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1.
Ischiopubic insufficiency fractures: MRI appearances 总被引:1,自引:0,他引:1
Objective. To evaluate the MRI appearances in insufficiency fractures. Design. A retrospective analysis of spin echo MR images with gadolinium-enhancement was undertaken with the emphasis on the signal
change and the shape of the fracture gap and the adjacent bone marrow. Patients. Five elderly women who had ischiopubic insufficiency fractures (pubis, 4; ischium 1) underwent MRI to exclude the possibility
of pathologic fractures. Results and conclusions. In no case was contrast enhancement noted at the fracture gap or the adjacent bone marrow, but a cleft-life, elongated bright
signal area suggesting “fluid collection” was noted within the fracture gap. Absence of contrast enhancement and “fluid collection”
at the fracture gap might suggest nonunion of a fracture, which is additional information provided only by MRI. 相似文献
2.
MR imaging of supra-acetabular insufficiency fractures 总被引:3,自引:0,他引:3
Objective. Diagnosis of insufficiency fractures in the pelvis is difficult, especially in patients with prior malignancy, irradiation,
steroid therapy or osteoporosis. This report shows the MR imaging appearance of supra-acetabular insufficiency fractures and
how they can be differentiated from metastatic disease. Design and patients. Twelve patients (four men, eight women, average age 72.8 years) at risk for pelvic insufficiency fractures and who had pelvic
or hip pain were studied with MR imaging. Indications were possible recurrent tumor or previous radiation to the pelvis (7
patients); osteoporosis from steroid use in rheumatoid arthritis (two patients); to exclude osteonecrosis of the hip (two
patients); or to rule out a hip fracture (one patient). Results. A characteristic linear region of low signal intensity on both T1- and T2-weighted sequences was found in the supra-acetabular
region paralleling the superior acetabulum in a curvilinear arc in 92% (11/12) of cases, and oblique in origin in 8% (1/11).
Diffuse bands of high signal on T2-weighted images indicated surrounding edema. In two cases, MR findings obviated biopsy.
One patient underwent a biopsy prior to the imaging studies being reviewed. All patients were treated conservatively and did
well. Discussion. Attention to insufficiency fractures has previously focused on characteristic locations in the sacrum and pubic bones. Supra-acetabular
insufficiency fractures also occur and are difficult to diagnose without a high degree of suspicion. MR imaging is a useful
tool for diagnosing supra-acetabular insufficiency fractures. The characteristic MR imag-ing appearance of these fractures
can preclude additional diagnostic studies and therapy in most instances. 相似文献
3.
Twelve parasymphyseal insufficiency fractures of the os pubis are described in eight osteopenic postmenopausal women, three of whom had rheumatoid arthritis. The fractures involved both right and left pubic bones in three women. Radiographically lesions often appear deceptively destructive and malignant. In six patients, biopsy was performed and showed no tumor. Biopsy can be avoided in an osteopenic woman with recent increased activity, pubic pain, and the characteristic pubic lesion. 相似文献
4.
Subchondral insufficiency fractures of the femoral head 总被引:2,自引:0,他引:2
The aim of this study was to increase awareness of, and to show the variable clinical and radiological features of, subchondral insufficiency fractures of the femoral head. The clinical and radiological findings in 7 patients with subchondral insufficiency fractures of the femoral head were reviewed retrospectively. The diagnosis was confirmed histologically in 4 patients. Radiographs were performed in all patients, MRI in 5 and scintigraphy in 4 patients. Radiographs showed varying degrees of femoral head collapse in 4 patients. In the remaining 3 patients radiographs showed a normal femoral head, regional osteoporosis and focal sclerosis, respectively. Magnetic resonance imaging showed a low-signal band on T1- and T2-weighted images in the subchondral bone adjacent or parallel to the articular surface associated with bone marrow oedema. Scintigraphy showed increased uptake in the femoral head. Insufficiency fractures of the femoral head are easily overlooked or confused with avascular necrosis and, when there is significant joint destruction, osteoarthritis. Unsuspected insufficiency fracture of the femoral head can lead to significant and rapid loss of bone stock in osteoporotic patients waiting for arthroplasty for osteoarthritis. Increased awareness of this condition will hopefully lead to earlier diagnosis and a successful outcome of conservative treatment. 相似文献
5.
Fujimoto H Nishimura G Motoori K Ueda T Tanaka Y Tsumurai Y Matsubara T Nosaka K 《Skeletal radiology》2000,29(5):286-288
We report a case of a metastatic bone tumor that mimicked spontaneous osteonecrosis of the medial condyle of the femur on
magnetic resonance imaging.
Received: 5 October 1999 Revision requested: 11 November 1999 Revision received: 10 January 2000 Accepted: 17 January 2000 相似文献
6.
Role of MRI in the diagnosis of insufficiency fractures of the sacrum and acetabular roof 总被引:4,自引:0,他引:4
Objective. To review the risk factors and the radiological appearance of insufficiency fractures of the sacrum and acetabular roof. Design and patients. Twenty patients with sacral and acetabular roof insufficiency fractures were reviewed retrospectively. There were 16 women
(80%) and 4 males (age range 48–86 years, excluding an 8-year-old boy). Thirteen patients had a known tumour, and nine had
received pelvic irradiation. All patients, except one who was asymptomatic, presented with low back or hip pain. In patients
with a known tumor, metastases were suspected. Plain radiography (20), bone scintigrams (16), MR examinations (20), and bone
densitometry (14) were performed. Nine patients also each had a CT scan. Results and conclusions. In three cases the CT scan performed 10–25 days after onset of symptoms was interpreted as normal. MR examination performed
a few days after the CT scan showed in each of these three patients a fracture line with a band of edema. Scintigraphy was
very sensitive, but the H-shaped pattern of sacral uptake, specific for an insufficiency fracture, was detected in only three
of 16 cases. The earliest MR sign was medullary edema, seen as early as 18 days after the onset of symptoms. On spin echo
(SE) T1-weighted images (T1WI), the hypointense signal of edema could mask a fracture line. On SE T2WI the fracture line could
be detected within the hyperintense edema (10 of 17 patients with examinations including SE T2WI). However, in four patients
a fracture of the sacrum was not seen on T2WI, these having been obtained in the axial plane. For this reason, intravenous
gadolinium was injected, revealing a fracture line in 12 of 14 examinations, or fat suppression sequences were performed,
revealing a fracture line in five of five cases. The total number of fractures detected was 17 [15 fractures of the sacrum
(bilateral in 10 cases) and two of the acetabular roof]. At a later stage, the edema resolved and the fracture was clearly
seen. The two cases of fracture of the acetabular roof were easily recognized at MRI, particularly in the sagittal plane. 相似文献
7.
Magnetic resonance appearance of sacral insufficiency fractures 总被引:5,自引:0,他引:5
Sevil Kursunoglu Brahme M.D. Vinicio Cervilla M.D. Vinton Vint M.D. Kay Cooper M.D. Keith Kortman M.D. Donald Resnick M.D. 《Skeletal radiology》1990,19(7):489-493
Insufficiency fractures of the sacrum are a commonly recognized form of stress fracture typically occurring in elderly patients. As such patients usually present with low back pain, MR imaging is often performed initially as a means of evaluation. We present 5 patients with sacral insufficiency fractures imaged with MR. Metastatic disease was a leading clinical suspicion as all patients were elderly and three had known primary neoplasms. T1-weighted sequences demonstrated bands of decreased signal intensity, usually paralleling the sacral aspect of the sacroiliac joints and occasionally occurring as a horizontal band across the sacral body. Four of five patients underwent further evaluation with computed tomography (CT) or nuclear bone scanning, which confirmed the diagnosis of sacral insufficiency fracture. We conclude that MRI is sensitive but not specific in detecting sacral insufficiency fractures. As MR imaging is rapidly becoming the method of choice for evaluating back pain, it is important to consider this diagnosis in elderly persons. 相似文献
8.
Insufficiency fractures of the sacrum 总被引:1,自引:0,他引:1
Insufficiency fractures of the sacrum are not uncommon. Shared imaging features on radionuclide bone scan, CT, and MR images
include linear vertical abnormalities, and unilateral or bilateral distribution. This pattern may be considered sufficiently characteristic to allow
a confident correct diagnosis to be made. Radiologists need to have a greater awareness of this condition. 相似文献
9.
Sacral insufficiency fractures develop over a period of time and show time-dependent changes. We report on 15 CT examinations of 5 patients with early-stage insufficiency fractures of the sacrum. In 4 patients only irregular sclerosis without distinct fracture lines was present in 7 of 8 fractures. Of these 4 patients; 3 exhibited intraosseous gas inclusions in a ventral part of a lateral mass; 5 of 8 fractures disclosed a ventral cortical break. When distinct fracture lines had developed in 1 patient, intraosseous vacuum phenomenon had disappeared. Fracture lines evolve over weeks to months and show central bone absorption. The fractures can heal as demonstrated in 4 of 6 fractures in 3 patients, can persist over 1 year without significant changes or can progress to pseudoarthrosis with bone destruction similar to neuropathic joint disease. Intraosseous vacuum phenomena can persist to this stage. Intraosseous vacuum phenomenon is recognized as a potential finding in the early stage of sacral insufficiency fracture, which also is true for irregular sclerosis and ventral cortical disruption.
Correspondence to: A. Stäbler 相似文献
10.
Diabetic muscle infarction: atypical MR appearance 总被引:4,自引:0,他引:4
We describe a case of diabetic muscle infarction which had atypical features of hyperintensity of the affected muscle on T1-weighted
images. Biopsy was performed which revealed diffuse extensive hemorrhage within the infarcted muscle. We believe increased
signal intensity on T1-weighted images should suggest hemorrhage within the infarcted muscle.
Received: 8 March 2000 Revision requested: 14 April 2000 Revision received: 5 May 2000 Accepted: 11 May 2000 相似文献
11.
Objective. The objective of this study was to evaluate the value of magnetic resonance (MR) imaging in the diagnosis of the os trigonum
syndrome. Design. Sagittal and coronal spin echo MR sequences of the ankle were acquired along with sagittal images in both dorsiflexion and
plantar flexion. Patients. Three consecutive patients presenting with posterior triangle pain were assessed. Results and conclusions. MR imaging delineated the anatomical site of the abnormality and demonstrated coexisting pathology in all patients. Flexion/extension
MR images yielded additional information regarding the mobility of the os trigonum in one patient. MR imaging is the technique
of choice for investigating the os trigonum syndrome. 相似文献
12.
13.
Objective. Spring ligament insufficiency is associated with chronic posterior tibial tendon dysfunction, and may constitute an indication
for surgical repair or reconstruction. This study examines the accuracy of MRI for the diagnosis of insufficiency of the spring
ligament. Design and patients. Two experienced musculoskeletal radiologists independently scored the MRI findings in 13 cases of surgically proven spring
ligament insufficiency and in 18 control subjects, using a standardized scoring system. Results. Insufficiency of the spring ligament was associated with increased signal heterogeneity on short TE spin echo images, and
an increase in the thickness of the medial portion of the ligament. The sensitivity of MRI for the diagnosis of spring ligament
insufficiency was 54–77%, while the specificity was 100%. MRI assessment of the plantar portion of the spring ligament was
unreliable (kappa=0.33), but the assessment of global ligament integrity was substantially reproducible (kappa=0.76). Conclusion. The medial portion of the spring ligament can be reliably assessed on routine MRI. The findings of spring ligament insufficiency
on MRI are only moderately sensitive but highly specific.
Received: 12 August 1998 Revision requested: 8 October 1998 Revision received: 21 January 1999 Accepted: 26 January 1999 相似文献
14.
The case of a 59-year-old man with chronic lateral ankle pain following an inversion injury is presented. MR imaging performed
to evaluate for soft tissue injury revealed an unsuspected fracture of the lateral process of the talus. The patient underwent
surgical exploration of the fracture with debridement of adjacent loose bodies and is currently undergoing aggressive physical
rehabilitation.
Received: 23 November 1998 Revision requested: 18 December 1998 Revision received: 4 January 1999 Accepted: 4 January 1999 相似文献
15.
Schneider G Uder M Altmeyer K Bonkhoff H Gruber M Kramann B 《European radiology》2000,10(9):1395-1400
We report a case of littoral cell angioma (LCA) of the spleen, a recently described splenic pathology, which imaging characteristics
and pathologic morphology have been discussed only by a few authors. The imaging findings in unenhanced and contrast-enhanced
MRI and CT as well as histologic specimen are presented. Diagnosis was made after elective splenectomy. Differential diagnosis
of splenic tumors as well as the imaging findings in this particular case are discussed.
Received: 7 July 1999; Revised: 18 January 2000; Accepted: 19 January 2000 相似文献
16.
We present the first reported MR imaging findings of a histologically proven clear cell hidradenoma. A fluid level was noted
on all pulse sequences in this lesion, which demonstrated a prominent hemorrhagic component on sectioning. The presence of
an enhancing nodule was also noted, differentiating this lesion from a post-traumatic hematoma. Fluid levels in a well-defined
subcutaneous soft tissue mass should suggest the possibility of a hidradenoma.
Received: 19 June 1998; Revision requested: 29 July 1998; Revision received: 28 October 1998; Accepted: 29 October 1998 相似文献
17.
The authors describe the MR features of a case of microgeodic phalangeal syndrome in a 9-year-old boy. Roentgenograms showed
multiple small areas of osteolysis in the middle phalanx of the right index finger. T1-weighted MR images showed lesions with
diffuse low signal intensity not only in this phalanx but also in other phalanges. These lesions exhibited high signal intensity
on T2-weighted images. Contrast- enhanced T1-weighted images showed a wide non-enhancing area in the middle phalanx of the
index finger.
Received: 26 September 2000 Revision requested: 2 November 2000 Revision received: 25 November 2000 Accepted: 27 November
2000 相似文献
18.
Miller TT 《Skeletal radiology》2000,29(2):81-84
Purpose. To describe a technique for intra-articular injection in the MR suite after conventional fluoroscopic landmarking in order
to streamline MR arthrography.
Design and patients. This technique was performed on 33 consecutive patients referred for MR arthrography of the shoulder to evaluate the glenoid
labrum and on 15 consecutive patients referred for MR arthrography of the hip to evaluate the acetabular labrum. The patients
were landmarked in the fluoroscopy suite, followed by a conventional MR examination. The intra-articular injection was then
performed on the MR table and the MR arthrographic sequences obtained.
Results. One of the 48 injections was extra-articular, requiring a second injection. The other injections were performed without incident,
and the average total procedure time for all injections was 10 min.
Conclusions. This technique is a reliable method of streamlining intra-articular injections when performing conventional MR imaging prior
to the MR arthrographic portion of the examination. It shortens the total MR examination time by eliminating a visit to the
fluoroscopy suite in the middle of the MR study, and its use of a straight anterior approach for both the shoulder and hip
joints should be familiar to most people who perform conventional arthrography.
Received: 27 August 1999 Accepted: 26 October 1999 相似文献
19.
Subchondral insufficiency fracture of the femoral head: histopathologic correlation with MRI 总被引:5,自引:0,他引:5
Objective. To correlate the magnetic resonance imaging (MRI) features with the histopathologic findings in subchondral insufficiency
fracture (SIF) of the femoral head.
Design and patients. This study was based on a retrospective review of the MRI features and histopathologic findings in seven patients with SIF
who had had total hip replacement.
Results. In all seven cases, MRI showed a bone marrow edema pattern in the femoral head, and a focal low-intensity band beneath the
articular cartilage on some slices (not all) on the T1-weighted images. The shape of the low-intensity band varied: it was
irregular and serpentine in four cases, well-delineated, smooth, and a mirror image to the articular surface in two cases,
and parallel to the articular surface in one case. On histologic examination, the low-intensity band on MRI corresponded to
a fracture line and its associated repair tissue. In all but one case, the band was not visible on T2-weighted or fat suppression
images, and the proximal subchondral portion of the lesion had a homogeneous high signal intensity. This region of high signal
intensity corresponded histopathologically to viable bone and marrow tissue with associated callus, edema, and vascular granulation
tissue.
Conclusions. SIF of the femoral head characteristically demonstrates a low-intensity band on T1-weighted images that corresponds, histopathologically,
to a linear subchondral fracture and its associated repair tissue. In most cases, the subchondral portion of the lesion appears
on T2-weighted images as an area of homogeneously high signal intensity.
Received: 1 June 2000 Revision requested: 17 August 2000 Revision received: 11 October 2000 Accepted: 9 January 2001 相似文献
20.
Objective. To evaluate the findings in MRI-studies of the knee in recreational long-distance runners after competition and to assess
the reversibility of the findings.
Design and patients. Eight recreational long-distance runners underwent MRI studies of the knee before, immediately after and 6–8 weeks after
taking part in the Vienna City Marathon. The studies were evaluated regarding alterations of pre-existing lesions and new
pathological findings.
Results. In six runners without major pre-existing alterations no negative effects were experienced. In one runner with pre-existing
grade III alterations of the menisci, signs of progressive osteoarthritis were experienced 2 months after the competition.
In all other cases increased meniscal signal alterations and minor signal changes in the bone marrow after the race were transitory.
Conclusion. In healthy individuals no negative long-term-effects were experienced. Pre-existing high-grade lesions of the menisci might
be a predisposing risk for osteoarthritis, triggered by the stress of long-distance running.
Received: 17 February 2000 Revision requested: 13 June 2000 Revision received: 21 August 2000 Accepted: 9 September 2000 相似文献