Search

MR imaging appearances of different types of reconstructive muscle flaps following reconstructive surgery of the lower extremity with associated post-surgical changes due to altered anatomy, radiation, and potential complications, can be challenging. A multidisciplinary therapeutic approach to tumors allows for limb salvage therapy in a majority of the patients. Decision-making for specific types of soft tissue reconstruction is based on the body region affected, as well as the size and complexity of the defect. Hematomas and infections are early complications that can jeopardize flap viability. The local recurrence of a tumor within six months after a complete resection with confirmed tumor-free margins and adjuvant radiation therapy is rare. Identification of a new lesion similar to the initial tumor favors a finding of tumor recurrence.

Gout is an ancient disease. Last decade has brought about significant advancement in imaging technology and real scientific growth in the understanding of the pathophysiology of gout, leading to the availability of multiple effective noninvasive diagnostic imaging options for gout and treatment options fighting inflammation and controlling urate levels. Despite this, gout is still being sub-optimally treated, often by nonspecialists. Increased awareness of optimal treatment options and an increasing role of ultrasound and dual energy computed tomography (DECT) in the diagnosis and management of gout are expected to transform the management of gout and limit its morbidity. DECT gives an accurate assessment of the distribution of the deposited monosodium urate (MSU) crystals in gout and quantifies them. The presence of a combination of the ultrasound findings of an effusion, tophus, erosion and the double contour sign in conjunction with clinical presentation may be able to obviate the need for intervention and joint aspiration in a certain case population for the diagnosis of gout. The purpose of this paper is to review imaging appearances of gout and its clinical applications.

The osseous pelvis is a well-recognized site of origin of numerous primary and secondary musculoskeletal tumors. The radiologic evaluation of a pelvic lesion often begins with the plain film and proceeds to computed tomography (CT), or magnetic resonance imaging (MRI) and possibly biopsy. Each of these modalities, with inherent advantages and disadvantages, has a role in the workup of pelvic osseous masses. Clinical history and imaging characteristics can significantly narrow the broad differential diagnosis for osseous pelvic lesions. The purpose of this review is to familiarize the radiologist with the presentation and appearance of some of the common benign neoplasms of the osseous pelvis and share our experience and approach in diagnosing these lesions.

Objective The purpose of this presentation is to review pathologic conditions that lead to pain at the radial aspect of the distal radius and to address anatomic variations of the first extensor compartment that exist and may have diagnostic and therapeutic implications. Methods Our presentation is based on a review of cases from teaching files and observations made in anatomic specimens. Results The discussed conditions include de Quervain tenosynovitis, intersection syndrome, and Wartenberg syndrome. Sonographic diagnosis of these conditions is addressed, and correlations are provided with anatomic specimens. Conclusions Sonography is able to depict and differentiate between these conditions.

The rotator cuff muscles generate torque forces to move the humerus while acting in concord to produce balanced compressive forces to stabilize the glenohumeral joint. Thus, rotator cuff tears are often associated with loss of shoulder strength and stability, which are crucial for optimal shoulder function. The dimensions and extent of rotator cuff tears, the condition of the involved tendon, tear morphologic features, involvement of the subscapularis and infraspinatus tendons or of contiguous structures (eg, rotator interval, long head of the biceps brachii tendon, specific cuff tendons), and evidence of muscle atrophy may all have implications for rotator cuff treatment and prognosis. Magnetic resonance imaging can demonstrate the extent and configuration of rotator cuff abnormalities, suggest mechanical imbalance within the cuff, and document abnormalities of the cuff muscles and adjacent structures. A thorough understanding of the anatomy and function of the rotator cuff and of the consequences of rotator cuff disorders is essential for optimal treatment planning and prognostic accuracy. Identifying the disorder, understanding the potential clinical consequences, and reporting all relevant findings at rotator cuff imaging are also essential.

In the present article, we correlate MR imaging studies of cadavers, volunteers and patients with cadaveric dissection and sectioning. First anatomy at wrist level is discussed. In a next section, we address the midhand with the flexor and extensor tendons, and interosseous and lumbricalis muscles. The dorsal hood at the level of the metacarpophalangeal joint is also addressed. An overview of the anatomy of the thenar is provided. Finally, the flexor system of the fingers with pulleys and volar plates, as well as the central and distal insertion of the finger extensor tendons is discussed. (C) 2005 Elsevier Ireland Ltd. All rights reserved.

Objective : To assess whether the presence of subchondral bone marrow abnormalities (bone marrow edema (BME)) and cartilage defects, determined by magnetic resonance imaging (MRI), would explain the difference between painful osteoarthritis of the knee (OAK) compared with painless OAK or pain without OAK. Method : Four groups of women (30 per group), aged 35–55 years, were recruited from the southeast Michigan Osteoarthritis cohort (group 1: painful OAK; group 2: painless OAK; group 3: knee pain without OAK; and group 4: no OAK or knee pain). OAK was defined by a Kellgren–Lawrence score of 2 or greater, while pain was based on self-report. BME and cartilage defects were identified from MRI. Results : BME lesions were identified in 56% of all knees. BME lesions were four times (95% CI=1.7, 8.7) more likely to occur in the painless OAK group as compared with the group with pain, but no OAK. BME lesions >1cm were more frequent (OR=5.0; 95% CI=1.4, 10.5) in the painful OAK group than all other groups. While the frequency of BME lesions was similar in the painless OAK and painful OAK groups, there were more lesions, >1cm, in the painful OAK group.About 75% of all knees had evidence of some cartilage defect, of which 35% were full-thickness defects. Full-thickness cartilage defects occurred frequently in painful OAK. One-third of knees with full-thickness defects and 47% of knees with cartilage defects involving bone had BME >1cm. Women with radiographic OA, full-thickness articular cartilage defects, and adjacent subchondral cortical bone defects were significantly more likely to have painful OAK than other groups (OR=3.2; 95% CI=1.3, 7.6). Conclusion : The finding on MRI of subchondral BME cannot satisfactorily explain the presence or absence of knee pain. However, women with BME and full-thickness articular cartilage defects accompanied by adjacent subchondral cortical bone defects were significantly more likely to have painful OAK than painless OAK.

Objective We assessed the probability that mid-aged women with a Kellgren and Lawrence (K–L) score of 1 are likely to progress to a score of 2 or regress to a score of zero at a second time point, 2–3 years later.Methods Osteoarthritis (OA) of measurements (weight-bearing X-rays and interviews) were undertaken in women from the Southeast Michigan population who were ≥40 years of age, and who participated in both the 1995 and 1998 measurements (N=679).Results Of the 17.1 % of women with a 1995 K–L score of 1 in their right knee, 37.1% had a K–L score of 1 in 1998 while 32.8 % had a score of ≥2 and 30.2% had a score of zero. For 26.0% of women, the score progressed by at least one unit over the 2.5 year period whereas scores for only 7.0% of women regressed in the same time period. Women who had a K–L score of 1 in the right knee in 1995 were 2.5 times more likely to have a K–L score of 1 in 1998 (95% CI=1.6–3.8); and were 2.2 times more likely to have a K–L score of 2 or greater (95% CI=1.4–3.5) in 1998 compared with other scores. These women were 74% less likely to have a score of zero in 1998 (95% CI=0.2–0.4). Further, other risk factors, specifically age and BMI were predictors of increasing K–L grade in 1998.Conclusion These findings suggest that a score of 1 is part of the advancement to emergent OAK; and suggest the following criteria to characterize individuals who are at an intervenable stage on the pathway toward OAK: age ≥40, BMI ≥30, and K–L score of ≥1. From the perspective of both the individual and the examiner, these assessment characteristics are relatively simple to assess clinically. Copyright 2002 OsteoArthritis Research Society Intenational. Published by Elsevier Science Ltd. All rights reserved.

Discrepancies exist between radiographic osteoarthritis of the knee (OAK) and report of knee joint pain. Little is known about how these two definitions of osteoarthritis (OA) and their correlates differ between African American (AA) and Caucasian (CA) women.Objective We compared the prevalence of radiographic OAK and knee joint pain in AA and CA women, and the congruency of these outcomes according to age, body size, and knee injury.Design A cross-sectional study of African American and Caucasian women aged 40–53 years (N=829) in Southeast Michigan used the Kellgren and Lawrence Atlas of Standard Radiographs of Arthritis to characterize radiographs of both knee joints (weight bearing) and self-report of knee pain.Results Current pain was a significantly more sensitive predictor of radiographic OAK among AA women (Se=0.51) compared to CA women (Se=0.35). Specificity was similar between AA women (Sp=0.77) and CA women (Sp=0.82). Positive predictive value was significantly greater for AA compared with CA women (PV+=0.40 and PV+=0.15, respectively). The odds of having radiographic OAK increased with BMI >32kg/m2in both groups. Knee pain was related to BMI in CA women, but not AA women. Previous knee injury was associated with knee pain in both AA and CA women (OR=3.0 and OR=2.4).Conclusions Joint pain in AA women was more likely to be associated with radiographic OAK as compared with CA women. This suggests differences in these two groups in both how pain is experienced in the OAK process and in the prevalence of non-OAK related pain in knee joints.

Objective We evaluated C-reactive protein (C-RP), a quantitative marker of the acute phase response, as a potential biomarker of prevalent and incident osteoarthritis of the knee (OAK). Methods Serum C-reactive protein concentrations were characterized with ultrasensitive rate nephelometry in a population-based sample of 1025 women (318 African-American and 707 Caucasian) who are enrollees in a study of musculoskeletal conditions at the mid-life. Assignment of OAK was based on Kellgren-Lawrence (K–L) scores of 2 or more on radiographs. Prevalent OAK was based on the baseline (1996) score while the classification of incident OAK was based on a score of 2 or greater at the follow-up examination 2.5 years later amongst those with a baseline K–L scores of 0 or 1. Results At baseline, the prevalence of radiographic OAK was 12% in participants who were aged 27–53 years and 18% in the subgroup of women aged 40–53 years. The mean C-RP value was 2.31mg/L, with values ranging from below detection (0.3mg/L) to 47.4mg/L. Higher C-RP concentrations were associated with both prevalent and incident OAK ( P 0.0001, and P 0.0001, respectively). For each K–L score increase from 0 to 3, there was a significantly higher mean C-RP value. Compared to women without incident OAK, women who developed OAK in the 2.5-year follow-up had significantly higher baseline C-RP concentrations. Women with bilateral OAK had higher C-RP concentrations than women with unilateral OAK (6.65mg/L±0.56 vs 3.63mg/L±0.42, P 0.007). BMI was highly correlated with C-RP ( r =0.58) and obesity was an effect modifier with respect to OAK and C-RP concentrations. When stratified according presence or absence of OAK and obesity (BMI >30kg/m 2 ), mean C-RP values were: obesity and OAK, 6.3±0.4mg/L; obesity but not OAK, 4.3mg/L±0.2; no obesity but OAK, 1.7mg/L±0.8; and neither obesity nor OAK, 1.3mg/L±0.2mg/L. These stratum means were significantly different from each other, indicating a higher C-RP with OAK after accounting for obesity. Conclusion C-RP, as a measure of an acute phase response and inflammation, is highly associated with OAK; however, its high correlation with obesity limits its utility as an exclusive marker for OAK. Copyright 2002 OsteoArthritis Research Society International. Published by Elsevier Science Ltd. All rights reserved .