Imaging features of musculoskeletal tuberculosis

The purpose of this article is to review the imaging characteristics of musculoskeletal tuberculosis. Skeletal tuberculosis represents one-third of all cases of tuberculosis occurring in extrapulmonary sites. Hematogenous spread from a distant focus elsewhere in the body is the cornerstone in the understanding of imaging features of musculoskeletal tuberculosis. The most common presentations are tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue involvement. The diagnostic value of the different imaging techniques, which include conventional radiography, CT, and MR imaging, are emphasized. Whereas conventional radiography is the mainstay in the diagnosis of tuberculous arthritis and osteomyelitis, MR imaging may detect associated bone marrow and soft tissue abnormalities. MR imaging is generally accepted as the imaging modality of choice for diagnosis, demonstration of the extent of the disease of tuberculous spondylitis, and soft tissue tuberculosis. Moreover, it may be very helpful in the differential diagnosis with pyogenic spondylodiscitis, as it may easily demonstrate anterior corner destruction, the relative preservation of the intervertebral disk, multilevel involvement with or without skip lesions, and a large soft tissue abscess, as these are all arguments in favor of a tuberculous spondylitis. On the other hand, CT is still superior in the demonstration of calcifications, which are found in chronic tuberculous abscesses.     

化脓性髋关节炎的CT与MRI表现

目的分析化脓性髋关节炎的CT与MRI表现,并评价其临床意义。方法回顾性分析30例经临床和手术病理证实的化脓性髋关节炎患者的CT与MRI表现,其中,行CT检查24例,MRI检查15例,同时行CT与MRI检查者9例。结果在CT与MR像上,软组织肿胀分别见于20例和14例,关节腔积液分别见于24例和15例,滑膜及肉芽组织增生分别见于13例和11例,关节间隙改变分别见于13例和9例,骨质改变分别见于24例和15例。CT显示骨内积气4例,MRI显示软组织脓肿1例。结论 MRI对化脓性髋关节炎的早期病理改变,诸如少量关节腔积液、邻近软组织轻度肿胀以及骨质早期改变的显示,明显优于CT,但是CT对骨内积气和骨质晚期改变的显示优于MRI。CT与MRI在化脓性髋关节炎诊断与指导治疗中起重要作用。     

Infectious spondylitis in adults

Summary In adults, infectious spondylitis is a rare but severe disease, caused by a bacterial thrombus in tissue of reduced resistance. In conventional radiographs initial findings are a narrowing of the intervertebral space, local osteoporosis and poorly defined erosive borders of the vertebral endplates. These changings can be found at least three to six weeks after the onset of disease. However, in Szintigraphy and MRT pathologic alterations are evident after ten to twelve days. Thus, early diagnosis and treatment becomes possible. In early stages of the disease a localized lysis surrounded by a reactive sclerosis appears in predisposed areas of the vertebral body (subchondral, anterobasal, ventral, central). Apparently, a soft tissue tumor is associated. Sclerosis and reduction of the soft tissue tumor are the first signs of repair processes. After at least 12 weeks, computed tomography can reveal typical sintering of the vertebral body and occasionally the development of a bony sequester. In addition, MRT as well as CT can be helpful in the detection and localization of complications as abscesses or affection of the vertebral canal. The tuberculous spondylitis can sometimes cause difficulties in differential diagnosis. Clinical findings, affection of several vertebral bodies, large soft tissue tumors with appearance of calcification as well as not typical locations are strongly suggestive of tuberculous spondylitis, but these findings are not specific of the disease. Degenerative disorders such as erosive osteochondrosis or changings due to chronic dialysis (e. g. amyloid or crystal arthropathies) may cause even more problems in differential diagnosis. Typical for a blastomatous process is the integrity of the interverebral disc space, which is a rare finding in spondylitis. Eingegangen am 5. Juli 1996 Nach überarbeitung angenommen am 19. Juli 1996     

低场磁共振成像在以腰背痛为首发症状的布氏杆菌脊柱炎中的诊断价值

目的：探讨布氏杆菌脊柱炎的影像特点及鉴别诊断。方法对12例布氏杆菌脊柱炎患者的磁共振成像（MRI）图像进行回顾性分析。结果布氏杆菌脊柱炎的患者可有不同程度的椎体受累,且均可见不同程度的软组织肿胀,但未见明显脓肿形成;6例增强扫描可见病变椎体内骨髓水肿部分均匀强化,椎旁软组织肿胀影均匀强化,其内未见无强化的脓腔。结论低场MRI对以腰背痛为首发症状的布氏杆菌脊柱炎具有重要的诊断价值,增强扫描对布氏杆菌脊柱炎的诊断有特殊的诊断意义。     

强直性脊柱炎在骶髂关节的CT表现(附25例报告)

目的探讨强直性脊柱炎在骶髂关节的CT表现. 资料与方法对25例临床、实验室检查已确诊的强直性脊柱炎患者的骶髂关节行CT扫描,分析其征象. 结果强直性脊柱炎患者骶髂关节改变的基本征象(1)局限性骨质稀疏、侵蚀、破坏;(2)骨质增生硬化;(3)关节间隙增宽或变窄;(4)关节强直;(5)关节软组织肿胀. 结论骶髂关节CT检查有助于提高强直性脊柱炎的早期诊断率.     

Toward high-contrast breast CT at low radiation dose

This study was approved by the local research ethics committee, and patient informed consent was obtained. The purpose of this study was to demonstrate that high-spatial-resolution low-dose analyzer-based x-ray computed tomography (CT) can substantially improve the radiographic contrast of breast tissue in vitro when compared with that attained by using diagnostic mammography and CT. An excised human breast tumor was examined by using analyzer-based x-ray imaging with synchrotron radiation. The correspondence between analyzer-based x-ray images and diagnostic mammograms, CT images, and histopathologic findings was determined. Calcifications and fine details of soft tissue, which are at the contrast detection limit on diagnostic mammograms, are clearly visible on planar analyzer-based x-ray images. Analyzer-based x-ray CT yields high contrast from smoothly varying internal structures, such as tumorous mass lesions, corresponding to information on actual structures seen at histopathologic analysis. The mean glandular dose of 1.9 mGy in analyzer-based x-ray CT is approximately equivalent to the dose administered during single-view screening mammography. The improved visibility of mammographically indistinguishable lesions in vitro suggests that analyzer-based x-ray CT may be a valuable method in radiographic evaluation of the breast, thereby justifying further investigations.     

Dual-modality imaging of function and physiology

Dual-modality imaging is a technique in which computed tomography (CT) or magnetic resonance imaging is combined with positron emission tomography or single-photon emission CT to acquire structural and functional images with an integated system. The data are acquired in a single procedure; the patient remains on the scanner table while undergoing both x-ray and radionuclide studies to facilitate correlation between the structural and functional images. The resulting data can aid in localization, enabling more specific diagnosis than can be obtained with a conventional imaging study. In addition, the anatomic information can be used to compensate the correlated radionuclide data for physical perturbations such as photon attenuation, scatter radiation, and partial volume errors. Thus, dual-modality imaging provides a priori information that can improve both the visual quality and the quantitative accuracy of the radionuclide images. Dual-modality imaging systems are also being developed for biologic research involving small animals. Small-animal dual-modality systems offer advantages for measurements that currently are performed invasively with autoradiography and tissue sampling. By acquiring data noninvasively, dual-modality imaging permits serial studies in a single animal, enables measurements to be performed with fewer animals, and improves the statistical quality of the data.     

Radiodiagnosis of temporal bone anomalies

The X-ray findings in temporal bone anomalies are reviewed. Radiological procedure and examination technique are presented, as are symptoms of important anomalies. The methods available are plain film X-ray of temporal bone, multi-directional tomography, and high-resolution CT. Although some of the abnormalities are visible even in plain films, consistent use of conventional tomography or CT is necessary for correct diagnosis. This procedure is indicated not only when an abnormality is clinically obvious, but also in all cases of unexplained hearing loss without evidence of acquired disease. The advantage of CT over conventional tomography is that soft tissue anomalies, such as primary cholesteatoma or tumor simulating vascular abnormalities, can be demonstrated. In these cases CT is obligatory.     

Retropharyngeal calcific tendinitis: case report and review of literature

Retropharyngeal calcific tendinitis, also known as acute calcific prevertebral tendinitis or longus colli tendinitis, is an uncommon benign condition presenting as acute neck pain. Clinically, it can be misdiagnosed as retropharyngeal abscess, traumatic injury, or infectious spondylitis. The diagnosis is made radiographically by an amorphous calcification anterior to C1–C2 and prevertebral soft tissue swelling. We present three cases of this uncommon condition to illustrate the classic findings on plain film, CT, and MRI. Recognition of the pathognomonic imaging appearance allows for easy diagnosis preventing unnecessary tests and treatment.     

CT诊断上颌窦疾病的研究

笔者回顾分析了ＣＴ诊断的５３例上颌窦疾病，经手术病理证实。ＣＴ扫描提示上颌窦炎性病变２３例，息肉样病变７例，囊性病变９例，良性肿瘤４例，恶性肿瘤９例，骨纤维异常增殖症１例。与病理诊断对比基本符合，仅１例（２％）为假阳性。在诊断上颌窦疾病方面，ＣＴ可以解决一些传统难题，如提高对窦壁周围组织估计的正确性，可证实肿瘤对翼部、咽部及鼻腔的侵犯，有助于手术方案的制定。由于ＣＴ密度分辨率高，超越了平片及多轨迹体层，得以确定软组织、骨壁及含气腔的隐匿性变化，加上增强扫描可推测病变为血管性或非血管性。对于鉴别囊肿、脓肿、良恶性肿瘤等均起到重要作用。     

Radiological evaluation of temporal bone disease: high-resolution computed tomography versus conventional X-ray diagnosis

Sixty-two patients with different temporal bone lesions were prospectively examined by high-resolution computed tomography (CT) and conventional plain radiography, including pluridirectional tomography. High-resolution CT enabled a clear diagnosis in 80% of cases, conventional radiology in 63%; 1.6-times more bone information was recorded by high-resolution CT which is clearly superior for imaging cholesteatomas, metastases and inflammatory processes and for evaluating osseous destruction. With regard to pathological soft tissue or effusions filling the tympanic cavities, conventional radiology shows poor sensitivity (0.61). High-resolution CT is the most sensitive method for the imaging and classification of temporal bone fractures, including labyrinthine damage and ossicular chain injuries. Only in cases of atypical fractures with an unfavourable relationship to the CT planes, can carefully directed tomography be more effective. In most cases high-resolution CT replaces conventional radiology and should be the method of choice for comprehensive radiological examination of the temporal bone.     

MSCT在肋软骨骨折诊断中的临床应用

目的探讨螺旋CT重建在肋软骨损伤中的临床应用价值。方法对65例有明确外伤史患者,进行胸部常规螺旋CT扫描,全部原始图像传送至AW4.1工作站进行多平面重建(MPR)、容积重建(VR)处理以显示肋软骨骨折。结果65例受检者的CT图像经过后处理显示29例有肋软骨骨折,CT表现为肋软骨条状影或钙化影中断或不连续,断端错位伴有局部软组织肿胀。结论MSCT能够显示完整的胸廓组成,尤其对外伤引起的软骨骨折的显示,是一种良好的肋软骨影像学检查方法。     

Histological investigation of osseous changes of mandibular condyles with backscattered electron images

OBJECTIVES: This study aims to confirm the radiographic morphology of mandibular condyles with microscopic observation and to investigate the mechanism of osseous changes of adult human mandibular condyles. METHODS: Following the radiographic examinations of ten temporomandibular joints (TMJs) from five cadavers using conventional tomography, helical CT and limited cone beam CT for dentistry (limited CBCT), ten mandibular condyles were removed. Micro CT images were made of the undecalcified dissected joints in the sagittal plane, perpendicular to the long axis of the condyles, to produce images similar in orientation to the radiographic images. Tissue morphology was observed through backscattered electron images and elemental analysis using electron probe microanalysis (EPMA). The microscopic findings were compared with the radiographic findings. RESULTS: Limited CBCT images most accurately depicted erosive change of the bone cortex of the mandibular condyle. EPMA indicated bone remodelling in all mandibular condyles analysed, which showed cartilage calcification different from typical enchondral ossification. No finding of dissolution or disruption of the superficial soft tissue was observed in all specimens, including those presenting radiographic findings of osteoarthrosis. Active bone remodelling with hypertrophic changes of superficial soft tissue was observed in mandibular condyles, which implied radiographic findings of osteoarthrosis. CONCLUSIONS: The high detectability of limited CBCT images on bony morphology of mandibular condyles was confirmed. It is speculated that bone remodelling of adult human mandibular condyles is brought about by cartilage calcification. It was suggested that the osseous changes classified as osteoarthrosis with radiographic images are normal bone remodelling.     

Value of conventional tomography and computer tomography in therapy-resistant diseases of the paranasal sinuses

The informational value of conventional tomography as primary diagnostic method is pointed out in diseases of nasal sinuses resistant to therapy. 5 cases demonstrate the additional information gained by CT-differentiation of soft tissue structures, intraorbital and intracranial expansion. In 78.4% of the examined group of 51 patients conventional tomography allowed the diagnosis of a process limited to the nasal sinuses, further evidence by CT could be omitted. In 11 patients examined by CT additionally, the expansion of the process was defined more precisely and the assumed intraorbital and intracranial growth confirmed.     

Computed tomography in evaluation of gunshot wounds of the spine

Seven patients with gunshot wounds to the cervical, thoracic, or lumbar spine were evaluated with conventional radiography, complex motion tomography, and computed tomography (CT). Computed tomography was better than complex motion tomography or conventional radiography for the assessment of the presence of fracture(s), bony and metallic fragments, and associated soft tissue injuries. In each case CT provided additional information not available by the other techniques.     

Computed tomographic diagnosis of postoperative maxillary cyst (POMC)--a comparison with conventional tomography

We reviewed the computed tomographic (CT) findings of postoperative maxillary cyst (POMC) in 64 patients with 79 lesions, and evaluated its diagnostic efficacy. Typical CT finding of POMC was an expansile and homogeneous soft tissue mass with bone erosion. Thin-walled capsule and bony septation were also demonstrated in 72% and 35% of the lesions, respectively. A comparison between conventional tomography and CT has been made in the same subjects for evaluation of the detectability and extension diagnosis of POMC. CT proved to be superior to conventional tomography in diagnosing the presence and the extent of POMC. We conclude that conventional tomography is not necessary in diagnosis of POMC, when full examination of the paranasal sinus is performed by CT.     

Longitudinal stress fractures of the tibia: comparative study of CT and MR imaging

The aim of this study was to compare the performance of CT and MRI in the diagnosis of longitudinal stress fracture of the tibia (LSFT). A retrospective study of imaging findings was performed in 15 patients with LSFT. The CT and MR images were compared for detection of fracture line, callus, bone marrow edema, and soft tissues changes. The CT and MRI techniques allowed the detection of the fracture line in 82 and 73 % of cases, respectively. The callus was always visualized with CT or MRI. The MRI technique had a markedly higher sensitivity than CT in the detection of bone marrow edema (73 vs 18 %) and soft tissue lesions (87 vs 9 %). This may cause a misleading aggressive appearance on MRI. Computed tomography remains the best imaging modality for diagnosis of LSFT. However, MRI findings should be known to obviate the performance of CT or bone biopsy. Received 26 May 1997; Revision received 1 October 1997; Accepted 13 November 1997     

MRT of intrathoracic space-occupying lesions--conventional and new rapid study technics

100 patients with histologically and cytologically confirmed intrathoracic space-occupying growths were examined by CT and MR over and above conventional x-ray film diagnosis. MR tomography was performed in all the 100 patients via ECG-triggered T1 and T2 weighted spin echo sequences. The last 35 patients were additionally examined via gradient echo sequences with which it is possible to examined 24 consecutive layers in any layer plane within 7 minutes without ECG triggering. Comparative evaluation of CT and MR tomography yielded an equally high degree of sensitivity when identifying intrathoracic growths. Compared to CT, determination of tumour status via MR tomography proved easier in individual cases. Other advantages of MR tomography were seen in the staging of bronchial carcinomas. Compared with conventional spin echo sequences the rapid gradient echo sequences reduced examination periods by more than 50%. In the cardiac region and the mediastinal structures that pulsate with it the diagnostic value of the gradient echo images is at present slightly impaired by fuzziness caused by movement. The image quality of the spin echo images is comparatively good in the regions of the superior and posterior mediastinum, the lungs and the thoracic wall.     

Computed tomography in unilateral extremity swelling of unusual cause.

Computed tomography (CT) were used in the evaluation of unilateral soft tissue swelling of unusual cause. Three patients with unilateral myositis are described and the diagnostic information provided by the CT scan is discussed. A fourth patient with lymphedema praecox and unilateral extremity swelling is presented.     

Occipital condyle fractures: clinical presentation and imaging findings in 76 patients

The aim was to assess the frequency and type of occipital condyle fractures in patients with significant trauma, and determine the frequency in which conventional radiographic findings are positive. Secondarily, we subjectively evaluate the application of existing classification systems. Fracture of the occipital condyle is an uncommon lesion that may be associated with craniocervical instability. Relying on conventional radiographs to detect these injuries may be inappropriate. An institutional trauma database of patients was searched for patients with occipital condyle fractures. The types of fractures were classified retrospectively based on re-review of imaging studies, using existing classification systems. Frequency of types was calculated, and the ease of use of the fracture classifications was evaluated subjectively. Conventional radiographs were reviewed for the presence of subjective soft tissue swelling and the visibility of the fracture(s). Seventy-six patients had CT images available for re-review. None of the occipital condyle fractures could be identified in the 60 patients who had radiographs available for re-review. Because of the presence of life support tubing and pharyngeal fluid limiting evaluation of prevertebral soft tissue swelling, the presence of widened prevertebral soft tissues was only helpful in 7 of the 60 patients. The multiplanar reformatted CT images were useful to determine alignment at C0–C1 and C1–C2. Occipital condyle fractures were not visualized on conventional radiographs. Secondary findings of soft tissue swelling were often absent or unreliable. CT scanning with multiplanar reconstruction imaging plays an indispensable role in evaluating for fractures of the cervical spine, and for determining alignment at C0–C1–C2. The most recently developed classification system of Tuli et al. (Neurosurgery 41: 368–376, 1997) is useful, but suffers from the lack of a defined distinction between undisplaced (Type I, stable) and displaced (Type 2A, unstable) fracture fragments.