Phalangeal microgeodic syndrome

Phalangeal microgeodic syndrome specifically affects the phalanges in infants. The radiographic findings are characterized by small lacunae measuring less than 1 mm in diameter in the phalanges. The symptoms usually subside spontaneously within 2 to 3 months with no residual deformity. Accurate diagnosis is possible by radiologists with knowledge on this disease entity.     

Bone mineral measurement of phalanges: comparison of radiographic absorptiometry and area dual X-ray absorptiometry

With a standard, image-intensifier-based, digital radiographic system, high-spatial-resolution images of the hand were acquired for analysis of phalangeal bone mineral density with dual x-ray absorptiometry (DXA). Results with phalangeal DXA had precision of plus or minus 0.67% and accuracy of 4.1% and correlated well with those with radiographic absorptiometry. This phalangeal DXA technique is potentially useful for clinical diagnosis of osteoporosis.     

Soft tissue manifestations of early rheumatic disease: imaging with MRI

PURPOSE: The aim of this study was to evaluate typical magnetic resonance imaging (MRI) findings in early rheumatic diseases manifesting at the soft tissues of the hand using a retrospective analysis. MATERIAL AND METHODS: A total of 186 MRI examinations of patients with clinical suspicion of a rheumatic disease were evaluated in a consensus reading by two experienced radiologists. All imaging patterns were assessed with respect to their type and localization. Under blinded and non-blinded conditions diagnoses were correlated with final clinical diagnosis. RESULTS: The most frequent diagnoses were rheumatoid arthritis (RA, 45.7%) and psoriatic arthritis (PsA, 15.6%). The mean correlation between clinical and MRI diagnosis (r) was 0.75 in blinded and 0.853 in non-blinded reading (p <0.001). The following extra-articular imaging patterns were found: synovitis (59.1%), tendovaginitis (91.4%), dactylitis (14.5%), and bone marrow edema (18.3%). Only dactylitis was specific for a particular rheumatic disease (PsA; r=0.934; sensitivity 84.9%, specificity 82.4%). CONCLUSION: Inflammatory conditions of the hand can be reliably detected with MRI. In many cases the definite diagnosis can only be made when taking clinical, serological, and radiographic results into account (+13.7% increase of significance).     

Membranous lipodystrophy: skeletal findings on CT and MRI

Membranous lipodystrophy, also known as Nasu–Hakola disease, is a rare hereditary condition with manifestations in the nervous and skeletal systems. The radiographic appearance of skeletal lesions has been well described in the literature. However, CT and MRI findings of lesions in the bone have not been documented to date. This report describes the radiographic, CT, MRI, and histopathologic skeletal findings in a case of membranous lipodystrophy. With corroborative pathologic findings, a diagnosis of membranous lipodystrophy on imaging allows for appropriate clinical management of disease manifestations.     

Radiologic approach to the diagnosis of infectious pulmonary diseases in patients infected with the human immunodeficiency virus

Nearly all patients infected with HIV experience respiratory infection at some point in the course of their illness. The spectrum of infections is varied and in order to generate a useful differential diagnosis based on imaging findings it is imperative for the radiologist to be aware of changing trends in disease prevalence and epidemiology, and the possible pathology related to new therapies. The characterization of the radiographic pattern in correlation with clinical findings and laboratory values (in particular the degree of immunosuppression as reflected in the CD4 level) would be helpful in narrowing the differential diagnosis of infectious pulmonary disease in HIV-positive patients. The most common radiologic patterns considered include areas of ground-glass, consolidation, nodules, and lymphadenopathy. We also include airways diseases and cavitary/cystic lesions because their prevalence has increased over recent years, and we also mention the significance of a normal chest radiograph in the suspicion of a lung infection. In most cases, the clinical and radiographic findings are sufficient for confident diagnosis. The radiologic diagnosis of thoracic infections in patients with AIDS has improved with the use of CT. The greatest value of CT is in excluding lung disease when the radiographic findings are equivocal and in confirming the presence of clinically suspected disease when the radiograph is normal.     

Carcinoma of the small intestine and colon as a complication of Crohn disease: radiologic manifestations

Barium examinations of the large and small bowel were analyzed in six of seven patients who had adenocarcinoma in areas of the intestine affected with Crohn disease; radiographic changes were correlated with clinical, surgical, and pathologic findings. Radiographic examinations were available in five of these patients at the time of diagnosis of tumor. Two of the five patients demonstrated classic radiographic changes associated with carcinoma. In the other three cases, the radiographic changes were atypical for carcinoma and demonstrated progression of disease over time to include more portions of the bowel and presence of fistulas, strictures, and obstruction. The most frequent clinical presentation of adenocarcinoma in these patients was a recrudescence of symptoms after a long quiescent period. In patients with long-standing Crohn disease plus these clinical features and the above radiographic findings, the diagnosis of a coexisting carcinoma should be considered.     

Frühmanifestationen rheumatischer Gelenkerkrankungen an den Weichgewebestrukturen der Hand

Purpose

The aim of this study was to evaluate typical magnetic resonance imaging (MRI) findings in early rheumatic diseases manifesting at the soft tissues of the hand using a retrospective analysis.

Material and methods

A total of 186 MRI examinations of patients with clinical suspicion of a rheumatic disease were evaluated in a consensus reading by two experienced radiologists. All imaging patterns were assessed with respect to their type and localization. Under blinded and non-blinded conditions diagnoses were correlated with final clinical diagnosis.

Results

The most frequent diagnoses were rheumatoid arthritis (RA, 45.7%) and psoriatic arthritis (PsA, 15.6%). The mean correlation between clinical and MRI diagnosis (r) was 0.75 in blinded and 0.853 in non-blinded reading (p <0.001). The following extra-articular imaging patterns were found: synovitis (59.1%), tendovaginitis (91.4%), dactylitis (14.5%), and bone marrow edema (18.3%). Only dactylitis was specific for a particular rheumatic disease (PsA; r=0.934; sensitivity 84.9%, specificity 82.4%).

Conclusion

Inflammatory conditions of the hand can be reliably detected with MRI. In many cases the definite diagnosis can only be made when taking clinical, serological, and radiographic results into account (+13.7% increase of significance).     

Pediatric elbow fractures: MRI evaluation

Magnetic resonance imaging (MRI) was performed in eight patients under the age of 8 years who suffered elbow fractures, to assess possible fracture extension into the distal nonossified epiphysis of the humerus in seven cases and to determine the displacement and location of the radial head in one case. MRI allowed accurate depiction of the fracture line when it extended into the cartilaginous epiphysis. In four cases, MRI findings were confirmed at surgery. In five cases, surgery was obviated because no articular extension of the fracture was seen on MRI (4 cases) or because no displacement was noted (1 case). In one patient, the plain film diagnosis of a Salter type II fracture was changed to Salter type IV on the basis of the MRI findings. It is concluded that MRI might play a role in the preoperative evaluation of pediatric patients presenting with elbow trauma when extension of the fracture cannot be determined with routine radiographic studies. Elbow injuries in children may be difficult to diagnose by routine clinical and radiographic techniques [1, 4, 12, 14]. Diagnostic difficulty is due to the presence of multiple ossification centers of the distal humeral epiphysis and proximal radius and ulna; these are mostly cartilaginous until the age of 11–12 years and therefore invisible on radiographs. Following distal radial and distal tibial physeal fractures, epiphyseal elbow injuries are the most frequent epiphyseal injuries [8, 16]. These fractures tend to be unstable and often require surgical intervention. In addition, lasting sequelae such as cubitus valgus and delayed ulnar nerve palsy can occur if these fractures are not treated properly [8]. Most elbow fractures suspected to be unstable by clinical and radiographic evaluation are operated upon without additional imaging. Occasionally, arthrography or computed arthrography are used to assess epiphyseal extension and cartilaginous malignment [1, 3, 4]. Because of its ability to depict cartilage, MRI provides a noninvasive means of gaining information regarding the nonossified epiphysis. The purpose of this article is to present our preliminary experience using magnetic resonance imaging (MRI) for the detection of articular extension of elbow fractures and determination of displacement of fragments.     

CT characteristics of orbital pseudotumors and other orbital inflammatory processes

Orbital pseudotumor is a nonspecific inflammatory process of unknown etiology that may mimic a true orbital neoplasm, specifically lymphoma. It exhibits a highly variable clinical and radiographic presentation. Thirty-nine patients with a presumptive diagnosis of orbital inflammatory disease were examined with CT and evaluated with respect to 13 findings associated with inflammatory disease of the orbit. Pseudotumor was included as part of the differential diagnosis in 25 patients. Twenty-one cases received a final (clinical) diagnosis of pseudotumor. The remainder were comprised of a broad range of orbital inflammatory conditions. Key radiographic features required to entertain or exclude the diagnosis of pseudotumor included establishing the presence of an orbital mass, extraocular muscle enlargement, bony erosion, enhancement, and associated paranasal sinus disease.     

Epidermolysis bullosa: radiographic findings in 16 cases

Epidermolysis bullosa is a group of dermatologic disorders with varied inheritance patterns having the common manifestation of blister or bulla formation after minor trauma. Sixteen patients with the disease had the following radiographic manifestations: esophageal stricture (16), fecal impaction (six), vaginal stenosis (one), epithelial bridging and fusion of the digits (six), and aspiration changes in the lungs (two). Esophageal strictures involved the pharynx or cervical esophagus in eight cases and were multiple in five; they ranged in length from 2 mm to 15 cm and tended to progress over time. The findings of esophageal stricture, particularly when multiple and involving the proximal esophagus, and/or the presence of distal phalangeal atrophy with soft-tissue webbing suggest the diagnosis of epidermolysis bullosa.     

Potts disease: Diagnosis with magnetic resonance imaging

The eponymously named Potts disease is a relatively rare form of Tuberculosis (TB) which affects the spine. TB of the spine is one of the earliest diseases known to man and in the 20th century was thought to be a disease which had been defeated by the advent of antitubercular drugs. Over the last two decades there have been several reports which indicate a revival of TB in both the developing and developed world. Factors which may be contributing to this are the spread of the HIV virus, increased immigration and the emergence of drug resistant strains of the TB bacteria. Potts disease has an insidious onset and often the radiographic findings are far advanced when a diagnosis is finally reached. MRI is able to detect changes to the vertebrae in Potts disease earlier than radiographs. This case report outlines the clinical presentation of a young male with Potts disease who was HIV negative, and the important role that MRI plays in diagnosis and therefore in appropriate and timely intervention. The typical magnetic resonance (MR) imaging features and the radiographic hallmarks of the disease will also be discussed.     

The radiology of opportunistic pneumonias. I: Epidemiological, laboratory and clinical background

In the guidelines of the German Society of Pneumology on diagnosis and therapy of opportunistic pneumonias, chest x-ray is listed as the basic diagnostic method in congenital and acquired immunodepression. In case of discrepancy between radiographic and the clinical findings or in cases of bilateral infiltrates, infection refractory to therapy or a difficult course in patients requiring artificial ventilation, a CT, or if necessary, ultrasound or MRI should be carried out. Cross-sectional imaging allows more precise assessment of the radiological pattern, estimation of the degree of severity (number of infiltrated segments) and detection of complications (pleural effusion, empyema, thorax wall infiltration). Clinical and laboratory parameters, bacteriological and serological examinations as well as information on the underlying immunocompromising factors must be taken into account in the differential diagnosis. The radiographic finding is an important diagnostic parameter which is used in the determination of the degree of severity of the pneumonia. The pattern of findings is one of rationales for the use of antibiotic therapy. In the first part of this contribution the epidemiological, laboratory and clinical background of the diagnosis of opportunistic pneumonias is discussed.     

Reflex sympathetic dystrophy syndrome. Contribution of magnetic resonance

An attempt was made to establish Magnetic Resonance Imaging (MRI) diagnostic criteria for the study of the reflex sympathetic dystrophy syndrome (RSDS). Five patients with hip and knee pain were studied. The radiographic pattern was "positive" only in two patients, while radionuclide studies showed increased activity in the painful joint in all; only in three cases Computed Tomography was performed. In all patients MRI demonstrates the lesions and defines their extension. MRI allows a differential diagnosis between RSDS and other bone lesions such as osteonecrosis and tumors. The relation between anatomopathological findings of RSDS and MRI features is discussed. MRI proved to be a reliable technique in showing and characterizing RSDS better than radiographic examination (often "negative" in early phases), and radionuclide study (a sensitive but not specific technique).     

椎管内蛛网膜囊肿的影像诊断

目的分析椎管内蛛网膜囊肿的X线平片、CT及MRI表现,以提高对本病的认识。资料与方法回顾性分析29例经手术病理证实的椎管内蛛网膜囊肿影像特征并评价不同影像方法对该病的诊断价值,X线平片及MRI检查29例,9例行CT检查。结果髓外硬脊膜下及较小的硬脊膜外蛛网膜囊肿X线平片无异常表现。较大的硬脊膜外蛛网膜囊肿X线平片、CT及MRI均显示椎管及椎间孔呈对称性扩大。CT及MRI显示囊肿的密度或信号与脑脊液类似,并能显示伸出椎间孔外的硬脊膜外蛛网膜囊肿有“分叉征”。只有MRI能正确显示囊肿在椎管内的位置,并能显示与蛛网膜下腔相通的裂孔平面的囊肿腔内有“脑脊液喷射征”。结论MRI对大多数椎管内蛛网膜囊肿具有定位和定性诊断价值,并可判断硬脊膜外蛛网膜囊肿与蛛网膜下腔相通的裂孔位置。CT对该病具有一定诊断价值,X线平片诊断意义有限。     

Hip osteoarthritis: what the radiologist wants to know

Osteoarthritis (OA) is the most common disease of the hip joint seen in adults. The diagnosis of OA is based on a combination of radiographic findings of joint degeneration and characteristic subjective symptoms. The lack of a radiographic consensus definition has resulted in a variation of the published incidences and prevalence of OA. The chronological sequence of degeneration includes the following plain radiographic findings: joint space narrowing, development of osteophytes, subchondral sclerosis, and cyst formation. There are cases though, that plain radiographs show minor changes and the clinical suspicion of early disease can be confirmed with more sophisticated imaging methods, such as multi-detector computed tomography and MR imaging. The present article will review all the clinical information on the hip OA together with an updated radiological approach, with emphasis on the early depiction and the differential diagnosis of the disease.     

Fractures easily missed by conventional radiographic diagnosis]

Although conventional radiography is the mainstay for diagnosing fractures, there are multiple conditions in which a fracture can be overlooked by the radiologist. This report focuses on the radiographic findings of various presentations of fractures including (1) minimally displaced fractures, (2) avulsion fractures, (3) stress fractures, (4) incomplete fractures and physeal injuries in children, and (5) occult fractures complicated with overt injury. Radiologists need to be familiar with these relatively common entities and aware of the limitations of radiography for fracture diagnosis; there are cases that can be diagnosed clinically without radiographic findings of cortical disruption. Repeated radiographic examination, CT, or MRI may be indicated depending on the clinical situation. The involvement of radiologists in the routine interpretation of conventional radiographs in trauma settings is encouraged to improve the detection of subtle fractures.     

Radiologie der opportunistischen Pneumonien

In the guidelines of the German Society of Pneumology on diagnosis and therapy of opportunistic pneumonias, chest x-ray is listed as the basic diagnostic method in congenital and acquired immunodepression. In case of discrepancy between radiographic and the clinical findings or in cases of bilateral infiltrates, infection refractory to therapy or a difficult course in patients requiring artificial ventilation, a CT, or if necessary, ultrasound or MRI should be carried out. Cross-sectional imaging allows more precise assessment of the radiological pattern, estimation of the degree of severity (number of infiltrated segments) and detection of complications (pleural effusion, empyema, thorax wall infiltration). Clinical and laboratory parameters, bacteriological and serological examinations as well as information on the underlying immunocompromising factors must be taken into account in the differential diagnosis. The radiographic finding is an important diagnostic parameter which is used in the determination of the degree of severity of the pneumonia. The pattern of findings is one of rationales for the use of antibiotic therapy. In the first part of this contribution the epidemiological, laboratory and clinical background of the diagnosis of opportunistic pneumonias is discussed.     

Magnetic resonance in the diagnosis of bone infections

Skeletal infections represent a variety of clinical and pathological conditions in which both an early diagnosis and the precise evaluation of disease extent are very important in planning proper therapy. To determine MRI capabilities and limitations in the evaluation of skeletal infections 21 patients--12 with a clinical diagnosis of osteomyelitis of the lower limbs and 9 with a clinical diagnosis of spondyloscitis--were studied with this technique. All patients were examined with conventional X-rays; conventional tomography was performed in 3 cases, and CT in 6. Signal intensities and morphological aspects were then evaluated with MRI. MRI diagnoses were compared with surgical findings or clinical follow-up, after antibiotic therapy: 19 true-positives were observed, together with 1 true-negative, 1 false-positive, and no false-negatives. MRI findings were correlated with those of conventional radiology: MRI identified the lesions and their nature in 100% of cases, whereas conventional radiology did the same in 85% of cases; in 50% of cases only the latter was able to define the nature of the process. Four patients underwent MRI follow-up. MRI was highly sensitive in determining the presence of lesions in an early stage and in demonstrating lesion regression. Moreover, MRI was able to identify the complications occurring in some cases of osteomyelitis and spondyloscitis. In all cases MRI allowed the extent of the disease to be accurately determined and, in osteomyelitis of the lower limbs, it was extremely useful to differentiate soft-tissue infections from bone marrow involvement.     

Maxillofacial fibrous dysplasia: personal experience with gadoliniumenhanced magnetic resonance imaging

PURPOSE: The authors sought to identify radiological criteria assisting in the diagnosis of craniofacial fibrous dysplasia and differential diagnosis of fibro-osseous lesions by comparing computed tomography (CT) and magnetic resonance imaging (MRI) findings and histological results in 23 patients with presumed fibrous dysplasia. MATERIALS AND METHODS: From February 2000 to March 2005, 23 patients (17 women and six men, aged 9-66 years) with facial bone disease underwent CT and MRI studies. Imaging findings were compared with the results of histological examination performed within 1 month of the radiological diagnosis. RESULTS: The combination of CT and MRI led to a presumptive diagnosis of fibrous dysplasia in all cases, but histology confirmed the diagnosis in 18 cases only. In two cases that had initially been considered cyst-like variants of fibrous dysplasia and were associated with irregular enhancement at MRI, histology characterised the lesions as single locations of multiple myeloma. In one case, targeted biopsy of areas showing intense enhancement led to a diagnosis of low-grade fibrosarcoma; in the remaining two cases, the definitive diagnoses were ossifying fibroma and myeloproliferative disease. CONCLUSIONS: MRI proved useful in differentiating fibrous dysplasia from other bone diseases, defining clinical behaviour, identifying neoplastic foci within dysplastic tissue and distinguishing benign from malignant bone lesions. The authors suggest a broader use of contrast-enhanced MRI for the diagnosis and follow-up of dysplastic lesions of the facial bones and for planning appropriate surgical treatment.     

Uncommon CT findings in relapsing polychondritis

Relapsing polychondritis is a rare inflammatory disorder of cartilage with well-established clinical features and imaging characteristics. Abnormal calcification and erosion of cartilaginous structures are the traditional radiographic findings. As with any disease, aberrancies of the expected clinical presentation may lead to a delayed (or missed) diagnosis. We discuss a rare case of relapsing polychondritis in which the diagnosis was suggested on the basis of CT findings, despite uncharacteristic clinical and radiographic manifestations of the disease.