Mixed connective tissue disease: the spectrum of radiographic manifestations.

Mixed connective tissue disease (MCTD) is a serologically distinct entity defined by a ribonuclease-sensitive extractable nuclear antigen. This unusual overlap syndrome has clinical features of scleroderma, systemic lupus erythematosus, polymyositis, and rheumatoid arthritis. In order to define the radiographic changes in MCTD, radiographs of the hands of 17 patients were studied, utilizing a fine-detail technique. Diffuse and periarticular osteopenia were found in 8 and 10 patients, respectively; soft-tissue swelling in 11; erosive changes in 9; joint-space narrowing in 7; tuft resorption and soft-tissue atrophy in 6; and subluxations in 2. In individual cases radiographs may appear normal or exhibit features of scleroderma, systemic lupus erythematosus or rheumatoid arthritis, thereby mirroring the clinical diversity of this entity.     

Metaphyseal sclerosis in patients with chronic renal failure

We reviewed radiographs of the hands and wrists of 33 patients with immature skeletons and chronic renal disease. Various radiographic manifestations of renal osteodystrophy were seen, including osteopenia in 23 patients (70%), subperiosteal resorption in 20 (61%), distal tuft resorption in 14 (42%), sclerosis of vertebral bodies in 2 (6%), and soft-tissue calcification in 1 (3%). We also noted that 13 patients (39%) exhibited metaphyseal sclerosis adjacent to the growth plates. Five of these 13 showed persistent sclerosis years after the growth plates had fused. None of the patients showed other radiographic changes of rickets, and there was no correlation between the serum calcium, phosphorus, or aluminum levels and the presence of metaphyseal sclerosis. Neither was there any association with the underlying cause of renal failure, method of treatment, presence of a transplant, or type of dialysis. We view this finding as another manifestation of renal osteodystrophy. The importance of distinguishing it from other sclerotic lesions is discussed.     

Osteosclerosis of the phalanges in Werner syndrome

Werner syndrome is an autosomal-recessive disease characterized by premature aging, shortness of stature, scleroderma-like skin changes, endocrine abnormalities, and cataracts. Although radiographic findings have been well documented, the presence of distinctive osteosclerotic changes in the phalanges of the hands and feet has not been emphasized in previous publications. The authors' review of radiographs of both hands in nine patients and of both feet in six patients with Werner syndrome documented the frequent occurrence of phalangeal sclerosis related predominantly to endosteal thickening. In the hand, sclerosis was present in every patient, was generally symmetric in distribution, predominated in the distal phalanges, and demonstrated an ulnar predilection. Similar changes in the phalanges of the feet were demonstrated in only two patients. The presence of osteosclerosis in the phalanges of the hand alone or both the hand and foot, when combined with osteoporosis and periarticular calcification, suggests the diagnosis of Werner syndrome.     

Magnetic resonance imaging and radiographic findings of seal finger

Purpose: To describe the magnetic resonance imaging (MRI) and radiographic findings of five patients with seal finger.

Material and Methods: The MR images and radiographs of five patients with seal finger were retrospectively evaluated. MRI was performed on four patients in the subacute phase, and follow-up imaging was done on one of them at 5 months. One patient had MRI only at a later stage 5 years after onset. Radiographs were taken three times in the subacute phase and once at a later stage. One patient had had seal finger in another finger previously.

Results: Short-tau inversion-recovery (STIR) sequence showed extensive subcutaneous soft tissue edema in all four patients in the subacute phase and tenosynovitis of the flexion tendons in two cases. Three patients had edema in 2-3 phalanges, and effusion in the distal interphalangeal (DIP) joint was seen in one case. At the later stage, no signal pathology in soft tissues or bones was seen in STIR images. In the subacute phase, radiographs showed digital soft-tissue swelling in three patients, and one patient had a narrowed DIP joint, periarticular osteoporosis, and a periosteal reaction. At the later stage, flexion contracture of the finger was seen.

Conclusion: In addition to soft-tissue infection, seal finger causes bone marrow edema, tenosynovitis, and effusion in the interphalangeal joints visible as increased signal intensity in STIR images. Radiographs reveal periarticular osteoporosis with loss of cartilage in the subacute phase and flexion contracture at the later stage. MRI (STIR) allows more precise delineation of the inflammatory process compared to radiography.     

新生儿先天性梅毒的骨骼X线表现

目的 评价骨骼X线片在新生儿先天性梅毒诊断中的价值。方法 搜集28例新生儿先天性梅毒的骨骼X线片,分析其表现。结果 28例中26例有骨骼异常改变。先期钙化带增宽23例,先期钙化带呈锯齿状边缘19例,先期钙化带下透亮带26例,肌膜反应6例,骨髓炎5例。骨骼改变呈多发、对称、广泛性,多侵犯长骨,也累及不规则骨。结论 新生儿生成生梅毒骨损害出现率高,其X线表现具有特征性,可作为诊断手段。摄片还应包括骨盆等不规则骨。     

Ultrasound appearance of knuckle pads

Objective We describe the ultrasound appearance of knuckle pads.Design and patients Retrospective analysis of imaging in a series of five patients initially referred for evaluation of periarticular soft-tissue swelling of the hands involving the dorsum of the PIP and MP joints. Two patients had associated Dupuytren’s contractures. Ultrasound and radiographs of the hands in all patients were reviewed and correlated with clinical history and physical exams.Results Radiographs in four patients demonstrated dorsal soft-tissue thickening. Ultrasound exams showed increased dorsal subcutaneous thickening, with either diffuse or focal hypoechoic areas corresponding to the areas of soft-tissue fullness identified on physical exam. No erosions or synovial proliferation were identified either by radiographs or ultrasound of the underlying joints.Conclusions Knuckle pads can sometimes be difficult to distinguish from synovitis on physical examination. Musculoskeletal ultrasound can quickly identify these superficial lesions and exclude underlying synovial proliferation.     

The interphalangeal joint of the great toe in rheumatoid arthritis.

The radiographic abnormalities of the interphalangeal joint of the great toe in 50 patients with rheumatoid arthritis were compared with those in 14 patients with psoriatic arthritis. Alterations were seen in 50% of the rheumatoid joints. Characteristic superficial erosions along the medial aspect of the proximal and distal phalanges, with little change in the joint space, differed from more widespread and extensive destruction of this joint in psoriasis. In addition, periosteal proliferation, bony ankylosis and tuft resorption, frequently noted in psoriatic arthritis, were unusual in rheumatoid disease. An anatomic investigation of the interphalangeal joint of the great toe explains the sites of marginal erosions in rheumatoid arthritis. Although selective involvement of this articulation occurs in psoriatic arthritis and Reiter's syndrome, it is the radiographic pattern of articular abnormality which allows their differentiation from rheumatoid arthritis.     

Heterotopic bone formation: clinical, laboratory, and imaging correlation

The clinical findings, laboratory data, radiographs, and radionuclide studies of 50 patients referred for evaluation of possible heterotopic bone formation (HBF) were reviewed. HBF begins approximately 17 days following injury or neurologic insult, heralded by an acute rise in serum alkaline phosphatase (SAP), and increased vascularity on three-phase radionuclide bone imaging (RNBI). RNBI soft-tissue uptake is evident at 24 days and radiographic calcification is visible 1 wk later. Clinical signs and symptoms occur relatively late in the course of disease. HBF mimics thrombophlebitis and should be considered in all patients referred for venography if the clinical situation is appropriate. Serial SAP measurements and three-phase RNBI should allow early diagnosis in virtually all cases.     

Radiographic appearance and clinical outcome correlates in 26 patients with severe acute respiratory syndrome

OBJECTIVE: We aimed to evaluate the appearance of chest radiographs in patients with severe acute respiratory syndrome (SARS) and correlate these findings with clinical outcomes. MATERIALS AND METHODS: We retrospectively reviewed the initial radiograph and a series of follow-up chest radiographs in 26 patients who had symptoms and signs consistent with SARS. Twenty-five patients completed the full course of radiographs in the hospital. The initial radiographic features and the distribution of parenchymal, mediastinal, and pleural abnormalities for each patient were evaluated. Follow-up radiographic findings were correlated with clinical outcomes for these patients. RESULTS: Initial chest radiographs showed abnormalities in 23 (88%) of 26 subjects. Eighteen patients (69%) had air-space consolidation, two (8%) had ground-glass attenuation, one (4%) had nodules, and two (8%) had mixed consolidation and nodules. Four patients (15%) had pleural effusion. Younger patients and those with normal initial radiographic findings or unifocal lung lesions had better outcomes. CONCLUSION: The initial predominant radiographic feature of SARS was air-space consolidation in the lateral and lower lung zones. Progressive deterioration to diffuse unilateral or bilateral consolidation in the series of follow-up chest radiographs is associated with a poor prognosis.     

Soft-tissue abnormalities of the external auditory canal: subject review of CT findings

We review the normal anatomy and discuss characteristic findings of soft-tissue abnormalities of the external auditory canal (EAC). The indications for computed tomography (CT) of the temporal bone have been significantly expanded with the inclusion of soft-tissue abnormalities of the external ear and the auditory canal. Soft-tissue abnormalities of the EAC that can be evaluated with CT include atresia, edema, hemorrhage, fracture, posttraumatic or infection-caused keloid, malignant external otitis, hemangioma, lymphangioma, papilloma, keratosis obturans, acquired cholesteatoma, adenoma, ceruminoma, fibroma, mixed tumor, sarcoma, and basal cell, squamous cell, or adenocystic carcinoma. CT scans of 25 patients who had soft-tissue abnormalities of the EAC were reviewed. The clinical data were correlated with the radiographic findings. We conclude that CT is the best overall radiographic modality for evaluating the extent and character of soft-tissue abnormalities of the EAC. Significant clinical information that is helpful in patient management decisions is added by this technique.     

Giant cell tumor of bone: radiographic changes following local excision and allograft replacement

The authors retrospectively evaluated the clinical records and radiographs obtained from 41 patients who had giant cell tumor of bone and who were treated by local resection and allograft replacement. Postoperative complications developed in 41% of the patients. However, the eventual clinical outcome was considered to be satisfactory in 85% of all cases. There were no instances of tumor recurrence, and surprisingly, postoperative arthritis was not a major problem. The major complications encountered were infection and allograft fracture; bone infection accounted for most of the clinical failures. All infections were associated with the increasing soft-tissue swelling and bone resorption detected on radiographic studies. Other radiographic parameters that were associated with an increased rate of complications included osteopenia, increased periosteal reaction, and decreased bone formation at the host-donor junction site. The clinical outcome was distinctly less favorable in those cases in which the patient had had a pathologic fracture or a previous resection, or in whom the graft was implanted at the distal radius.     

Bone scans with one or two new abnormalities in cancer patients with no known metastases: reliability of interpretation of initial correlative radiographs

To determine the reliability of radiographs obtained for correlation with bone scans showing one or two new abnormalities in cancer patients without known metastases, a retrospective study of 306 scans showing such lesions was performed. Overall, 14% of the lesions proved to be malignant. The initial radiographic interpretation was normal for 43% of the new bone scan lesions; 17% of these lesions were metastases. A benign process was identified on radiographs for 38% of the abnormalities; only one (1%) was a metastasis. Twelve percent of new bone scan lesions correlated with radiographic abnormalities considered either suggestive of or consistent with metastasis, of which 24% and 71%, respectively, proved to be metastases. In cancer patients with one or two new bone scan abnormalities, correlative radiographs showing a benign abnormality are reliable. However, if the radiographs are either normal or show findings considered suggestive of or consistent with metastasis, further evaluation or follow-up is warranted.     

Detection of heterotopic calcification with 99mTc-pyrophosphate in spinal cord injury patients

Whole body 99mTc-pyrophosphate scans were obtained and correlated with skeletal radiographs for detection of heterotopic calcification in 122 spinal injury patients. There were 27 patients with recent injury (less than 6 months) and 95 with injury of 6 months to 25 years duration. Ectopic calcification was detected in 8 of the 27 patients (30%) with recent injury and in 32 of the 95 (34%) with injury of over 6 months duration. Ectopic calcification seen on radiographs were also seen on scans in all instances. The scan was a sensitive indicator of the ectopic calcification particularly at its early stage, and detected its presence before observable radiographic changes in 5 patients with injury of 1-3 months duration. In 3 of the 5 patients, the ectopic calcification mimicked deep vein thrombosis in presentation, and the scan was valuable in identifying the nature of the complication.     

Association of gastrocnemius tendon calcification with chondrocalcinosis of the knee

 Objective. Chondrocalcinosis of the knee is a common radiological finding in the elderly. However, visualization of chondrocalcinosis may be difficult in patients with advanced cartilage loss.The purpose of this study was to determine sensitivity, specificity, and accuracy of gastrocnemius tendon calcification that might serve as a radiographic marker of chondrocalcinosis in patients with painful knees. Design and patients. We prospectively evaluated 37 knee radiographs in 30 consecutive patients (29 men, 8 women; mean age 67 years, age range 37–90 years) with painful knees who had radiographic evidence of chondrocalcinosis. The frequency of fibrocartilage, hyaline cartilage, and gastrocnemius tendon calcification was determined. For a control group, we evaluated knee radiographs in 65 consecutive patients with knee pain (54 men, 11 women; mean age 59 years, age range 40–93 years) who had no radiological signs of chondrocalcinosis. The frequency of gastrocnemius tendon calcification in the control group was determined. Results. Gastrocnemius tendon calcification was 41% sensitive, 100% specific, and 78% accurate in predicting chondrocalcinosis. The gastrocnemius tendon was calcified on 15 of 37 (41%) radiographs in the experimental group and on 0 of 67 radiographs in the control group. In the chondrocalcinosis group, 23 (62%) had posterior hyaline cartilage calcification, 14 (38%) had anterior hyaline cartilage calcification, 31 (84%) had medial meniscus calcification, and 36 (97%) had lateral meniscus calcification. Conclusions. Our results show that gastrocnemius tendon calcification is an accurate radiographic marker of chondrocalcinosis in patients with knee pain.     

Role of chest CT in non-Hodgkin lymphoma

A retrospective study of 48 patients with non-Hodgkin lymphoma (NHL) who underwent 54 computed tomographic (CT) examinations of the chest evaluated the role of chest CT in the management of this disease. Of 18 cases in which chest radiographs were not indicative of NHL, CT scans showed abnormalities consistent with NHL in five (28%). Of 11 cases where radiographs were questionable, CT confirmed NHL in five (45%) and excluded it in six (55%). Of 25 cases where radiographs were consistent with NHL, CT confirmed the findings in 23 (92%) and added information in all 25. Chest CT affected management in eight of 25 treated and five of 19 untreated patients. It appears to be useful in untreated patients with stage I or II NHL but no definite radiographic abnormalities, or with abnormal radiographs but no extrathoracic spread, and in treated patients with questionable radiographs. CT is not helpful in untreated patients with stage III or IV NHL or treated patients with normal radiographs.     

Respiratory viral infections in lung transplant recipients: radiologic findings with clinical correlation

PURPOSE: To evaluate radiologic finding of respiratory viral infection in lung transplant recipients with clinical correlation. MATERIALS AND METHODS: Over 5 years, 21 episodes of respiratory viral infection (parainfluenza [n = 9], respiratory syncytial virus [n = 8], adenovirus [n = 5], influenza [n = 2]) were diagnosed 6-727 days (mean, 270 days) after lung transplantation in 20 recipients. Chest radiographs, computed tomographic (CT) images, and clinical records were reviewed. RESULTS: Sixteen episodes of respiratory viral infection were diagnosed in patients with symptoms of lower respiratory tract infection or acute allograft dysfunction; five were diagnosed in asymptomatic patients. Chest radiographs were abnormal in 11 (52%) episodes; findings included heterogeneous or homogeneous opacities and masslike consolidation. All patients with radiographic abnormalities were symptomatic. Chest radiographs were unchanged from baseline in 10 (48%) episodes; in one, CT revealed findings not depicted at radiography. Adenoviral infection (n = 5) was typically symptomatic, was associated with new radiographic abnormalities, and was rapidly lethal (n = 4). Infection with parainfluenza and/or respiratory syncytial virus was commonly asymptomatic and was not associated with radiographic abnormalities; affected patients had good outcomes. CONCLUSION: Respiratory viral infections are important causes of morbidity and mortality in lung transplant recipients. Radiographic abnormalities in patients with respiratory viral infections were usually accompanied by symptoms of lower respiratory tract infection. Adenoviral infection was frequently accompanied by progressive pulmonary opacity and fatal outcome.     

Can imaging findings help differentiate spinal neuropathic arthropathy from disk space infection? Initial experience

PURPOSE: To determine if radiographic, computed tomographic (CT), and magnetic resonance (MR) imaging findings can help differentiate spinal neuropathic arthropathy from disk space infection. MATERIALS AND METHODS: Imaging studies in 33 patients were evaluated, including 14 patients with spinal neuropathic arthropathy (12 radiographic, seven CT, and six MR studies) and 19 with disk space infection (13 radiographic, nine CT, and 12 MR studies). Potential imaging discriminators, including endplate sclerosis or erosions, osteophytes, spondylolisthesis, facet involvement (narrowing or erosions), vacuum disk, paraspinal soft-tissue mass, joint disorganization, and osseous joint debris, were recorded, as were MR imaging signal intensity and gadolinium-enhancement characteristics. RESULTS: The most helpful findings for diagnosis of spinal neuropathic arthropathy were vacuum disk on radiographs and CT images, debris on radiographs and CT and MR images, disorganization on radiographs and CT and MR images, facet involvement on radiographs and CT and MR images, spondylolisthesis on CT and MR images, diffuse signal intensity patterns in vertebral bodies on MR images, and rim enhancement of disks on gadolinium-enhanced MR images. Findings that were not helpful included endplate sclerosis and erosions, osteophytes, paraspinal soft-tissue mass, and decreased disk height. CONCLUSION: Vacuum disk, facet involvement, vertebral body spondylolisthesis, joint disorganization and debris, and gadolinium-enhancement patterns of vertebral bodies and disks may help differentiate spinal neuropathic arthropathy from infection.     

Childhood diskitis: computed tomographic findings

The spectrum of computed tomographic findings in seven children with diskitis is reported. Paravertebral inflammatory masses, intraspinal (epidural) soft-tissue extension with thecal sac deformity, and psoas involvement with abscess were demonstrated in 7/7, 6/7, and 1/7 patients, respectively. Plain radiographic findings of disk space narrowing and vertebral end-plate destruction were confirmed by CT in all cases. Follow-up CT in two patients revealed persistent bone destruction despite resolution of soft-tissue inflammation and clinical abnormalities. CT proved most useful in the diagnosis of early and atypical cases. The CT spectrum of childhood diskitis may simulate other diseases, including neoplasm, tuberculosis, and disk herniation. While CT is not routinely indicated in typical childhood diskitis, it may confirm the diagnosis in those patients with atypical clinical presentation or nonspecific plain radiographs, and exclude other lesions in patients unresponsive to routine treatment.     

肺硬化性血管瘤的影像学与病理学对照研究

目的回顾性分析肺硬化性血管瘤(PSH)的影像学表现，并与病理学对照，旨在提高对PSH影像表现的认识。方法1976年1月至2002年12月由手术及病理证实的PSH共45例，其中男3例，女42例(93．3％)，年龄18～67岁，中位年龄49岁。无症状由体检发现19例(42．2％)。影像学资料(包括胸部正、侧位X线片和CX)完整的PSH共20例。平扫7例，直接增强扫描13例。将影像表现与病理对照。结果典型X线片表现为圆形、卵圆形边界清楚的肿物或结节，无分叶及毛刺。CT平扫7例，病变密度与肌肉密度相仿。直接增强扫描13例，9例为均匀强化(其中4例增强早期呈不均匀强化，延时后均匀强化)，4例呈不均匀强化，强化程度略高于或明显高于肌肉密度，强化的最大CT值为135HU。13例增强CT的病变中，强化程度高于或明显高于肌肉的11例，全部含有较多的血管瘤成分。含有较大面积低密度区的1例，组织学显示有囊变。影像检查见有钙化的5例均与病理学所见吻合。结论有助于PSH影像诊断的指标为：(1)40-60岁的女性患者；(2)胸片上表现为圆形、卵圆形边界清楚的肿物或结节；(3)CT平扫密度均匀，有时有小低密度区和粗大点状钙化，偶尔可见囊性变；(4)CT增强后有中度至明显强化。对于增强早期呈明显不均匀强化的圆形、卵圆形边界清楚的肿物或结节，应行延时扫描。     

Changes on radiographs of wives of workers exposed to asbestos

Between January and March 1986, 117 wives of insulation workers exposed to asbestos were screened by means of chest radiography, pulmonary function testing, and a detailed questionnaire. The final study group included 93 women over 40 years of age. Eighteen of these (19.4%) demonstrated pleural changes consistent with asbestos exposure, including pleural plaque (88.9%), diaphragm plaque (27.8%), pleural calcification (16.6%), and diffuse pleural thickening (5.5%). In statistical correlation between the groups with normal and abnormal radiographs, the only factor that proved significant was the year of first exposure (the duration of the latent period). Finally, radiographs of the husbands were compared for 17 of the 18 wives with radiographic abnormalities. Fourteen of the husbands (82%) demonstrated more severe radiographic changes than their wives.