Hallux rigidus deformity: radiologic assessment

Hallux rigidus (osteoarthritis leading to reduced motion) is one of the most common afflictions of the first metatarsophalangeal joint. The diagnosis is based on the presence of pain, specific physical findings, and certain radiologic features. In this essay, we illustrate the grades of radiologic changes, which are an integral part of the surgeon's preoperative evaluation, and show examples of the postoperative radiologic appearance.     

Value of polydirectional tomography in the assessment of the postoperative spine after anterior decompression and vertebral body autografting

With the growing number of orthopedic reconstructive spinal procedures, the use of bone grafting has steadily increased in the past decade. An understanding of the biology of bone grafting is essential for both the clinician and radiologist. Despite the advent of computed tomography and magnetic resonance imaging, conventional polydirectional tomography remains an important tool in the evaluation of vertebral body autografts. Trispiral or hypocycloidal tomography plays a valuable role in the assessment of bone graft fusion and possible complications, especially in the presence of metallic fixation devices. We present our imaging experience derived from 375 patients with cervical, thoracic, or lumbar anterior spinal fusion. True graft complications occurred in 27 patients (7%) and consisted of fracture (4%), malpositioning (3%), and infection (<1%).     

Helical CT of calcaneal fractures: technique and imaging features

 Since the degree of comminution, fracture alignment, and articular congruity of intra-articular calcaneal fractures are important determinants in surgical treatment and patient prognosis, we review helical computed tomographic (CT) technique and features for detecting and assessing the extent of acute calcaneal fractures. Helical CT can be used to classify these fractures and facilitate the surgeon’s understanding of the anatomy and position of the fracture components in all orthogonal planes independently of the patient’s condition, foot placement in the CT gantry, or other injuries.     

Pelvic inflammatory disease: sonographic-pathologic correlation

A retrospective analysis of the sonographic findings in 65 women with pelvic inflammatory disease was correlated with pathologic findings at surgery and laparoscopy. Abnormal sonograms could be classified into one of the following three groups: Type I pattern (endometritis); Type II pattern (focal mass); Type III pattern (total pelvic distortion). A simulated uterine appearance, the "pseudouterus sign," was observed in three patients with previous hysterectomy. Various pathologic entities of the pelvic inflammatory disease spectrum could not be reliably distinguished sonographically.     

Defecography: does parity play a role in the development of rectal prolapse?

Few studies related to parity address the changes in anorectal function in women. Since the majority of patients with rectal prolapse are women, we undertook this study to assess the role of parity in the development of rectal prolapse. We retrospectively reviewed defecography studies performed on 354 female patients over a 10-year period. Studies noting the presence of intra-anal and external rectal prolapse (full thickness protrusion of the rectum into and through the anal sphincter) were reviewed. Cases with intrarectal or hidden rectal prolapse, a condition of lesser clinical importance, were excluded. The obstetric histories of the patients with rectal prolapse (n = 27) were compared to those of patients without rectal prolapse (n = 88). There was a larger proportion of nulliparous women in the rectal prolapse group than in the group without rectal prolapse, suggesting that factors in addition to parity play a role in the development of rectal prolapse. However, parous women with rectal prolapse had delivered significantly more children (3.3) than parous women without prolapse (2.5) (P = 0.03). The exact cause of rectal prolapse remains unclear. Childbearing appears to play a limited role in its pathogenesis since nulliparous women are also at risk of developing rectal prolapse. Received: 27 November 1997; Revision received: 15 April 1998; Accepted: 13 May 1998     

Efficacy of magnetic resonance imaging in the evaluation of posterior cervical spine fractures

STUDY DESIGN: A retrospective study using two independent, blinded musculoskeletal radiologists to evaluate the sensitivity, specificity, and predictive value of cervical spine magnetic resonance imaging in detecting posterior element fractures of the cervical spine. OBJECTIVE: To evaluate the sensitivity, specificity, and predictive value of magnetic resonance imaging, using computed tomographic scanning as the gold standard, in the diagnosis of posterior element cervical spine fractures. SUMMARY OF BACKGROUND DATA: Few investigators have evaluated the accuracy of magnetic resonance imaging in the determination of cervical spine fractures. METHODS: From January 1994 through June 1996, 75 cervical spine fractures in 32 patients were confirmed by computed tomography. Two musculoskeletal radiologists who were blinded to the clinical history and presence or absence of cervical injury among the study population, independently evaluated each cervical magnetic resonance image recording the presence or absence of soft tissue or bony injury. RESULTS: The overall sensitivity and specificity rates for the diagnosis of a posterior element fracture by magnetic resonance imaging was 11.5% and 97.0%, respectively. The positive predictive value for this group was 83%, and the negative predictive value was 46%. In reference to anterior fractures, the sensitivity was 36.7% and the specificity 98%. Positive and negative predictive values were 91.2% and 64%, respectively. CONCLUSIONS: Magnetic resonance imaging was not effective in recognizing bony injury to the cervical spine and in particular was not as sensitive or as specific as computed tomography in identifying cervical spinal fractures. Computed tomography remains the study of choice for the detection and precise classification of bony injuries to the cervical region, especially when plain radiographs are difficult to evaluate. Magnetic resonance imaging, although not as effective as computed tomography in defining specific bony disorders, remains the gold standard in the evaluation of spinal cord injury, occult vascular injury, and intervertebral disc disruption (hyperextension injury), including herniation and other soft tissue disorders (hematoma, ligament tear).     

MR imaging of plantar fasciitis: edema, tears, and occult marrow abnormalities correlated with outcome.

OBJECTIVE: We sought to evaluate various MR imaging signs of plantar fasciitis and to determine if a difference in these findings exists between clinically typical and atypical patients with chronic symptoms resistant to conservative treatment. CONCLUSION: We found signs on MR imaging that, to our knowledge, have not been described in the scientific literature for patients with plantar fasciitis. These signs included occult marrow edema and fascial tears. Patients with these manifestations seemed to respond to treatment in a manner similar to that of patients in whom MR imaging revealed more benign findings.     

Cervical spine trauma radiography: comparison of general and musculoskeletal radiologists, with emphasis on number of views

We investigated the number of views necessary to evaluate trauma patients for suspected cervical spine fractures, comparing general and musculoskeletal radiologists. At separate sittings, independently and blindly, two musculoskeletal (MSKR) and two general (GR) radiologists evaluated sets of cervical spine images on a 1- to 5-point confidence scale for the presence of fracture in 68 trauma patients. First they evaluated anteroposterior and lateral views, then these plus an odontoid view, and lastly these three plus bilateral oblique radiographs. Overall, MSKR were slightly more accurate than GR (77.9 % vs. 74 %, P < 0.05). With two views, GR were more accurate (75.7 % vs.72.1 %); with three and five views, MSKR were more accurate (80.1 % vs.73.5 % and 81.6 % vs. 72.8 %). Confidence scores for excluding fractures increased with number of views (1.9, 1.6, 1.4, P < 0.0001); however, confidence scores for diagnosing fractures were affected neither by specialty (MSK = 3.8, GR = 3.9) nor by number of views (3.7, 3.9, 4.0). With more views, MSKR were more accurate and confident in excluding suspected cervical spine fractures than GR.