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Background@#Non-specific focal uptake in the skeleton is a diagnostic pitfall on 18F-PSMA-1007 PET/CT, but adjunctive measures to aid interpretation of these lesions are currently lacking. We present two cases where dual time point imaging provided additional information. @*Case Presentation@#The first patient had a PI-RADS 3 lesion on MRI. No PSMA-avid abnormality was seen on PET, save for focal uptake in the right pubis with no anatomic correlate. Additional imaging showed a decrease in lesion SUV, and this was interpreted as benign. Another patient, diagnosed with prostate cancer, had multiple PSMA-avid pelvic foci. Two suspiciously malignant bone lesions had increasing SUV trend after dual time point imaging despite only faint sclerosis on CT. In contrast, one faint PSMA-avid lesion with no anatomic abnormality was read as benign after a decrease in SUV. A decrease in lesion SUV may point to a benign etiology, while an increase would heighten suspicion for malignancy. One possible molecular explanation is that a true PSMA-overexpressing lesion would bind to the tracer for a longer period than a false positive.@*Conclusion@#Dual time point imaging provides additional information that may be useful in the interpretation of non-specificskeletal lesions with increased 18F-PSMA-1007 uptake.
Subject(s)
Positron Emission Tomography Computed TomographyABSTRACT
@#Intraosseous lesions at phalanges are rare. They frequently present with pain and swelling. Fortunately, the majority of the lesions are benign. However, some lesions are destructive and early interventions are required. We report two cases of similar presentations of swelling and discomfort at the little finger for six months. The lytic lesions involved the whole middle phalanx with cortical breach sparing the joints. A provisional diagnosis of osteomyelitis was made, although unlikely. Bone biopsy was performed early to plan for definitive treatment and surgery. Patient 1 was diagnosed for intraosseous gout whereas Patient 2 for epithelioid hemangioma. Both were benign destructive bone lesions. Thus, we counselled the patients for curettage of lesion, bone grafting and spanning external fixation in view of extensive lesion. Patient 1 defaulted treatment. Patient 2 had an uneventful surgery. She regained her grip strength. In two years follow up, there was no evidence of infection, recurrence or malignant transformation.
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Abstract. Knee pathology is a reason for consultation and prevalent condition in children, making it important to know the normal variants as well as the most frequent pathologies. This review includes a brief description of the main pathologies and normal variants that affect the knee in children, with their main clinical features, as well as the findings described in the various, most-used, imaging techniques (X-ray, ultrasound, computed tomography, and magnetic resonance (MR).
Resumen. La patología de rodilla es un motivo de consulta y una entidad prevalente en la edad pediátrica, razón por la cual es importante conocer tanto las variantes normales como las patologías más frecuentes. En esta revisión se realiza una breve descripción de las principales patologías y variantes normales que afectan a la rodilla en la edad pediátrica, tanto de sus características clínicas principales como de los hallazgos descritos en las distintas modalidades de imagen más utilizadas (radiografía, ecografía, tomografía computarizada y resonancia magnética (RM).
Subject(s)
Humans , Child , Knee Injuries/diagnosis , Knee , Knee/pathologyABSTRACT
Background: A spectrum of pathological bone lesions can be presented in any form from inflammatory to neoplastic conditions. Diagnosis of all bone lesions is made by radiological modalities like plain X-ray, CT scan, MRI and bone scintigraphy. Aim and Objectives: To study histopathological features of bone lesions and correlate them with age, site and type of lesions. Material and Methods: The study was carried out at tertiary care center from April 2013 to November 2013. A total of 102 bone lesions were analyzed. Bone biopsy was performed after detailed clinical and radiological examination. After fixation, decalcification, processing and H&E staining, histopathological diagnosis was made. Results: Out of all 102 cases, 44.11% bone lesions were found between 25-50 years with male predominance. The incidence of non neoplastic lesions was 74.5% and neoplastic lesions were 25.4%. Amongst neoplastic lesions, incidence of benign tumors was 17.64% and malignant tumors were 7.8%. The Tuberculous Osteomyelitis was most common non neoplstic lesion while giant cell tumor and osteochondroma were common among benign tumors and osteosarcoma and Secondary metastasis were common among malignant bone tumors. Conclusion: Though Bone tumors are less common, if viewed in perspective of clinico radiology and histopathology, correct diagnosis can be made.
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A Displasia Cemento-Óssea Florida representa uma das poucas situações clínicas de contraindicação para a colocação de implantes osseointegráveis. Como qualquer outro procedimento cirúrgico, inclusive a biópsia, se realizada, a colocação de implante pode abrir as portas para as bactérias acessarem o ambiente ósseo. O osso altamente esclerosado e irregular representa um meio adequado para a proliferação bacteriana e constituição de exuberantes biofilmes microbianos, impedindo o acesso ao local das células e moléculas da defesa orgânica, assim como de antibióticos que, por ventura, venham a ser administrados para o tratamento de uma Osteomielite Crônica Purulenta Secundária, muito comumente vista em pacientes com Displasia Cemento-Óssea Florida. A doença representa um distúrbio dos maxilares no processo de remodelação óssea e, apesar de sua elevada frequência, ainda não se sabe suas causas ou fatores associados, exceto sua predominância em pessoas com alguma afrodescendência, especialmente em mulheres de meia idade...
Florid cemento-osseous dysplasia represents one of the few clinical contraindications to osseointegrated implant placement. As in any other surgical procedure, including biopsy, implant placement might open up the doors to bacteria access to the bone environment. Highly sclerosed irregularbone is appropriate for bacteria proliferation and formation of exuberant microbial biofilm, thereby hindering access not only of local cells and molecules of organic defense, but also of antibiotics potentially administered to treat secondary purulent chronic osteomyelitis commonly found inflorid cemento-osseous dysplasia patients. The disease is a disorder of the maxilla, established during the process of bone remodeling; and despite its high frequency, its causes or associated factors remain unknown, except for its predominance among afrodescendents, especially middle-aged women...
Subject(s)
Humans , Female , Middle Aged , Bone Diseases, Developmental , Bone Diseases, Developmental/diagnosisABSTRACT
FNAC should be considered as the part of routine preliminary investigation of orthopaedic patients presenting with musculoskeletal tumorous lesions. A total of 110 cases were screened cytologically in the background of clinical, radiological findings and biochemical tests. Primary malignant tumor formed the major entity accounting for 56% of the cases, while benign tumors comprised 8% only. Overall success rate of needle aspiration cytology in diagnosing tumors and tumor like lesions was 92%. Giant cell tumors of bone was the most common malignant lesion observed in 15 cases (30%), followed by Ewing's Sarcoma in 5 cases (10%). Cytologic diagnosis was completely compatible with the final histopathologic diagnosis in 82.3% of cases.
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[Objective]To evaluate the operability and clinical efficacy of injectable calcium sulfate for grafting bone defects.[Method]From June 2004 to August 2005,22 cases with benign bone lesions were treated with curettage and grafting with injectable calcium sulfate bone graft substitute(minimally invasive injectable graft X3,MIIG X3).There were 13 male cases and 9 femal cases.Their average age was 34.6(ranged,4~55).All the 22 cases were followed-up from 23 months to 37 months,average 31.6 months.All cases took radiographic examination regularly after the operation to assess the absorption rate of MIIGX3 and the formation rate of new bone.[Result]This injectable calcium sulfate with vacuum mixing was easy to use,providing complete fill and bony strength instantly when grafting bone defects.According to the raeiographs,MIIGX3 was absorbed almost at the same rate as new bone ingrowth in 8 to 24 weeks.[Conclusion]MIIGX3 is convenient to graft bone defects with fewer complications,capable of absorbing almost at the same rate as replacement of new bone.It's one of the best bone graft substitutes for grafting bone defects induced by benign bone lesions.
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Objective To evaluate the clinical value of CT-guided percutaneous biopsy for bone lesions.Methods Forty-Eight patients with different sited bone lesions had received the procedure of CT-guided percutaneous biopsy from July 2003 to January 2005,including 34 cases only with complete clinical records.The procedure was carried out with patient lied on CT table and followed by localization scanning to demonstrate the best sites for puncture and biopsy route.11-14 G bone puncture needle or 18 G trigger type biopsy needle was undertaken to penetrate into the lesion for obtaining specimens under local anesthesia and CT monitoring and in turn for fixation with 10% formalin to have pathologic examination.Results The whole procedure finished within 20-40 minutes with adequate samples obtained for pathologic examination of all cases.Confirmed diagnosis was made in 30 cases with an accuracy of 91.2% and no correlative complications were found.Conclusions The CT-guided percutaneous biopsy is safe and efficient for diagnosis of bone lesions,deserving to be extensively used.(J Intervent Radiol,2006,15: 603-606)