Calcaneal fractures: CT aspects

Calcaneal fractures account for 33.3% of foot fractures and 1.5% of all fractures. They were divided by Warrick and Brenner into two main groups according to whether they modify the astragalocalcaneal joint or not. Given the anatomical complexity of the foot, conventional X-rays are not always able to correctly visualize the articular facets and therefore provide insufficient information as to the characteristics of the fracture line, the position of bone fragments, and the involvement of capsulo-ligamentous structures. The authors report their personal experience with CT in the study of 12 patients with monolateral calcaneal fractures previously diagnosed on conventional X-rays. High-resolution CT (HRCT) was employed with 3-mm contiguous sections on the axial and the coronal planes. CT was used to study the normal anatomy of the foot and to evaluate 3 patients with calcaneal fracture without impaction of the posterior facet; 9 patients with impaction into the calcaneal body were also examined with CT. In the first 3 cases, an oblique fracture line was observed crossing from craniolateral to mediocaudal and thus dividing the calcaneus into 2 large fragments: sustentaculum tali and posterior facet of the talar joint. In the extant 9 cases the impaction of the posterior facet was indicated by an interruption in lateral and/or medial calcaneal walls. In 2/9 cases bone fragments were seen in the tarsal sinus, in 4/9 the sustentacular fragment was displaced, in 2 the cuboid bone was impacted into the anterior process of the calcaneus and, finally, in 7/9 cases a lateral/medial dislocation of the calcaneal tuberosity was observed. On the basis of these results, CT proved to be of greater value than conventional X-rays in the imaging of calcaneal fractures and to have a fundamental role every time an accurate evaluation of the region is needed to plan treatment.     

Magnetic resonance imaging of para-acetabular insufficiency fractures in patients with malignancy

AIM: To describe the characteristic magnetic resonance imaging (MRI) findings of para-acetabular insufficiency fractures in patients with malignancy, and compare the MRI appearance of these fractures with that of metastatic bone disease. MATERIALS AND METHODS: MRI examinations were reviewed in 16 patients with a known malignant tumour and severe hip pain that raised the possibility of local recurrence or metastatic disease. Six patients had received pelvic irradiation, and three patients were receiving steroid medication. RESULTS: The total number of fractures detected was 21: a solitary fracture was present in 11 patients and five patients had bilateral para-acetabular fractures. Two patients had associated sacral insufficiency fractures, and one of them had stress fractures involving both acetabular columns. Conventional radiography allowed the diagnosis of 14 (67%) fractures; six (28%) radiographic examinations were negative; and one (5%) examination was equivocal for fracture. Available scintigraphic and computed tomography (CT) studies revealed typical findings of fracture. Using MRI, insufficiency fractures appeared as linear regions of low signal intensity on T1- and T2-weighted images. Marked marrow oedema was evident in all cases. Fractures characteristically were parallel to the superior acetabulum in a curvilinear fashion in 18 (86%) instances, and were oblique in three (14%) instances. The fractures demonstrated considerable enhancement after intravenous gadolinium administration. No associated soft tissue masses were documented. CONCLUSION: Para-acetabular insufficiency fractures are a cause of hip pain, which may mimic skeletal metastasis in the patient with malignancy and pelvic irradiation. Recognition of the characteristic MRI findings of these fractures can preclude misdiagnosis and unnecessary bone biopsy.     

SARS合并糖尿病死亡原因分析

目的 :研究SARS合并糖尿病死亡原因。方法 :以我院 2 0 0 3年 4～ 6月收治的SARS合并糖尿病的 4 6例患者为研究对象 ,分为死亡组 (A组 )及治愈组 (B组 )。比较两组的生化指标、血氧饱和度 (SpO2 )、胸片、多器官功能衰竭 (MODS)、二重感染、激素用量、血常规以及CD3+ ,CD4 + ,CD8+ T淋巴细胞计数等。结果 :①A组丙氨酸转氨酶(ALT) ,尿素氮 (BUN) ,血清肌酸激酶 (CK) ,乳酸脱氢酶 (LDH)显著高于B组 (P <0 .0 1)。②A组SpO2 <95 % ,合并MODS ,二重感染及糖皮质激素日均用量≥ 16 0mg/d的例数均明显多于B组 (P <0 .0 5 )。③A组血小板 ,淋巴细胞 ,CD3+ ,CD4 + ,CD8+ T淋巴细胞计数显著低于B组 (P分别 <0 .0 1,0 .0 5 ,0 .0 0 1)。结论 :SARS合并糖尿病患者的死亡原因与肺损害、低氧血症、MODS、二重感染及激素用量密切相关。     

Indium-111 platelet kinetics in patients with diabetes mellitus

We performed in vitro aggregation and indium-111 labeled platelet kinetic and biodistribution studies in seven patients with diabetes mellitus and in five control subjects. All subjects were male. All diabetic patients were poorly controlled at the time of study with blood glucose greater than 140 mg % and hemoglobin A1c greater than 10%. In vivo kinetic and biodistribution studies were performed following reinjection of autologous platelets labeled with indium-111 oxine in a dose of approximately 50 microCi (42-67 microCi). Images obtained at 4 and 24 h were computer-analyzed to determine splenic and hepatic uptake, and platelet survival times were calculated using four mathematical models. Unexpectedly, diabetic patients with fewer vascular complications tended to have shorter platelet survival times than patients with advanced vascular disease. However, no significant differences were observed between diabetic and control groups for any of the parameters of platelet function evaluated.     

糖尿病并发脓肿的CT表现

目的：探讨糖尿病并发脓肿的CT表现特征。方法：回顾性分析26例糖尿病患者合并脓肿的CT表现。结果：并发脓肿的26例糖尿病患者中,25例病灶内出现气体,24例未出现液体,仅2例出现少量液体。结论：糖尿病并发脓肿在CT平扫上具有明显的特征,大多数不需要增强就可以明确诊断。     

Acetabular insufficiency fractures

Isolated acetabular insufficiency fractures are relatively uncommon occurrences that are difficult to diagnose if not suspected. Patients may present with variable signs and symptoms including emergent, incapacitating hip pain. Plain radiography is typically negative. Early diagnosis is important because most patients respond well to conservative therapy. This report describes three cases of isolated insufficiency fractures of the acetabulum diagnosed by magnetic resonance imaging (MRI).     

Supraacetabular insufficiency fractures

Insufficiency fractures in the supraacetabular region were identified in five women, aged 55-83 years. Factors contributing to the diminished resistance of their bones included postmenopausal osteoporosis, steroid therapy, radiation therapy, and rheumatoid arthritis. The supraacetabular fractures were seen on routine radiographs as hazy bands of sclerosis located immediately above and parallel to the acetabular roof. All five patients had additional fractures in the spine or pelvis. Supraacetabular insufficiency fractures may be an unsuspected cause of hip pain, especially in older women.     

Iliac insufficiency fractures

Twenty-five post-menopausal women with one or more insufficiency fractures of the pelvic ring are reported. In 80% of cases the fractures were multiple and a total of 79 insufficiency fractures was identified. Twelve iliac insufficiency fractures were present in 11 patients located at one of three sites: above and parallel to the acetabular roof ("supra-acetabular"), extending diagonally across the iliac ala from the greater sciatic notch ("oblique iliac"), and adjacent to the sacro-iliac joint ("superomedial iliac"). The plain radiographic appearances of these iliac fractures were typically subtle with ill defined medullary sclerosis, due to trabecular compression, the cardinal sign. Scintigraphy revealed the fractures as foci of increased activity which, in the presence of multiple pelvic insufficiency fractures, may be mistaken for metastatic disease. Computed tomography can be helpful in confirming the presence of suspected fractures, revealing further occult fractures and also excluding the likelihood of malignancy.     

糖尿病患者心电图改变的临床研究

目的观察和分析2型糖尿病患者心电图异常情况,以进一步加深对糖尿病心脏损伤的认识。方法对369例2型糖尿病患者常规和动态心电图进行分析,并与年龄、性别、基础疾病相匹配无糖尿病的对照组比较。结果糖尿病组最高心率（113±8）次/min较对照组（98±8）次/min显著增高,最低心率（51±10）次/min较对照组（66±8）次/min明显减低,心律失常较对照组明显增加,其中窦性196/43、房性307/99、交界性78/22、室性301/126、传导异常178/41、ST-T缺血性改变也均较对照组显著增多（ST段221/68、T波192/63）,差异有统计学意义（P〈0.05）。结论 2型糖尿病患者易发生心电图异常,可能与高血糖和低血糖对心脏损害等有关。     

带线锚钉治疗髌骨下极撕脱粉碎性骨折

目的探讨带线锚钉治疗髌骨下极撕脱粉碎性骨折的手术方法及治疗效果。方法回顾性分析2009年10月．2010年5月收治髌骨下极撕脱粉碎性骨折15例,采用带线锚钉固定治疗方法。结果术后患者伤121均一期愈合。随访6个月,3例关节强直,其余12例膝关节功能恢复良好。结论使用带线锚钉治疗髌骨下极撕脱粉碎性骨折操作简便,所需手术时间短;软组织剥离少,手术创伤小;固定牢固;适合手术后早期功能锻炼;对细小骨块不造成任何损伤,无须二次手术取出。     

Altered biodistribution of FDG in patients with type-2 diabetes mellitus

Objective

Positron emission tomography–computed tomography (PET–CT) imaging of patients with diabetes can be problematic because elevated glucose levels may cause competitive inhibition of [F-18]-2-deoxy-2-fluoro-d-glucose (FDG) uptake in different tissues. Therefore, the aim of the study was to evaluate the biodistribution of FDG in patients with type-2 diabetes mellitus.

Methods

Two hundred forty patients were retrospectively enrolled to the study. Study population was divided into three subgroups, named as the normal (group 1), the insulin (group 2) and the oral anti-diabetic (group 3). Unenhanced low-dose CT and PET emission data were acquired from the mid-thigh to the vertex of the skull. FDG uptakes in different organs were evaluated qualitatively or semi-quantitatively.

Results

In the diabetic groups, diffuse FDG uptake of the colon was increased (p > 0.001) but segmental FDG uptake was decreased (p > 0.001). Intestinal FDG uptake was detected in 20 % of the study population and only 3 % of these uptakes were in diffuse pattern. Segmental FDG uptake in the bowel was increased significantly in the groups of patients with diabetes (p = 0.002). Maximum standardized uptake values of the liver in the groups 1, 2, and 3 were 2.66 ± 0.6, 3.25 ± 0.9 and 3.16 ± 0.8, respectively, and the difference between the groups was not statistically significant (p = 0.083). Cardiac FDG uptake was decreased significantly in the groups of patients with diabetes (p < 0.001).

Conclusions

According to our results, whole body biodistribution of FDG uptake seems to be changed in patients with type-2 diabetes who were using insulin or oral antidiabetic drugs. Although the use of oral antidiabetic drugs was known to change the biodistribution of FDG, insulin use also seems to change FDG uptake in different organs of diabetic patients.     

绝经后女性2型糖尿病患者骨代谢研究

目的探讨绝经后女性2型糖尿病患者骨代谢及生化指标的特征。方法对我院内分泌科住院44例中老年女性2型糖尿病患者（均为绝经后）的骨代谢及相关指标进行检测。糖尿病患者根据病程分为糖尿病1组（糖尿病病程10年以下）及糖尿病2组（糖尿病病程10年以上,含10年）;根据糖化血红蛋白水平（HbA1c）分为糖尿病3组（HbA1c〈8％）及糖尿病4组（HbA1c≥8％）。同时选取我院50例体检健康女性作为对照组。结果①糖尿病组25-羟维生素D3、I型前胶原氨基末端（C端）前肽（PICP）及估计肾小球滤过率（eGFR）明显低于正常对照组,而抗酒石酸碱性磷酸酶（TrACP一5b）N显较正常对照组升高,且有统计学差异fP〈O．05）。②糖尿病2组患者血I型前胶原氨基末端（N端）前肽fPINP）、PICP和eGFR水平明显低于糖尿病1组患者（P〈0．051,而TrACP-5b水平高于糖尿病1组,雌二醇（estradiol,E）、25-羟维生素D,则无明显统计学差异。③糖尿病3组血PINP、PICP和eGFR明显高于糖尿病4组,TrACP-5b低于糖尿病4组,差异存在统计学意义（P〈0．05）。（4）HbAlc和eGFR与PINP、PICP和TrACP-5b存在显著相关性（相关系数〉0．3）,而雌二醇与PINP、PICP、25-羟维生素D3、TrACP-5b无明显相关性。结论（1）2型糖尿病患者的骨形成降低,而骨吸收增加,肾脏出现较重的损害,这提示糖尿病患者的骨质形成减弱、骨质破坏增加。②随着糖尿病病程的延长,患者的骨质形成速率减慢,骨吸收增加,肾脏损害加重。③血糖控制不佳会对骨的形成及骨质的吸收产生影响,而肾脏损害亦是加重发生骨质疏松的重要因素,因而严格的血糖控制可有效延缓骨质疏松进展。     

Muscle infarction in patients with diabetes mellitus: MR imaging findings

PURPOSE: To describe the magnetic resonance (MR) imaging findings in diabetic patients with muscle infarction and to describe commonly associated clinical features. MATERIALS AND METHODS: The MR imaging studies of 21 patients with diabetic muscle infarction were reviewed retrospectively. Of the 21 patients, 12 were women, and nine were men; the mean age was 48 years (range, 30-77 years). RESULTS: Eight patients had bilateral lower-extremity involvement; six had involvement confined to the right lower extremity and seven to the left. The thigh was involved in 17 patients (81%). One or more of the musculi vastus, the most frequently affected muscle group, were affected in 16 patients (76%). Four patients (19%) had isolated calf involvement. MR imaging studies showed diffuse enlargement of involved muscle groups and partial loss of normal fatty intermuscular septa. MR imaging also allowed identification of areas of subfascial fluid in 16 patients (76%) and subcutaneous edema in 19 patients (90%). MR imaging showed involved muscle groups best with T2-weighted, inversion-recovery, and gadolinium-enhanced sequences, where the infarcted muscles appeared diffusely hyperintense compared with adjacent muscles. Comparison of T2-weighted and gadolinium-enhanced MR images of nine patients showed enlarged, enhancing muscles in all patients and small, focal, rim-enhancing fluid collections in six of nine patients (66%). CONCLUSION: Diabetic muscle infarction is suggested in diabetic patients with sudden onset of severe pain in the thigh or calf muscles who have MR imaging findings of diffuse edema and swelling of multiple thigh and calf muscles (often in more than one compartment).     

糖尿病及并发症患者血清免疫球蛋白相关性研究

 目的 为探讨糖尿病及并发症患者血清免疫球蛋白(IgA)的异常特性。方法 采用日本岛津CL-7200全自动生化分析仪检测88名Ⅰ型糖尿病患者和79名Ⅱ型糖尿病患者血清免疫球蛋白(IgA)的含量。结果 Ⅰ型和Ⅱ型糖尿病患者IgA的含量比对照组IgA的含量显著增高(P＜0.01)。Ⅰ型糖尿病并发症神经病变患者的IgA含量最高,Ⅱ型糖尿病并发症高血压患者的IgA含量最高。其他各型并发症IgA的含量没有显著差异。结论 糖尿病患者IgA含量的变化对于糖尿病并发症的形成及发展程度密切相关,与机体的自身免疫功能密切相关。     

Role of MRI in hip fractures, including stress fractures, occult fractures, avulsion fractures

MR imaging plays a vital role in the diagnosis and management of hip fractures in all age groups, in a large spectrum of patient groups spanning the elderly and sporting population. It allows a confident exclusion of fracture, differentiation of bony from soft tissue injury and an early confident detection of fractures. There is a spectrum of MR findings which in part is dictated by the type and cause of the fracture which the radiologist needs to be familiar with. Judicious but prompt utilisation of MR in patients with suspected hip fractures has a positive therapeutic impact with healthcare cost benefits as well as social care benefits.     

Imaging of insufficiency fractures

This review focuses on the occurrence, imaging and differential diagnosis of insufficiency fractures. Prevalence, the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures occur with normal stress exerted on weakened bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. Other conditions which affect bone turnover include osteomalacia, hyperparathyroidism, chronic renal failure and high-dose glucocorticoid therapy. It is a challenge for the radiologist to detect and diagnose insufficiency fractures, and to differentiate them from other bone lesions. Radiographs are still the most widely used imaging method for identification of insufficiency fractures, but sensitivity is limited, depending on the location of the fractures. Magnetic resonance imaging (MRI) is a very sensitive tool to visualize bone marrow abnormalities associated with insufficiency fractures. Thin section, multi-detector computed tomography (MDCT) depicts subtle fracture lines allowing direct visualization of cortical and trabecular bone. Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but limited specificity. The most important differential diagnosis is underlying malignant disease leading to pathologic fractures. Bone densitometry and clinical history may also be helpful in confirming the diagnosis of insufficiency fractures.     

Imaging of insufficiency fractures

This review article focuses on occurrence, imaging, and differential diagnosis of insufficiency fractures. Prevalence and the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures are due to normal stress exerted on weakened bone. Most commonly postmenopausal osteoporosis is the cause for insufficiency fractures. Additional conditions affecting bone turnover include osteomalacia, chronic renal failure, and high-dose corticosteroid therapy. It is a challenge for the radiologist to detect and diagnose insufficiency fractures as well as to differentiate them from malignant fractures. Radiographs are the basic modality used for screening of insufficiency fractures, yet depending on the location of the fractures, sensitivity is limited. Magnetic resonance imaging is a very sensitive tool to visualize bone marrow abnormalities associated with insufficiency fractures and allows differentiation of benign versus malignant fractures. Thin section multidetector computed tomography (CT) depicts subtle fracture lines allowing direct visualization of cortical and trabecular bone. Dedicated Mikro-CTs (Xtreme-CT) can detect subtle fractures reaching an in-plane resolution of 80 μm. Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but unsatisfactory specificity. Positron emission tomography-CT with hybrid-scanners has been the upcoming modality for the differentiation of benign from malignant fractures. Bone densitometry and clinical fracture history may determine the future risk of possible insufficiency fractures.