MR arthrography: anatomic-pathologic investigation

To enhance the efficacy of magnetic resonance (MR) imaging in evaluating articular soft-tissue structures, arthrography was performed before imaging 45 fresh cadaveric specimens. Contrast agents used were gadolinium-DTPA, 0.9% saline, diatrizoate, and air. MR imaging was performed with and without intraarticular contrast material, and specimens were subsequently sectioned in the same plane. Gd-DTPA was the most effective agent. Saline and diatrizoate exhibited equivalent signal behavior and necessitated T2-weighted sequences, while air was not useful. Depiction of normal anatomy was enhanced with MR arthrography. After surgical creation of lesions in selected specimens, subtle tears were delineated exclusively with MR arthrography, and major tears were diagnosed more confidently. Intraarticular contrast material may enhance the diagnostic capabilities of MR imaging in the setting of joint disease.     

Morton neuroma: sonographic evaluation

One hundred consecutive patients with symptoms suggestive of Morton neuroma were examined with sonography, and 134 intermetatarsal masses were demonstrated. Forty-five patients underwent surgical exploration, which revealed Morton neuromas. The typical sonographic appearance is that of an ovoid, hypoechoic mass oriented parallel to the long axis of the metatarsals. Most masses were between the second and third or third and fourth metatarsals and seemed to produce symptoms when reaching a diameter of 5 mm.     

Sciatic nerve block under fluoroscopic guidance

Sciatic nerve block under fluoroscopic guidance was performed in 17 patients. This anesthetic technique along with femoral nerve block was found to be effective in patients having unilateral femoral arteriography or occlusive arteriography of their extremities. No complication was encountered in this group of patients.     

Shoulder impingement syndrome: sonographic evaluation

A method of shoulder sonography in which lateral and anterior elevation of the arm is used during scanning was demonstrated to be effective in cases of suspected impingement syndrome. The value of the method lies in its ability to demonstrate fluid collection in the subacromial-subdeltoid bursal system, with gradual distention of the bursa and lateral pooling of fluid to the subdeltoid portion while the arm is elevated. In 102 of 381 patients studied, surgical diagnosis was available for correlation. Among this group there were seven false-negative and three false-positive sonographic findings. A comparison of sonographic with surgical findings demonstrated a sensitivity of 81% and a specificity of 95% in stages I-III, and a sensitivity of 71% and a specificity of 96% in early stages I and II of the impingement syndrome. The results of dynamic shoulder sonographic examination with fluoroscopic radiography provide valuable information in patients with suspected early-stage impingement syndrome.     

Severe nonimmune hydrops fetalis: sonographic evaluation

Reported survival rates in nonimmune hydrops fetalis vary considerably. Among 27 fetuses exhibiting severe sonographic features of nonimmune hydrops fetalis, 33% survived the neonatal period. For five of the nine survivors, the prognosis remains uncertain or poor. On the basis of sonographic features alone neither prognosis nor potential survivors were reliably predicted.     

Papillary renal cell carcinoma: CT and sonographic evaluation

The CT, sonographic, and pathologic appearances of 13 surgically confirmed cases of papillary renal cell carcinoma were reviewed. CT-pathologic correlation was available in all 13 cases. Sonography was performed in eight patients (10 distinct renal masses). CT features closely correlated with the previously established clinicopathologic and angiographic appearances. Papillary renal cell carcinoma demonstrated low stage at presentation in most cases (10 of 13 had stage I or II), had a high frequency of calcification (seven), and had less enhancement (diminished vascularity) than typical hypernephroma on CT scans. No consistent sonographic pattern existed; one of 10 masses was hyperechoic, five were hypoechoic, and four were isoechoic compared with normal kidney cortex. On the basis of these observations, a prospective CT diagnosis of papillary renal cell carcinoma can be confidently made in many circumstances. This is particularly important when renal-sparing surgery is a clinical consideration.     

Amyotrophic lateral sclerosis: sonographic evaluation of dysphagia

Purpose

The authors sought to determine the role of video ultrasonography (VUS) in the diagnostic assessment of dysphagia in patients with amyotrophic lateral sclerosis (ALS).

Materials and methods

Nine patients underwent simultaneous static and dynamic VUS examination and videofluoroscopy (VFS) of swallowing.

Results

At the static phase, VUS showed 5/9 patients had lingual atrophy. Abnormal bolus position was observed in 6/9 patients at VUS and 3/9 at VFS. Both techniques identified an inability to keep the bolus in the oral cavity in 4/9 patients. At the dynamic phase, reduced lingual movement was observed in 5/9 patients at VUS and 2/9 at VFS. Disorganised tongue movement was seen in 3/9 patients at VUS and in 2/9 at VFS. Fragmented swallowing was only visualised at VUS. Stagnation of ingested material was never visualised at VUS, whereas it was clearly depicted in 2/9 patients at VFS.

Conclusions

VUS can be integrated into the diagnostic protocol for evaluating swallowing in patients with ALS, as it has higher sensitivity than VFS in assessing the dynamic factors that represent the early signs of dysphagia.     

Prominent periportal echogenicity: its sonographic evaluation and its significance

Prominent periportal echogenicity was detected during sonographic examination of patients suffering from recurrent pyogenic cholangitis, hepatocellular carcinoma and acute cholecystitis. To document the finding, 140 normal individuals were studied to establish a norm for the evaluation of the periportal echogenicity. The significance of this sonographic finding and its possible aetiology are discussed.     

Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve

Sciatic hernia is a rare condition with diverse clinical manifestations. We report a case of sciatic hernia causing sciatica, in which the diagnosis made on CT was subsequently confirmed on MRI including magnetic resonance neurography. The salient clinical and imaging features and a brief review are presented.Sciatic hernia is a rare condition that can lead to bowel obstruction, sciatica, pelvic pain, back pain or ureteric obstruction [1, 2]. Clinical diagnosis of this condition is difficult. Ultrasonography and CT are the imaging modalities commonly used to diagnose sciatic hernia, although MRI can be used in cases in which entrapment of the sciatic nerve is suspected. Magnetic resonance neurography (MRN) provides high-resolution images to demonstrate entrapment of the nerve and morphological changes in the nerve [3]. Colour Doppler can be useful in surgical planning, as it can provide information regarding bowel viability.     

Breast masses. Mammographic and sonographic evaluation.

Asymmetric breast tissue can nearly always be distinguished from a true mass by means of mammographic evaluation. Stellate masses from early invasive breast cancer are often extremely subtle so that optimal technique and meticulous interpretation are essential. Benign stellate masses such as post-biopsy scarring and fat necrosis frequently have a characteristic appearance. A radial scar is usually indistinguishable from malignancy on the mammogram. Nearly all circumscribed masses are benign and are usually cysts, fibroadenomas, or intramammary lymph nodes. A few circumscribed masses represent in situ or invasive carcinoma or both. Characteristics that may allow a definitively benign diagnosis for a circumscribed mass include the presence of fat and certain calcification patterns on the mammogram and features of a simple cyst on the sonogram. Management decisions for other circumscribed masses will depend on characteristics such as shape, margins, calcification, multiplicity, size, stability, and sonographic features as well as patient age and risk factors. Most nonspecific circumscribed masses should be followed rather than biopsied as they are commonly present on mammograms and have a change of malignancy of less than 5%. Even when biopsied on the basis of interval change, most small circumscribed cancers will not have metastasized to the regional nodes. For palpable breast masses, selection of mammography or ultrasonography as the primary imaging modality will depend on patient's age and risk factors.     

Prenatal sonographic evaluation of short-limbed dwarfism: an algorithmic approach

Prenatal sonographic evaluation of short-limbed dwarfism is initiated when a significantly shortened femur is found or by referral of a patient with a family history of skeletal dysplasia. If a short femur is demonstrated, all the long bones are measured and evaluated for bowing, fractures, and mineralization. The bone dysplasia is categorized according to whether it is mesomelic, rhizomelic, or micromelic and whether bowing or fractures are present. The fetal spine, head, thorax, hands, and feet are carefully evaluated to differentiate the type of bone dysplasia and to determine whether it is lethal. Serial examinations may be necessary. This approach will provide sufficient information to counsel the family, manage the pregnancy, and direct the postnatal evaluation.     

Changes in normal thymus size during infancy: sonographic evaluation

One hundred and sixty-one normal infants underwent mediastinal examination to determine the variations in size of the thymus with age and sex. The longest craniocaudal extent was measured in longitudinal scans. The maximum transverse dimension and anteroposterior dimension of the right and left lobes were measured during expiration in the scan in which the largest maximum transverse dimension was obtained. Infants were grouped according to their ages in months and mean values of thymic measurements in each group were calculated. Our measurements showed that the thymus grows during the first months of life. The craniocaudal extent and maximum tranverse dimension reached their maximum values at about the fourth month; for the anteroposterior dimensions the greatest sizes of the right and left lobes were reached at the fourth and third months, respectively. Between 4 and 9 months only small variations in size and then a gradual decrease in all thymic dimensions were observed. At the eleventh month, while the craniocaudal extent and maximum transverse dimension returned to their size in newborns, the anteroposterior dimensions were less than the newborn size. No significant difference was found between the mean values for each sex, irrespective of age. Correspondence to: M. Kizilcan