Imaging review of 250 cases of primary osteogenic sarcoma and other subtypes: our experience at king hussein medical center and hussein cancer center

Radiology plays a crucial role in diagnosis, work-up and staging of osteosarcoma. The main aim of the study is to review, analyze and characterize the imaging findings of a large series of histologically proven osteosarcomas focusing on the nonconventional subtypes. We retrospectively reviewed the imaging findings of 250 cases with histologically proven primary osteosarcoma. The study was conducted at King Hussein Medical Center and King Hussein Cancer Center, Amman-Jordan during the period 2003-2012. Approval by the ethical committee and institutional review board was taken from both institutions before starting the study. Patient demographic data was recorded. Images from plain radiographs [n=238], angiograms [n=28], bone isotope scans [n=56], computed tomography scans [n=99], computed tomography angiograms [n=27] and magnetic resonance imaging [n=189] were evaluated for the origin site, location, tumor size, matrix pattern, extrinsic and intrinsic characteristics and the soft tissue component of the tumor. The sample included 162 males [65%] and 88 females [35%], with an age range of 12-48 years [mean age of 23.5 years]. Simple descriptive statistical methods [frequency, mean and percentage] were used to describe the study variables. The most common histological diagnoses were conventional [n=193], telangiectatic [n=14], small cell [n=3], low grade central [n=3], high grade surface [n=2], parosteal [n=4], and periosteal [n=5] and non specific [n= 26]. The most frequent origin site in the long bones is the metaphysis [80%] followed by diaphysis [9%], and less frequently the epiphysis [2%], 10% were found in the spine and flat bones. The commonest lesion location was distal femur [25%], proximal femur [18%], proximal humerus [17%], proximal tibia [15%], spine and flat bones [16%], other places [9%]. The tumor size ranged from 2-21cm. The majority of cases [78%] demonstrated osteoid matrix abnormal mineralization, 32 of them showed obvious and marked mineralization, three cases with marked mineralization were noted in the spine, one of them gave an ivory vertebra appearance. A purely lytic pattern was seen in 48%. Soft-tissue components were seen in 58% of cases. This study provides a good relation between the radiological imaging and histological subtypes of osteosarcoma in a relatively large series of osteosarcoma and highlights our experience at King Hussein Medical and Cancer Centers.

Shoulder instability: the role of MR arthrography in diagnosing anteroinferior labroligamentous lesions: Our experience at King Hussein Medical Center

To determine the reliability and accuracy of magnetic resonance arthrography of the shoulder for the diagnosis of anteroinferior labroligamentous lesions in patients with gleno-humeral joint instability. This retrospective study was performed at King Hussein Medical Center in Jordan. Twenty eight patients who underwent shoulder MR arthrogram and arthroscopy during a 22-month period were reviewed. All the twenty eight patients had history of previous shoulder dislocation and clinical suspicion of anteroinferior labroligamentous lesions and glenohumeral joint instability. The series included 24 males and 4 females. The mean average age of the patients was 29 years. All patients underwent shoulder MR arthrogram and the results of MR arthrogram were compared with the arthroscopic findings which were used as the reference standard. MR arthrograms were analyzed for the presence and type of labroligamentous injuries which include [Bankart, anterior labral periosteal sleeve avulsion [ALPSA], Perthes, glenolabral articular disruption [GLAD], or nonclassifiable lesion]. Sensitivity, specificity and accuracy for the detection and classification of anteroinferior labroligamentous lesions with MR arthrography were calculated. At arthroscopy, 21 anteroinferior labroligamentous lesions were diagnosed, including 15 Bankart lesions, three ALPSA lesions, two Perthes lesions and one GLAD lesion. Seven labral lesions were nonclassifiable at arthroscopy, all of which occurred after a history of chronic instability. When compared with arthroscopic findings, Shoulder MR Arthrography had two false-negative results [sensitivity, 92.8%] and no false-positive results. The sensitivity of shoulder MR Arthrography in detecting anteroinferior labroligamentous lesions was 92.8% [26/28] and specificity was [100%]. The overall accuracy of Shoulder MR Arthrography in detecting labroligamentous lesions in this study was 90.5% [19/21]. MR arthrography of the shoulder is reliable and accurate in classification of acute and chronic anteroinferior labroligamentous injuries

effect of cigarette smoking on bone healing and fracture repair

To determine the effect of cigarette smoking on bone healing and fracture repair among patients with malleolar fractures of ankle joint. Prospective study for 62 patients was done at King Hussein Medical Center, Amman, Jordan between January 2003 and December 2005 for treatment of malleolar fractures of ankle joint in term of healing time between groups of smokers and non smokers. From the 62 patients who were identified for specific ankle injury, 95% of non-smokers healed completely while only 68% of the smokers healed completely. The average time until complete healing was over 4 weeks longer in the smoker patients. Smoking cigarettes shows a significant difference in the healing time of bone fractures between smokers and non-smokers. Smoking places the patient at risk for delay in fracture healing and consequently increases the complications

Subcallosal striations: the role of FLAIR MR imaging in detecting these lesions in patients with multiple sclerosis

To evaluate the reliability of Fluid Attenuation Inversion Recovery [FLAIR] in detection of subcallosal striations in clinical Multiple sclerosis [MS] patients and determine its role as a good noninvasive tool for the diagnosis of this disease. Forty patients with clinically proved MS were examined along with 40 control patients well matched for age who presented with other indications for MRI study. Two mm Sagittal FLAIR sequence was added to the routine MRI studies of the brain. The images were reviewed for the presence of subcallosal striations. The study was conducted at King Hussein Medical Centre, Amman-Jordan from January 2005 to July 2007. All the 40 patients with clinical MS had subcallosal striations. Of the 40 without MS only four had subcallosal striations. Subcallosal striations were highly associated [P<.001] with clinical MS. FLAIR is a reliable tool for detection of subcallosal striations in MS which are not seen on routine axial MR images. However, these striations later produce the ovoid lesions visible on routine MR imaging

Double-phase technetium 99m setamibi scintigraphy for the localization of parathyroid adenoma

The purpose of the present study was to evaluate the accuracy of double phase Tc99m sestamibi scintigraphy in the assessment of parathyroid glands in patients with hyperparathyroidism and to compare this method with the high-resolution ultrasonography. From August-1998 through August-2000, we performed Tc99m -MIBI scintigraphy [MIBI] and neck ultrasonography in 35 patients who were clinically and biochemically suspected of having hyperparathyroidism. All patients underwent surgical neck exploration. Before surgery, blood intact parathyroid hormone and serum calcium level were measured peripherally. Early and delayed cervical images of MIBI scans and neck ultrasonography were interpreted by two radiologists. The findings were compared to ultrasonography and scintigraphic results. The sensitivity and positive predictive values of both modalities for localizing the diseased glands were determined by comparing scan findings with pathological findings, which were considered the gold standard. All resected glands were abnormal. They belonged to 25 patients with a single adenoma, two patients with ectopic glands, two patients with double adenomas and 6 patients with hyperplastic parathyroid glands. The sensitivity and positive predictive values for localizing the diseased glands in patients with hyperparathyroidism were 91% and 97%, respectively for Tc 99m MIBI. The values were 74% and 100%, respectively, for ultrasonography. Tc 99m MIBI sensitivity was higher in patients with parathyroid adenomas [96%] than that in patients with parathyroid hyperplasia [67%]. Our results demonstrate that Tc99m sestamibi scintigraphy is highly accurate in identifying parathyroid adenoma when performed by an experienced radiologist. It is helpful in preoperative localization of parathyroid adenoma in patients with suspected ectopic glands. Nevertheless, because of the greater accessibility, lower costs and simplicity, ultrasonography could be used as a screening modality for parathyroid adenoma localization