Imaging of radial wrist pain. I. Imaging modalities and anatomy

Radial wrist pain is a common clinical complaint. The relatively complex anatomy in this region, combined with the small size of the anatomical structures and occasionally subtle imaging findings, can pose problems when trying to localize the exact cause of pain. To fully comprehend the underlying pathology, one needs a good understanding of both radial-sided wrist anatomy and the relative merits of the different imaging techniques used to assess these structures. In part I of this review, these aspects will be discussed.     

Imaging studies down overall, but new modalities show increase.

While the number of diagnostic procedures performed from 1983 to 1984 decreased by 5%, the newer modalities all show an increase. This article, the first in a series on radiology market trends and conditions, presents findings for a wide range of imaging studies.     

骨原发性恶性纤维组织细胞瘤影像诊断

目的探讨骨原发性恶性纤维组织细胞瘤(BMFH)影像表现及诊断要点。方法回顾性分析6例经病理确诊为BMFH的X线、CT及MRI表现。结果4例侵犯单骨,2例侵犯多骨。溶骨型4例,混合型2例。股骨下端3例,肱骨上端1例,楔骨1例,横突1例,共侵犯12个骨骼。6例均有骨及骨皮质明显破坏,以溶骨性破坏为主,2例病灶周围有轻度骨硬化。全部病例均有软组织肿块,巨大肿块2例,局限性肿块4例,1例肿块内可见散在小钙化影。全部病例未见骨膜反应,3例合并病理性骨折。结论原发性BMFH好发于长骨干骺端或骨端,多见于股骨下端及胫骨上端。虫蚀状或大片状溶骨性骨质破坏,巨大软组织肿块,无骨膜反应,是其影像学特点,诊断需密切结合临床和病理。     

The scintigraphic findings in Paget's disease of bone.

Bone scans and radiographic skeletal surveys have been done in 41 patients who had Paget's disease. The scintigraphic findings are consistent with what is known of the pathophysiology of Paget's disease. Diseased bone demonstrates increased vascularity, an increased degree of uptake of bone-seeking radiotracers and, in appropriate bones, evidence of marrow replacement. The bone scintiscan is a more sensitive indicator of the extent of polyostotic Paget's disease than conventional radiograph, demonstrating 34% more lesions. Because it reflects shorter term changes in osteoblastic activity the bone scan is of some value in providing immediate objective evidence of the therapeutic effectiveness of Mithramycin which has been used in this study in the treatment of the minority of patients with pain in Pagetoid bone. A technique for documenting alterations in uptake by diseased bone numerically is presented. Upon treatment with Mithramycin the ratio of abnormal uptake in relation to normal bone fell from 8.7 to 3.9.     

Imaging of primary malignant bone tumors (nonhematological)

Primary malignant bone tumors are uncommon and are diagnosed typically based on radiographic and microscopic findings combined with clinical and demographic features. CT and MR imaging scans are useful in further staging the tumors by determining intraosseous and extraosseous spread.     

Facial bone scintigraphy. IV. Diagnosis of bone involvement by purulent sinusitis.

Facial bone scintigraphy demonstrated bone tissue involvement by purulent maxillary sinuitis in 11 patients examined. In no case was bone involvement demonstrated by radiography. Bone scintigraphy in this respect appears more sensitive than does conventional radiography.     

Bone, bone marrow, and MIBI scintigraphic findings in Gaucher's disease "bone crisis"

PURPOSE: The authors report the utility of Tc-99m MIBI imaging in Gaucher's disease, which results in the accumulation of glucocerebroside in macrophages. Inflated macrophages, or Gaucher's cells, involve the reticuloendothelial organs. MATERIALS AND METHODS: A 38-year-old man with type I Gaucher's disease, splenectomy, and early bone involvement was examined for a low back "bone crisis." He had a history of total left hip replacement. Results of pelvic radiographs were normal. Magnetic resonance imaging showed complete infiltration of the bone marrow in the lumbar spine and the sacrum. The left iliac bone, the sacrum, and the adjacent part of L5 showed heterogeneously decreased uptake on bone scintigraphs. Hematopoietic bone marrow was absent in these regions and in the left femur. No infection of the prosthesis was revealed with labeled granulocytes. RESULTS: Avascular necrosis in the left iliac bone was diagnosed, which is a very unusual location. There was no uptake of MIBI in the iliac bones or the femurs. CONCLUSION: These findings suggest that MIBI may not be a good tool for the evaluation of medullary infiltration by Gaucher's cells.     

Imaging findings, prevalence and outcome of de novo and secondary malignant fibrous histiocytoma of bone

Objective  

To evaluate the radiographic and magnetic resonance (MR) imaging features of primary and secondary malignant fibrous histiocytoma in bone and determine the demographics, prevalence and outcome of patients with this tumor.     

Imaging by multiple modalities of patients with a carotidynia syndrome

The purpose of this article is to familiarize readers with the clinical syndrome of carotidynia. In the past, the International Headache Society (IHS) described idiopathic carotidynia as a diagnostic entity consisting of a self-limiting neck pain syndrome and tenderness over the carotid bifurcation without structural abnormality and then recently removed it from its classification. Although the clinical criteria of carotidynia in the former classification of the IHS included the absence of structural abnormality, several publications have demonstrated associated radiological findings and have described the usefulness of radiological investigations in diagnosing this syndrome. In this paper, we report four additional cases with a carotidynia clinical syndrome (according to the former classification) and the presence of abnormal soft tissue infiltration surrounding the symptomatic carotid artery as demonstrated by multiple imaging modalities, without any other underlying cause for the carotid pain syndrome. Our findings support the hypothesis that carotidynia could be a distinct disease entity, possibly caused by inflammation.     

Cutaneous malignant melanoma: clinical aspects, imaging modalities and treatment

Cutaneous melanoma is a highly malignant tumour of the melanocytes presenting characteristic metabolic and biological features. Early detection decreases mortality and morbidity and provides the best chance for optimal clinical management. Imaging techniques, including scintigraphy, have assumed an important role in detection strategies. As a functional modality, nuclear medicine offers a variety of possibilities to assist in the clinical management of malignant melanoma. This review discusses the clinical aspects and treatment of melanoma, and the imaging techniques used for its diagnosis, staging and follow-up. A survey of currently available techniques is presented.     

Cutaneous malignant melanoma: clinical aspects, imaging modalities and treatment

Cutaneous melanoma is a highly malignant tumour of the melanocytes presenting characteristic metabolic and biological features. Early detection decreases mortality and morbidity and provides the best chance for optimal clinical management. Imaging techniques, including scintigraphy, have assumed an important role in detection strategies. As a functional modality, nuclear medicine offers a variety of possibilities to assist in the clinical management of malignant melanoma. This review discusses the clinical aspects and treatment of melanoma, and the imaging techniques used for its diagnosis, staging and follow-up. A survey of currently available techniques is presented.     

Metastatic calcification in a patient with malignant parathyroid carcinoma. Correlation of clinical, surgical, radiographic, and scintigraphic findings

A patient whose bone scan showed features typical of a "superscan," having extensive pulmonary, cardiac, and renal calcifications is described. Metastatic parathyroid carcinoma with renal insufficiency and phosphate retention are cited as the cause. Early diagnosis and surgical extirpation offer the best chance for cure or palliation. Pitfalls of plain film radiography in identifying metastases and pathologic soft tissue calcifications in the setting of severe hyperparathyroidism are discussed, and the advantages of functional radionuclide imaging assessments are emphasized.     

Long-term scintigraphic appearance of extremities following bone tumor resection and allograft reconstruction.

The authors retrospectively reviewed the Tc-99m medronate scan findings in six patients who had no evidence of metastatic disease following en bloc resection of a primary osteosarcoma and subsequent limb reconstruction using allograft bone. Persistently increased radionuclide uptake was noted at the junction between the host bone and the graft, while the graft cortical bone showed persistently decreased activity. Radionuclide uptake at the periphery of the graft varied. Over time the youngest patient in the series had increasingly normal scan findings.     

Imaging modalities for evaluation of the spine

The spine can be evaluated by a number of different imaging modalities. Although magnetic resonance imaging has assumed the dominant role in the diagnosis of spinal disease, the individual clinical situation still determines the procedure of choice. This review discusses the different imaging techniques and their currently accepted indications.     

Objective evaluation of scintigraphic diagnosis of bone metastasis

Using bone scintigraphs (B.S.) from neoplasic patients, a quantitative analysis of the relation existing between objective scintigraphic signs and the diagnosis of presence or absence of bone metastases was carried out. In this way, an attempt was made to increase the specificity of the B.S. for this diagnosis. Thus, a group of signs from the B.S. was chosen and an analysis of the frequency of their presence in relation to the diagnosis of bone metastasis was carried out. For each sign, considered as discrete mathematical variables, an index arising from the following expression: Sensitivity-(1-Specificity) was calculated. In this manner, each scintigraph may be quantified by the addition of the indices which correspond to the signs present in it. The set of possible numerical values was divided into 7 intervals, each of which establishes a different degree of reliability in the diagnosis of bone metastasis. This approach permitted ROC analysis and the formation of the representative curve.     

Preliminary results on scintigraphic evaluation of malignant external otitis

Malignant external otitis (MEO) is a potentially fatal otitis occurring in diabetic and immunosuppressed patients, which may cause cranial nerve palsies and massive thrombophlebitis of the brain. We studied five diabetic patients with the clinical diagnosis of external otitis who were suspected of having MEO and one diabetic patient presumed cured from MEO. All of them underwent methylene diphosphonate, nanocolloid and gallium single-photon emission tomography studies with quantitative analysis on the basis of regions of interest and count profile curves. This combined assessment helped us to diagnose and follow-up soft tissue and temporal bone infection, especially in the case of transsphenoidal extension of the disease, since conventional radiology and computed tomography were of no particular help. On the basis of these results, we consider scintigraphic demonstration of skull base infection as a fourth criterion of MEO given that the classical Chandler's triad (diabetes, granuloma, and Pseudomonas aeruginosa) is not always present. Correspondence to: J. Malamitsi     

Objective evaluation of scintigraphic diagnosis of bone metastasis

Using bone scintigraphs (B.S.) from neoplasic patients, a quantitative analysis of the relation existing between objective scintigraphic signs and the diagnosis of presence or absence of bone metastases was carried out. In this way, an attempt was made to increase the specificity of the B.S. for this diagnosis. Thus, a group of signs from the B.S. was chosen and an analysis of the frequency of their presence in relation to the diagnosis of bone metastasis was carried out. For each sign, considered as discrete mathematical variables, an index arising from the following expression: Sensitivity - (1 - Specificity) was calculated. In this manner, each scintigraph may be quantified by the addition of the indices which correspond to the signs present in it. The set of possible numerical values was divided into 7 intervals, each of which establishes a different degree of reliability in the diagnosis of bone metastasis. This approach permitted ROC analysis and the formation of the representative curve.     

Interpretation and classification of bone scintigraphic findings in stress fractures

A new system for classification of stress fractures identified by bone scintigraphy was developed and divided into four grades according to lesion dimension, bone extension, and tracer accumulation. The scintigraphic findings were evaluated for severity of lesions by extent of the visualized bone response, ranging from ill-defined cortical lesions with slightly increased activity (I) to well-defined intramedullary transcortical lesions with intensely increased activity (IV). Bone scintigraphies using [99mTc]MDP were obtained in 310 military recruits suspected of having stress fractures. In 235 patients, 391 stress fractures were diagnosed. Forty percent of the lesions were asymptomatic. Most of the lesions were in the tibiae (72%), and 87% of the patients had one or two lesions, while 13% had three to five lesions. Eighty-five percent of the lesions were classified as mild and showed early and more complete resolution on follow-up studies after treatment as compared to the severe grades. Furthermore, specific scintigraphic patterns have been introduced for distinguishing inflammatory shin-splints from stress fractures, allowing for their appropriate early treatment. Thus, early recognition of mild stress fracture scintigraphic patterns representing the beginning of pathologic bone response to stress enabled a prompt and effective treatment to prevent progression of lesions, protracted disability, and complications.