of them suffered from blunt chest trauma. According to the Swiss Federal Office of Statistics, traumas represented in men the fourth major cause of death (4 %) after cardiovascular disease (38 %), cancer (28 %), and respiratory disease (7 %) in 1998. The outcome of chest trauma patients is determined mainly by the severity of the lesions, the prompt appropriate treatment delivered on the scene of the accident, the time needed to transport the patient to a trauma center, and the immediate recognition of the lesions by a trained emergency team. Other determining factors include age as well as coexisting cardiac, pulmonary, and renal diseases. Our purpose was to review the wide spectrum of pathologies related to blunt chest trauma involving the chest wall, pleura, lungs, trachea and bronchi, aorta, aortic arch vessels, and diaphragm. A particular focus on the diagnostic impact of CT is demonstrated. Received: 29 November 1999; Accepted: 28 January 2000     

Agfa新一代数字X线成像系统DX-S在小儿胸片中的应用

目的：探讨Agfa新一代X线成像系统（DX-S）在儿童胸片应用中的临床价值。方法：选择年龄3-4岁，体重在12-15公斤患儿100名，将这100名患儿随机分成2组，分别使用市场上同级别品稗CR和Agfa DX-S进行胸部摄片．由放射科有经验的医师3名在双盲前提下对这100张胸片进行分析，评价胸部特定的8个解剖区域（周围肺实质、中心肺实质、肺门、心脏、横膈、上纵隔，骨骼和软组织），应用5分指标对所有100张胸片进行胸片质量分析比较，进行统计学分析。并对这100张胸片所用曝光条件千伏（KV），毫安秒（mAs）进行比较。结果 Agfa DX-S图像质量高于该品牌，更有利于诊断，同时Agfa DX-S使用的曝光条件明显低于市场上同类产品。结论：Agfa新一代数字X线成像系统DX-S值得在儿科放射领域推广应用。     

严重急性呼吸道综合征的影像学分析

目的 :探讨严重急性呼吸道综合征 (SARS)的影像学特点。方法 :对临床确诊的 3 8例SARS患者的X线胸片和CT影像进行回顾性分析。结果 :X线表现轻度 18例 ( 4 7% ) ,中度 14例 ( 3 7% ) ,重度 6例 ( 16% ) ,中、重度患者病变均累及双侧。结论 :SARS同时存在急性肺炎和急性间质性肺炎 ,影像检查对SARS的诊断有重要价值 ,但要注意和普通肺炎、免疫功能损害患者肺炎及一些非感染性疾病肺部表现相鉴别。     

Comparison of in-office magnetic resonance imaging versus conventional radiography in detecting changes in erosions after one year of infliximab therapy in patients with rheumatoid arthritis

Abstract

The objective of this study was to compare standard hand radiographs with in-office 0.2?T magnetic resonance imaging (MRI) in monitoring response to therapy in patients with rheumatoid arthritis (RA) who were receiving infliximab, to evaluate the frequency and location of erosions, and to determine if there were differences in outcome based on disease duration at baseline. Patients who satisfied the American College of Rheumatology criteria for RA and were receiving infliximab therapy were evaluated with a baseline and 1-year follow-up MRI. Magnetic resonance images were interpreted by two blinded, board-certified radiologists. Bone erosions were identified as well-defined defects extending through the cortical margin. The mean age of the 48 patients was 58.5 years. The median infliximab dosage was 4?mg/kg. Baseline data showed that 41 patients had abnormal MRIs. The mean time between the baseline and follow-up MRI examinations was 10.5 months. Follow-up MRI revealed regression in 11 patients. Thirty-one patients had both MRIs and radiographs. Magnetic resonance imaging was approximately twice as sensitive as radiography in detecting erosions at baseline. In-office MRI was useful in monitoring disease response after the initiation of infliximab treatment. Magnetic resonance imaging is potentially a very valuable diagnostic tool and prognostic indicator for use in patients with RA.     

Influence of bone marrow on membrane-guided bone regeneration of segmental long-bone defects in rabbits

Defects 10 mm long were created in long bone in the diaphysis of both radii of 18 rabbits (test and control side). On the test side, ingrowth of bone marrow into the defects was hindered or delayed by: plugging the opening of the cut bone ends with gutta-percha points (n = 7); plugging with Gelfoam (n = 6); or by removing the bone marrow by flushing with saline (n = 5). The defects on both test and control side were covered with an expanded polytetrafluoroethylene membrane, shaped as a tube. Healing was followed with radiographs for four to five months, after which the animals were killed and ground sections of the areas of the defects were prepared for histological examination. On the control side, nine of 18 animals had complete osseous bridging of the defect, and a small transverse non-mineralised zone remained in the centre of the healed defect in the other animals. This zone consisted of loose connective and cartilagenous tissue as well as connective tissue obviously derived from the outside of the membrane. By preventing or delaying the ingrowth of bone marrow we retarded the regeneration of mineralised bone, particularly in the gutta-percha and flushed bone marrow groups. The principle of guided tissue regeneration may be used to achieve regeneration of extensive long-bone defects. Any attempts to delay or prevent bone marrow ingrowth into the defects did retard regeneration of segmental long-bone defects.     

Evaluation of X-ray table mattresses for radiation attenuation and impact on image quality

IntroductionMattresses in the radiology department tend to be an overlooked aspect of imaging equipment. This paper evaluates the radiation attenuation characteristics of mattresses and the effect they have on image quality.MethodsThirteen mattresses (from new to 20 years of age) were evaluated. Incident air kerma (IAK) was measured in two conditions, with and without mattress over a range of exposure factors using a digital dosimeter. Image quality was assessed by calculating the inverse image quality factor (IQF_inv) using a commercially available phantom (CDRAD) for the same exposure factors. The correlation of age and attenuation and image quality was calculated.ResultsMeasured IAK and image quality was affected by the addition of a mattress with older mattresses having greater attenuation; there is a moderate/large correlation (0.38–0.51) between age and IAK. IQF_inv deteriorated with the addition of a mattress but there was no correlation with age (?0.41 to 0.16). Clinically, there is no impact of any mattress in the study as changes to the exposure factors to account for the attenuation are smaller than the increments in mAs available on X-ray equipment.ConclusionThe results indicate that while the presence of a mattress does impact on transmitted radiation and the quality of the image, the clinical impact is insignificant. Attenuation correlates with age but with no clinical significance. There is no correlation between age and image quality.Implications for practiceQuality control tests for attenuation and impact on image quality are not required in clinical practice. The method could be used by manufacturers to test new materials and mattresses and could provide users with specifications of new products.     

The role of conventional radiography to assess the outcome of oncologic skeletal reconstructions of lower limbs aided by vascularized fibular autograft

IntroductionVascularized fibular autografts (VFA) are used in the oncologic skeletal reconstructions of long bones, alone or combined with massive bone allografts (MBA). Data regarding the role of imaging in assessing these complex skeletal reconstructions are lacking, and have mainly focused on Computed Tomography (CT). Our aim was to evaluate if early conventional radiography (CR) findings are correlated with the outcome of these skeletal reconstructions.Materials and methodsAll consecutive patients who underwent oncologic resection of lower limbs long bones followed by VFA reconstruction were included in this single-center retrospective study. We compared the CR obtained immediately after surgery with the CR at the 6-month control, as well as the CR at 6 months with the CT at 6 months when available. The following scores were assigned to the VFA: 0 (unchanged), 1 (osteopenia-cortical bone thinning), 2 (increase in bone density-cortical thickening). We then investigated whether this score correlated with the implant outcome within 12 months (optimal integration, suboptimal integration, integration requiring further surgery or lack of integration) using Kaplan-Meier and Cox regression analyses, considering the occurrence of integration and the duration time before the surgical removal of the whole bone reconstruction.ResultsForty-five patients were included (32 men [71.1%], mean age 14.6 years), 26 affected by osteosarcoma, 14 by Ewing sarcoma, 3 by adamantinoma and 2 operated for the failure of previous reconstructions for bone sarcoma. VFA changes on 6-month CR were significantly associated with optimal integration of the implants (log-rank P = 0.0137, multivariate Hazard ratio = 7.62, 95% confidence interval = 1.13–51.25). None of the other clinical and surgical features were associated with the implant outcome. The findings on 6-month CR and CT follow-up were not significantly different. CT at 6 months was available in 36 patients (80.0%).ConclusionThe assessment of VFA morphological changes on CR performed at 6 months can predict the outcome of the skeletal implant. This data should be considered for clinical decision-making, selecting patients requiring additional images (CT), and possible subsequent revision surgical procedures.