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1.
The usefulness of computed tomography (CT) in the evaluation of musculoskeletal tuberculosis was assessed in 10 patients. In six tuberculosis affected the dorsal spine, in two the chest wall, in one the sacrum and sacroiliac joint, and in one the greater trochanter. At all sites the CT findings were qualitatively similar: specifically, destructive osseous changes associated with adjacent soft-tissue masses showing a characteristic rim enhancement. Soft-tissue calcification was present in 8 of the 10. In all patients, CT demonstrated more extensive involvement than could be seen on plain radiographs. In five patients, CT first suggested the diagnosis. We conclude that CT is helpful in the evaluation of patients with musculoskeletal tuberculosis. 相似文献
2.
We present a case of Langerhans' cell histiocytosis (LCH) of the liver and spleen in an adult. The imaging features are different
from those in the few previously reported cases of individual organ involvement by LCH.
Received: 22 October 1997; Revision received: 17 March 1998; Accepted: 20 March 1998 相似文献
3.
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. 相似文献
4.
We report a paediatric case of non-Hodgkin's lymphoma with secondary breast involvement. On US exam there were bilateral
multiple well-defined masses. Contrast-enhanced thorax CT demonstrated the breast lesions as well as enhancing masses. To
our knowledge, this type of lymphomatous breast involvement in a child is rare and its CT features are very rarely demonstrated.
Received: 16 October 1998; Revision received: 21 April 1999; Accepted: 28 May 1999 相似文献
5.
Objective. To determine the prevalence of radiographic evidence of sacroiliitis in a large population of patients with psoriatic arthritis.
Patients and design. Patients were recruited from 15 clinical centers. This was part of a large, multicenter study of patients with an established
diagnosis of ankylosing spondylitis, psoriatic arthritis, or reactive arthritis. For this cohort, an established diagnosis
of psoriatic arthritis was required, with cutaneous manifestations and involvement of at least three appendicular joints.
At entry, patients were not selected for the presence of axial involvement. Radiographs – one anteroposterior view of the
pelvis and one oblique view of each sacroiliac joint – were graded using the New York classification scale by a musculoskeletal
radiologist masked to the specific diagnosis and clinical symptoms. Re-evaluation of 10% of the films 3 years later quantified
intraobserver variability. Results. Two hundred and two patients with psoriatic arthritis were studied. Duration of the disease averaged 12 years; all patients
had psoriasis and peripheral arthritis. The prevalence of radiographic evidence of sacroiliitis (grade 2 or higher) was 78%;
71% of these had grade 3 disease. Conclusions. Previously reported prevalence of sacroiliitis in patients with psoriatic arthritis ranges from 30% to 50%. The prevalence
of radiographic evidence of sacroiliitis in this large multicenter cohort of patients with appendicular psoriatic arthritis
was substantially higher.
Received: 21 October 1998 Revision requested: 11 December 1998 Revision received: 19 January 1999 Accepted: 22 January 1999 相似文献
6.
It is currently very rare to find mammary involvement in cases of tuberculosis, in either primary or secondary form. Diagnosis
is classically clinical and microbiological, and the basic techniques used in imaging diagnosis are mammography and ultrasound.
Computed tomography may define the involvement of the thoracic wall in those cases which present as mammary masses adhering
to deep levels, and is also able to evaluate accompanying pulmonary disease, if it is present. Traditionally, treatment has
consisted of quadrantectomy and specific antibiotic therapy. We present a case of tuberculous mammary abscess secondary to
pulmonary disease, which was treated by percutaneous drainage controlled by CT and specific antibiotic therapy. We revise
the diagnosis, differential diagnosis and treatment of mammary tuberculosis.
Received: 27 July 1998; Revision received: 2 February 1999; Accepted: 20 April 1999 相似文献
7.
The objective of this study was to determine the utility of CT scan findings for the diagnosis of chest wall tuberculosis,
excluding the spine. We reviewed 15 patients (13 Africans and 2 Indians) with chest wall tuberculosis, retrospectively. The
radiologic examination consisted of a plain X-ray and a CT scan of the chest for each patient. The site of disease was the
rib in 13 patients or the body of the sternum in 2 patients. One rib was involved in 11 patients, 2 contiguous ribs (one site)
in 2 patients, and bilateral disease (two sites) was observed in the remaining patient. The 14 rib sites involved the posterior
arc or costovertebral joint in 11 cases, the anterior arc in 2 cases, and the anterior and middle arc in 1 case. The CT scan
findings were an abscess ( n = 14) or a soft tissue mass ( n = 2), osteolytic lesions ( n = 13), periosteal reaction ( n = 10), and sequestrum ( n = 14). Bone sclerosis was observed only in 3 cases of rib involvement. The association of a soft tissue abscess, an osteolytic
lesion, and sequestrum, especially in immigrants to France, suggests chest wall tuberculosis on CT scan.
Received: 22 October 1998; Revision received: 11 January 1999; Accepted: 8 February 1999 相似文献
8.
MRI was performed on patients with miliary pulmonary tuberculosis to look for brain involvement and to study the features
sequentially, during treatment. We studied seven patients with typical radiographic tuberculosis, and no symptoms or signs
of central nervous system involvement. Conventional spin-echo (SE) imaging, including contrast enhanced images, was performed
in all cases. All patients showed brain involvement: four patients showed lesions mainly less than 3 mm in diameter, better
seen on contrast-enhanced images. These patients showed oedema around the lesions after 2 months of treatment, with subsequent
regression on follow-up. The remaining three patients had multiple lesions, 3 mm or more in diameter, which showed a gradual
decrease on follow-up. We conclude that the brain may commonly be involved in miliary pulmonary tuberculosis. The response
to treatment depends on the stage of the granuloma and shows a definite pattern of healing on follow-up.
Received: 2 October 1996 Accepted: 7 February 1997 相似文献
9.
Purpose. To assess the MR imaging characteristics, presenting symptoms, age and nerve distribution of fibrolipomatous hamartoma.
Design. A computer search was performed of the term fibrolipomatous hamartoma through the musculoskeletal section MR imaging results
at our institution from June 7, 1996 to January 21, 1998 followed by a search of the terms lipomatous hamartoma, median nerve,
surrounding fat, increased fatty signal, coaxial, and neuroma. MR images and medical files were retrospectively reviewed by
two experienced musculoskeletal radiologists for imaging characteristics, nerve and age distribution as well as for history
of trauma. In addition three consultation cases from outside institutions were added for determination of image characteristics.
Results. Ten fibrolipomatous hamartomas were identified: eight in the median nerve, one in the ulnar nerve and one in the sciatic
nerve. Mean age was 32.3 years (range 4–75 years, SD 21 years). Imaging characteristics were serpiginous low-intensity structures
representing thickened nerve fascicles, surrounded by evenly distributed fat, high signal intensity on T1-weighted sequences
and low signal intensity on T2-weighted sequences. The amount of fat varied; however, distribution in eight cases (80%) was
predominantly between nerve fibers rather than surrounding them peripherally. All had a coaxial-cable-like appearance on axial
planes and a spaghetti-like appearance on coronal planes that was not seen in any other type of median nerve abnormality imaged
during the study period. Conclusion. The MR imaging characteristics of fibrolipomatous hamartoma are pathognomonic, obviating the need for biopsy for diagnosis.
Received: 19 October 1998 Revision requested: 11 December 1998 Revision received: 22 January 1999 Accepted: 25 January 1999 相似文献
10.
Both the prognosis and the morbidity of a patient with a primary malignant musculoskeletal tumour have improved over the
past 25 years due to the advent of adjuvant chemotherapy and limb-sparing surgery. This has important implications for the
role of imaging at the time of initial diagnosis and during follow-up. This pictorial essay reviews the imaging and pitfalls
in the interpretation of musculoskeletal sarcoma metastases using a variety of radiological techniques. The optimal imaging
strategy will be stressed.
Received: 29 January 1998; Revision received: 13 May 1998; Accepted: 14 May 1998 相似文献
11.
Bone infections are usually due to haematogenous spread from distant infected organs. Spread of local sepsis or contamination
of open wounds are less frequent routes of infection. The commonest cause of osteomyelitis is Staphylococcus aureus. The term rare bone infections refers to diseases where only a few percent affect bone or diseases which are essentially
rare; these include bacteria, fungi, parasites and non-specific conditions. Common examples are tuberculosis, salmonellosis,
brucellosis, hydatidosis, madura, actinomycosis, aspergillosis and American fungal infections. Certain bone infections have
become exceedingly rare, particularly atypical mycobacteria, viral embryopathies and spirochaetes. Rare bone infections are
encountered in many parts of the world commonly in the tropics and in the U. S. Immunocompromise and ease of travel can lead
to increased incidence. A high index of clinical suspicion is necessary for diagnosis. Specific laboratory diagnosis is not
always possible. Radiographs, computed tomography, isotope studies and magnetic resonance are useful but may not make the
diagnosis. Aspiration or biopsy is necessary. Rare bone infections may simulate non-infective bone lesions.
Received: 14 February 1998; Revision received: 3 August 1998; Accepted: 7 October 1998 相似文献
12.
Spinocerebellar ataxia type 6 (SCA6) is an autosomal dominant, slowly progressive cerebellar ataxia without multisystem involvement.
We report a 57-year-old woman with genetically confirmed SCA6 who showed clinical features of olivopontocerebellar atrophy.
Conventional T2-weighted and FLAIR MRI demonstrated high signal in the middle cerebellar peduncles, in addition to mild atrophy
of the pons and cerebellum.
Received: 24 July 1998 Accepted: 20 October 1998 相似文献
13.
Objective. To determine the relationship between joint symptoms and radiographically identifiable erosions in patients on maintenance
hemodialysis for 4 or more years. Patients and design. A prospective study was carried out on 21 patients who underwent rheumatological evaluation and radiographic surveys of all
clinically examined joints. The radiologist was masked to the clinical information and the clinicians were masked to the radiographic
findings. Cuprophane dialyzers were used on all patients. The statistical analysis was performed by unpaired t-test and Fisher’s exact test. Results and conclusions. Ten men and 11 women comprised the 21 patients, of whom 10 had joint symptoms and clinical signs whereas 11 did not. Age,
gender, and duration of hemodialysis did not differ significantly between the symptomatic and asymptomatic group. Of the 21
patients, 10 had radiological evidence of erosions and 11 did not. The average age of patients with erosions was 64.9 years;
this was significantly different from the age of the group without erosions, which was 54.1 years. The group with radiographic
evidence of erosions had been on dialysis for an average of 9.6 years, while those without erosions had received dialysis
for an average of 6.4 years. Of the 11 patients without radiographic evidence of erosions, three were symptomatic. Of the
10 patients with erosions, seven had musculoskeletal symptoms, but only in four was there concordance between radiological
findings and symptoms of the corresponding joints. The positive predictive value of radiographic erosions in predicting clinically
significant disease was 40%. There was poor correlation between the presence of radiographic erosions and clinical signs and
symptoms of joint disease.
Received: 15 June 1998; Revision requested: 1 October 1998; Revision received: 20 October 1998; Accepted: 23 October 1998 相似文献
14.
With the resurgence of pulmonary tuberculosis and musculoskeletal tuberculosis in North America and Europe over the last 20 years, the typical pattern of extraspinal musculoskeletal tuberculosis has been changing; presentation of the disease often mimics that of neoplasia. However, certain radiographic features may offer some clues to the more benign nature of the process and its inflammatory and infectious nature. Although the diagnosis of extraspinal musculoskeletal tuberculosis depends largely on clinical context, it is the radiologist's role to guide the imaging workup to initiate the specific treatment as early as possible. As in classic extraspinal tuberculosis, delayed diagnosis may lead to deformity of the involved joint and permanent disability. This review considers atypical osteoarticular tuberculosis and tuberculous osteomyelitis. We discuss examples of these atypical presentations. All patients were permanent residents in Europe and North America, and all were immunocompetent. 相似文献
15.
Two cases of hepatobiliary tuberculosis are described. Case one, the macronodular type of hepatic tuberculosis, presented
as pyrexia of unknown origin and was eventually diagnosed by sectional imaging when a mass lesion developed in the liver and
aspiration revealed acid-fast bacilli. Case two presented with jaundice due to a hilar bile duct stricture. The patient was
successfully treated by repeated bile duct stenting and later chemotherapy for tuberculosis. In both cases previous positive
histology or culture would have expedited diagnosis and treatment. Acute hepatobiliary tuberculosis remains a rare disease.
Suspicion of the disease and adequate biopsy are important to allow prompt appropriate treatment.
Received: 24 July 1998; Accepted: 13 August 1998 相似文献
16.
Three cases of granular cell tumor (GCT) of the subcutis are presented. Computed tomography showed a mass isodense with muscle
with an ill-defined margin. Magnetic resonance imaging showed a mass with inhomogeneous low signal intensity on both T1- and
T2-weighted images. Another characteristic feature of subcutaneous GCT is its attachment in part to muscle. Histological examination
confirmed the diagnosis in all cases.
Received: 20 July 1998; Revision requested: 12 October 1998; Revision received: 30 October 1998; Accepted: 16 November 1998 相似文献
17.
Background: studies that investigate risk factors for musculoskeletal injuries in female youth athletes are limited, especially related to training attributes and position status. Objective: to determine risk factors including training attributes and position status for a self-reported musculoskeletal injury history in female youth soccer players. Methods: we conducted a cross-sectional study of young female soccer players (mean age: 13.6 ± 2.3 years). we asked about their history of musculoskeletal injuries using an electronic questionnaire. the proportion of young female soccer players with and without a history of soccer-related musculoskeletal injuries were compared based on physical characteristics, training attributes, position status (single vs. multiple), lower extremity strength, and joint laxity. a binary logistic regression analysis was used to generate, and adjusted odds ratios adjusted for potential co-variates (aor). a 95% confidence interval (95%ci) that did not cross one or p < 0.05 were considered statistically significant. Results: a total of 160 young female soccer players (mean age: 13.6 ± 2.3 years) participated in the study. an independent association was found between prior musculoskeletal injuries and older ages (aor: 1.60, 95%ci: 1.17, 2.20, p = 0.004), higher weight (aor: 1.10, 95%ci: 1.01, 1.20, p = 0.026), and greater bmi (aor: 1.43, 95%ci: 1.07, 1.90, p = 0.014). Conclusions: musculoskeletal injuries were associated with age, weight, and bmi in female youth players. the current study indicates that maintaining proper body composition may be beneficial to reduce musculoskeletal injuries among female youth soccer players. 相似文献
18.
An unusual case is reported of a soft tissue mass in the lower extremity, without bone involvement, in an 85-year-old woman;
the histopathological diagnosis was Burkitt's lymphoma. Pertinent clinical history, histological examination, and imaging
procedures allowed early diagnosis. To our knowledge, the radiological findings in Burkitt's lymphoma with this unusual clinical
presentation have not been described previously.
Received 27 October 1997; Revision received 6 February 1998; Accepted 18 February 1998 相似文献
19.
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
20.
Objective. To test the agreement between MR imaging and CT in the assessment of osteoarthritis of the lumbar facet joints, and thus
to provide data about the need for an additional CT scan in the presence of an MR examination. Design and patients. Using a four-point scale, two musculoskeletal radiologists independently graded the severity of osteoarthritis of 308 lumbar
facet joints on axial T2-weighted and on sagittal T1- and T2-weighted turbo-spin-echo images and separately on the corresponding
axial CT scans. Kappa statistics and percentage agreement were calculated. Results. The weighted kappa coefficients for MR imaging versus CT were 0.61 and 0.49 for readers 1 and 2, respectively. The weighted
kappa coefficients for interobserver agreement were 0.41 for MR imaging and 0.60 for CT, respectively. There was agreement
within one grade between MR and CT images in 95% of cases for reader 1, and in 97% of cases for reader 2. Conclusion. With regard to osteoarthritis of the lumbar facet joints there is moderate to good agreement between MR imaging and CT. When
differences of one grade are disregarded agreement is even excellent. Therefore, in the presence of an MR examination CT is
not required for the assessment of facet joint degeneration.
Received: 12 June 1998 Revision requested: 20 October 1998 Revision received: 29 December 1998 Accepted: 14 January 1999 相似文献
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