Clinical utility of sonography in diagnosing plantar fasciitis.

OBJECTIVE: The purpose of this study was to investigate the efficacy of sonography in the detection of plantar fasciitis (PF) compared with magnetic resonance imaging (MRI) findings in subjects with inferior heel pain. METHODS: Seventy-seven patients with unilateral (n = 9) and bilateral (n = 68) heel pain were studied. Seventy-seven age- and sex-matched asymptomatic subjects served as a control group. Magnetic resonance imaging was used to establish a diagnosis of PF with sagittal T1-weighted, T2-weighted, and short tau inversion recovery sequences. The sonographic appearances of PF were compared with MRI findings. Plantar fascia and heel pad thickness were also measured on both imaging modalities. RESULTS: Compared with MRI, sonography showed 80% sensitivity and 88.5% specificity in assessing PF. A strong correlation was found between plantar fascia and fat pad thickness measurements done by sonography (P < .001; r = 0.854) and MRI (P < .001; r = 0.798). Compared with the asymptomatic volunteers, patients with PF had significant increases in plantar fascia and heel pad thicknesses, weight, and body mass index (P = .0001). Heel pad thickness was also significantly increased with pain duration (P = .021). CONCLUSIONS: Although MRI is the modality of choice in the morphologic assessment of different plantar fascia lesions, sonography can also serve as an effective tool and may substitute MRI in the diagnosis of PF.     

Posttraumatic Painful Hip

Objective. Nondisplaced hip fractures may be radiographically occult and require magnetic resonance imaging (MRI) or bone scintigraphy for diagnosis. Both examinations are expensive and are not readily available in many hospitals. Our objective was to evaluate sonography as a screening tool for occult hip fractures in posttraumatic painful hips in elderly patients. Methods. We prospectively evaluated 30 patients (mean age, 73 years), who were admitted for painful hips after having low‐energy trauma with nondiagnostic hip radiographs. After inclusion, patients underwent sonography of both hips for signs of injury. After completion of the sonographic examination and analysis of the results, patients underwent MRI of both hips. The sonographic findings were compared with the MRI findings, which served as the reference standard for accurate detection of a hip fracture. Results. Ten hip fractures were diagnosed by MRI. Sonography showed trauma‐related changes in all of those patients and in 7 additional patients, 3 of whom had pubic fractures. Sonography correctly identified 13 patients without hip fractures. The sensitivity of sonography was found to be 100%, whereas the specificity for hip fractures was 65%. Conclusions. Sonography for posttraumatic hip pain with negative radiographic findings did not result in a single missed hip fracture. Therefore, sonography may serve as an effective screening tool, mandating MRI only for cases with positive findings, whereas patients with negative sonographic findings need no further investigation. Sonography may therefore be very useful in hospitals around the world, where MRI may not be readily affordable or available.     

Correlation between sonographic and pathologic findings in muscle injury: experimental study in the rabbit.

OBJECTIVE: To evaluate the serial sonographic findings of experimental muscle injury and to correlate those findings with the pathologic findings at each period. METHODS: A muscle injury was artificially inflicted in 18 legs of 9 rabbits. Sonographic follow-up images were obtained 1, 3, and 7 days and 2, 3, 4, 6, and 8 weeks after infliction of muscle injury. Pathologic specimens were obtained for comparison with sonographic findings on each date. RESULTS: There was high echogenicity in the central portion after 3 days. It changed to low echogenicity after 7 days. There were linear echogenic lines in the central portion after 4 weeks, and these lines increased in number after 6 weeks. The peripheral portion exhibited high echogenicity up to 7 days. This high echogenicity was normalized after 2 weeks. Pathologic specimens showed hematomas, fibrin, and necrotic muscle fibers in the central portion up to 3 days after injury. Fibrin occupied most of the central portion after 2 weeks. Regenerating muscle fibers appeared within the fibrin clot after 4 weeks, and they became more prominent after 6 weeks. Necrotic muscle fibers, hemorrhage, and inflammatory cells of the peripheral portion disappeared after 2 weeks. CONCLUSIONS: Serial sonography of muscle injury was well correlated with the pathologic specimen up to 7 days after injury. After 4 weeks, regenerating muscle fibers showed a good correlation with the finding on sonography. Therefore, sonography can be helpful in diagnosis of muscle injury as well as in evaluation of the regenerating muscle fibers.     

Detection of muscle atrophy on routine sonography of the shoulder.

OBJECTIVE: To describe the utility of sonography in visualizing muscle atrophy during routine sonographic examination of the shoulder for evaluation of the rotator cuff tendons. METHODS: A retrospective review of 199 shoulder sonographic examinations performed by 2 musculoskeletal radiologists trained in musculoskeletal sonography with knowledge of the typical sonographic findings of muscle atrophy was performed. Reports were reviewed for the presence of muscle atrophy. If atrophy was present, the reports from those examinations were rereviewed for concomitant rotator cuff abnormalities. RESULTS: Forty-five examinations (23%) showed atrophy in at least 1 muscle on the basis of the criteria of increased echogenicity and decreased bulk. There were a total of 81 individual muscles that showed atrophy, with the following distribution: 16% supraspinatus (n = 13), 31% infraspinatus (n = 25), 36% teres minor (n = 29), 2% subscapularis (n = 2), and 6% biceps brachii (n = 5). In 34 of the 45 examinations with muscle atrophy, there were 57 concomitant full-thickness tendon tears: 64% supraspinatus (n = 29), 38% infraspinatus (n = 17), 7% subscapularis (n = 3), 0% teres minor (n = 0), 16% long head of biceps (n = 7), and 2% deltoid (n = 1). CONCLUSIONS: Although primary sonographic evaluation of the painful shoulder concentrates on the tendons of the rotator cuff, we suggest that examination of the muscles should become a standard component of the comprehensive shoulder sonographic examination, particularly given the potential clinical implications of muscle atrophy on the outcome of rotator cuff surgery.     

低场MRI诊断急性膝关节韧带损伤的应用效果分析

目的 观察低场核磁共振成像(MRI)在诊断膝关节侧副韧带和交叉韧带损伤程度的准确性,并与手术探查结果比较.方法 2007年6月至2009年6月期间因膝关节外伤来本院就诊接受MRI检查并接受手术治疗的患者186例,分析比较患者的MRI检查和手术探查结果.结果 186例患者MRI检查显示侧副韧带损伤患者169例(90.7%)、交叉韧带损伤患者119例(64.0%),均经手术探查证实,灵敏度为100%;MRI诊断侧副韧带和交叉韧带严重度与手术所见符合率分别为93.8%和94.1%.结论 MRI可以准确地诊断内外侧副韧带损伤和前后交叉韧带损伤,并能准确诊断其严重程度,为临床治疗方案的选择提供可靠依据.     

低场MRI诊断急性膝关节韧带损伤的应用效果分析

目的 观察低场核磁共振成像(MRI)在诊断膝关节侧副韧带和交叉韧带损伤程度的准确性,并与手术探查结果比较.方法 2007年6月至2009年6月期间因膝关节外伤来本院就诊接受MRI检查并接受手术治疗的患者186例,分析比较患者的MRI检查和手术探查结果.结果 186例患者MRI检查显示侧副韧带损伤患者169例(90.7%)、交叉韧带损伤患者119例(64.0%),均经手术探查证实,灵敏度为100%;MRI诊断侧副韧带和交叉韧带严重度与手术所见符合率分别为93.8%和94.1%.结论 MRI可以准确地诊断内外侧副韧带损伤和前后交叉韧带损伤,并能准确诊断其严重程度,为临床治疗方案的选择提供可靠依据.     

Puerperal vulvovaginal hematoma: sonographic findings with MRI correlation

Puerperal hematomas are a major complication of delivery. Little information about the role of sonography in the management of puerperal hematomas is available in the English literature. We report a case of a vulvovaginal hematoma that developed subsequent to vaginal delivery and that was managed conservatively using sonography. Our report includes the sonographic follow-up of the lesion with MRI correlation. The present case report suggests that sonography has a role in the detection and follow-up of the condition, with MRI providing a more detailed mapping of the lesion and excluding any retroperitoneal involvement.     

Sonographic evaluation of lower extremity interosseous membrane injuries: retrospective review in 3 patients.

OBJECTIVE: To describe the sonographic findings of lower extremity interosseous membrane disruption with computed tomographic and surgical correlation. METHODS: Three patients with sonographic evaluation of the lower extremity interosseous membrane were identified through the clinical experience of 1 author over a 5-year period. Sonographic images of the symptomatic and unaffected lower extremities were retrospectively characterized and correlated with computed tomographic and surgical findings by 2 fellowship-trained musculoskeletal radiologists. RESULTS: The normal interosseous membrane was identified in the asymptomatic lower extremities in all 3 patients, which appeared as a thin, hyperechoic (nearly equal to bone cortex) line, continuous from the tibia to the fibula. The abnormal interosseous membrane in all 3 cases appeared abnormally hypoechoic, poorly defined, and discontinuous at the tibia. A proximal fibular fracture was shown on sonography in 1 of 3 symptomatic lower extremities with radiographic evidence of a fracture. The sonographic findings correlated with the computed tomographic images. Distal tibiofibular syndesmosis injuries were confirmed and treated at surgery in 2 patients. CONCLUSIONS: Sonography can show both normal and injured interosseous membranes of the lower extremity, as well as associated proximal fibular fractures.     

Rudimentary horn pregnancy: first-trimester prerupture sonographic diagnosis and confirmation by magnetic resonance imaging.

OBJECTIVE: Two cases of rudimentary horn pregnancy diagnosed in the first trimester by sonography and confirmed by magnetic resonance imaging (MRI) are reported. We suggest criteria for early, prerupture sonographic diagnosis of this rare condition. METHODS: We report a case in which pregnancy in a rudimentary horn was suspected on routine sonographic examination. In the second case, sonographic examination at 11 weeks' gestation revealed a right unicornuate uterus and a noncommunicating left rudimentary horn containing a gestational sac. In both cases, MRI clearly confirmed the sonographic diagnosis, showing an empty cavity of the uterine body and a pregnant uterine horn without an endometrial communication to the uterine body. RESULTS: Both patients underwent surgery, and the pregnant rudimentary horns were resected with no complications. CONCLUSIONS: We suggest the following criteria for sonographic diagnosis of rudimentary horn pregnancy: (1) a pseudopattern of a asymmetrical bicornuate uterus, (2) absent visual continuity tissue surrounding the gestational sac and the uterine cervix, and (3) the presence of myometrial tissue surrounding the gestational sac. Typical hypervascularization of placenta accreta may support the diagnosis. Additionally, MRI can be used to confirm the diagnosis before an invasive procedure is undertaken.     

Comparison of sonography and MRI for diagnosing epicondylitis

PURPOSE: The aim of this prospective study was to compare the sensitivity and specificity of sonography with those of MRI in evaluating epicondylitis. METHODS: The affected elbows of 11 patients with suspected epicondylitis were examined sonographically, and the contralateral (normal) elbow was also examined for comparison. In 10 of these patients, the affected elbow was also examined with MRI. In addition, both elbows of 6 volunteers without epicondylitis were examined sonographically; 1 elbow of each volunteer was designated as the "test" elbow and was examined with MRI. The sonograms of the patients' affected elbows and the volunteers' test elbows were paired with the sonograms of the contralateral elbows for comparison and were randomly shown twice to 2 readers. These readers, working independently and without knowledge of the findings of MRI, were instructed to state whether each elbow was normal or affected by epicondylitis. The MRI scans were then shown to the readers for similar review. RESULTS: Sonographic features of epicondylitis included outward bowing of the common tendon, presence of hypoechoic fluid subadjacent to the common tendon, thickening, decreased echogenicity, and ill-defined margins of the common tendon. Sensitivity for detecting epicondylitis ranged from 64% to 82% for sonography and from 90% to 100% for MRI. Specificity ranged from 67% to 100% for sonography and from 83% to 100% for MRI. CONCLUSIONS: Sonography is as specific but not as sensitive as MRI for evaluating epicondylitis. Used as an initial imaging tool, sonography might be adequate for diagnosing this condition in many patients, thus allowing MRI to be reserved for patients with symptoms whose sonographic findings are normal.     

网球腿的MRI诊断价值及临床意义

目的:总结网球腿的MRI影像学特征,探讨MRI对网球腿的诊断价值及临床意义.方法:回顾性分析56例经临床诊断为网球腿患者的MRI资料,其中男47例,女9例;MRI检查主要采用冠状面T1加权成像(T1WI)、冠状面及横轴面脂肪抑制-质子加权成像(FS-PDWI)序列对小腿进行成像,由2名高年资放射科诊断医师分析MRI表现...     

What Does Magnetic Resonance Imaging Add to the Prenatal Sonographic Diagnosis of Ventriculomegaly?

OBJECTIVE: The purpose of this study was to determine the contribution of magnetic resonance imaging (MRI) in evaluating fetuses with the sonographic diagnosis of ventriculomegaly (VM). METHODS: Over 4 years, consecutive fetuses with the sonographic diagnosis of VM at 1 facility who underwent prenatal MRI at a second facility were included. The roles of MRI and follow-up sonography were tabulated. The patients were analyzed in 2 groups based on the presence or absence of other central nervous system (CNS) abnormalities. RESULTS: Twenty-six fetuses with a gestational age range of 17 to 37 weeks had sonographically detected VM (atria > or =10-29 mm), including 19 with mild VM (atria 10-12 mm). In group 1, 14 had isolated VM, 6 of which reverted to normal by the third trimester. Magnetic resonance imaging showed cerebellar hypoplasia not shown by sonography in 1 fetus and an additional finding of a mega cisterna magna in a second fetus. In group 2, 12 fetuses had VM and other CNS anomalies on sonography. Additional findings were seen with MRI in 10 of these fetuses, including migrational abnormalities (n = 4), porencephaly (n = 4), and 1 diagnosis each of abnormal myelination, hypoplasia of the corpus callosum, microcephaly, a kinked brain stem, cerebellar hypoplasia, and congenital infarction. There were significantly more fetuses with additional CNS anomalies found by MRI among those in group 2 compared with those in group 1 (Fisher exact test, P = .001). CONCLUSIONS: Although sonography is an accurate diagnostic modality for the evaluation of fetuses with VM, MRI adds important additional information, particularly in fetuses in whom additional findings other than an enlarged ventricle are seen sonographically.     

超声阴性胎盘早剥MRI表现及其诊断价值

目的 观察超声无阳性发现的胎盘早剥的MRI表现及其诊断价值。方法 收集53例产后确认为胎盘早剥孕妇的产前MRI,观察胎盘位置、血肿位置、分期及其与胎盘早剥分型和妊娠结局的关系。结果 16例胎盘位于子宫前壁及侧壁,37例胎盘位于子宫底及后壁。53例均可见胎盘血肿;29例血肿位于胎盘绒毛膜下,表现为新月形和弧形异常信号,T1WI、T2WI及DWI多呈高信号;24例血肿位于底蜕膜下,其中9例单纯底蜕膜下血肿表现为三角形和梭形异常信号,T1WI多呈等信号、T2WI及DWI呈高信号, 15例绒毛膜及底蜕膜下连续血肿表现为梭形、弧形或新月形异常信号,T1WI和T2WI多呈高信号,DWI呈低信号。32例血肿渗透至胎盘内,其中16例胎盘增厚。34例胎盘与子宫壁分离,胎盘母体面与子宫肌层之间存在间隙。不同位置胎盘早剥分型和妊娠结局差异均无统计学意义（P均>0.05）。底蜕膜下血肿较绒毛膜下血肿、急性期血肿较非急性期血肿更易发生重型胎盘早剥及接受急诊剖宫产（P均<0.05）。结论 MRI有助于判断胎盘血肿位置及分期,预测胎盘早剥分型;发现底蜕膜下急性出血时应予紧急处理。     

低场MRI诊断急性膝关节韧带损伤的应用效果分析

目的观察低场核磁共振成像（MRI）在诊断膝关节侧副韧带和交叉韧带损伤程度的准确性,并与手术探查结果比较。方法2007年6月至2009年6月期间因膝关节外伤来本院就诊接受MRI检查并接受手术治疗的患者186例,分析比较患者的MRI检查和手术探查结果。结果186例患者MRI检查显示侧副韧带损伤患者169例（90．7％）、交叉韧带损伤患者119例（64．O％）,均经手术探查证实,灵敏度为100％;MRI诊断侧副韧带和交叉韧带严重度与手术所见符合率分别为93．8％和94．1％。结论MRI可以准确地诊断内外侧副韧带损伤和前后交叉韧带损伤,并能准确诊断其严重程度,为临床治疗方案的选择提供可靠依据。     

Prenatal 3-dimensional sonographic and MRI findings in omphalocele-exstrophy-imperforate anus-spinal defects complex

We describe the second-trimester 3D sonographic and MRI findings of omphalocele-exstrophy-imperforate anus-spinal defects (OEIS) complex. We suggest that fetal 3-dimensional sonography with tomographic ultrasound imaging and MRI are useful adjuncts to conventional 2-dimensional sonography in the prenatal diagnosis of OEIS complex.     

脂质沉积性肌病的MRI诊断

目的:研究脂质沉积性肌病(LSM)的MRI表现,并评价MRI在LSM诊断中的应用价值。材料和方法:选择骨盆及双侧大腿肌肉,对9例LSM患者行MRI检查,采用自旋回波序列(SE)、快速自旋回波序列(FSE)及短时反转恢复序列(STIR)。结果:8例LSM患者的受累肌群均表现为片状短T1长T2异常信号,以臀肌及大腿后肌群受累为主,2例活动期患者的病变肌肉中尚混杂有斑片状长T1长T2异常信号影;1例无阳性表现。结论:LSM的MRI表现具有一定的特征性,受累肌群主要表现为脂肪沉积改变,在活动期,肌纤维可见斑片状坏死信号,病变双侧对称;MRI能为LSM的诊断、疗效判断及病情随访提供客观资料,并能为临床选取准确的活检部位提供定位。     

Sonography of intramuscular myxomas: the bright rim and bright cap signs.

OBJECTIVE: The objective of this study was to retrospectively review sonographic images of pathologically proven soft tissue myxomas to determine whether a sonographic correlate to the bright rim and bright cap signs described in the magnetic resonance imaging literature is present. METHODS: The study group consisted of 6 patients with pathologically proven soft tissue myxomas (1 man and 5 women; age range, 41-72 years; mean, 56.5 years). The available sonographic images for each subject were retrospectively reviewed by 2 authors (L.F. and K.F.), with agreement reached by consensus. Among other findings, images were also reviewed for a peripheral rim of increased echogenicity (termed the "bright rim sign") and for the presence of a triangular hyperechoic area adjacent to at least one of the poles of the mass (termed the "bright cap sign"). RESULTS: The bright rim and bright cap signs were seen in 5 (83%) of the 6 myxomas. The single case without the bright cap sign was not the same case as the one lacking the bright rim sign. CONCLUSIONS: The sonographic bright rim and bright cap signs were associated with 5 (83%) of the 6 intramuscular myxomas. These findings correlate with their magnetic resonance imaging equivalents, which are well documented in the literature, due to muscle atrophy and adjacent fatty infiltration. Recognition of these features may assist in a more accurate sonographic diagnosis before biopsy.     

Fine‐tuning the Diagnosis of Fetal Scalp Cysts

Objective. The purpose of this series is to emphasize the importance of an exhaustive and appropriately conducted sonographic examination in the correct diagnosis of fetal cystic scalp lesions and the place of magnetic resonance imaging (MRI) in the diagnostic sequence. Methods. Transabdominal and transvaginal 2‐ and 3‐dimensional sonography with color and power Doppler imaging as well as 3‐dimensional rendering techniques such as inversion and Doppler angiography were used. In 1 case, an MRI study was performed. Results. In 1 case, the MRI missed and the different sonographic techniques correctly made the diagnosis of a meningocele. In the second case, sonography was sufficient to establish the diagnosis of an epidermal cyst. Conclusions. These 2 cases show the value of going the distance with the newly available high‐frequency sonography. Ultimately, the correct diagnoses were made with the tools offered by sonography without the need for any other imaging modality.     

Sonography of partial-thickness quadriceps tendon tears with surgical correlation.

OBJECTIVE: With the use of surgical findings as the reference standard, the purpose of this study was to describe the sonographic findings of partial-thickness and complete tears of the quadriceps tendon and to determine whether sonography can potentially aid diagnosis. METHODS: Three hundred eighty-nine consecutive sonographic reports (January 1996 to April 2001) of the knee/quadriceps tendon were reviewed retrospectively and assessed for subsequent surgery on the quadriceps tendon. Seven cases were thus identified. Findings at surgery (complete versus partial tears) were compared with the original sonography reports. RESULTS: All 4 partial tears and 1 of 2 complete tears were diagnosed correctly on the basis of sonography. One complete tear was described as a partial tear on the basis of sonography. In a seventh case, complete disruption of the extensor mechanism with osseous avulsion of the superior pole of the patella was identified correctly. Dynamic scanning was essential in diagnosing a partial quadriceps tendon tear in 1 case. CONCLUSIONS: Sonography, including the use of dynamic evaluation, was helpful in the diagnosis of partial-thickness tears of the quadriceps tendon and may aid in differentiation of such cases from complete quadriceps tendon tears, particularly in the acute setting. The presence of scar tissue in the setting of chronic injury may represent a potential pit-fall in the assessment of partial versus complete quadriceps tears. Further study is needed to define the accuracy of sonography for detecting quadriceps tendon tears.     

Fetal magnetic resonance imaging in the evaluation of fetuses referred for sonographically suspected abnormalities of the corpus callosum.

OBJECTIVE: Fetal magnetic resonance imaging (MRI) has been shown to be useful in assessing the developing central nervous system. However, its utility in specific brain disorders has not been well investigated. We hypothesized that fetal MRI can better assess the integrity of the brain in cases with sonographically suspected callosal abnormalities. METHODS: We retrospectively reviewed fetal MRI and prenatal sonographic studies of 10 fetuses referred for MRI for sonographically suspected callosal abnormalities. RESULTS: An abnormal corpus callosum was identified on fetal MRI in 80% of cases. The type of callosal abnormality (complete or partial agenesis) was similar on both prenatal sonography and fetal MRI in all cases. All sonographically identified additional brain abnormalities were detected on fetal MRI, with the exception of choroid plexus cysts. Furthermore, in 63% (5 of 8) of cases with a callosal abnormality on both sonography and fetal MRI, additional brain abnormalities were detected on fetal MRI that were not apparent on sonography. These sonographically occult findings were confirmed on postnatal MRI or autopsy in 3 of 5 patients. CONCLUSIONS: Fetal MRI is an important adjunct to sonography in assessing the corpus callosum and other aspects of brain development when agenesis of the corpus callosum is suspected. It can identify frequent additional findings that are not visible on sonography such as abnormal sulcation. In light of the association between additional brain abnormalities and worse neurodevelopmental outcome, the potential of fetal MRI as an important adjunctive prognostic imaging test in fetuses with callosal agenesis can now be tested.