Meniscal tears--comparison of arthrography, CT, and MRI.

A total of 1750 knees were prospectively evaluated using a high-resolution noninvasive axial computed tomography (CT) scanning technique. A total of 203 knees underwent subsequent arthroscopic or arthrographic evaluation. In this group, the sensitivity of CT for the detection of a torn meniscus was 88.5%; the specificity was 95.5%; and the accuracy was 91.5%. An additional 270 knees were prospectively evaluated by both CT and magnetic resonance imaging (MRI) to determine the ability of both techniques to characterize knee menisci in patients believed to have meniscal tears. Of these knees, 94 were subsequently examined by arthroscopy. In this group, the overall accuracy of MRI for detecting a torn meniscus was 89.5% and for CT it was 92.2%. Properly performed, both CT and MRI are accurate and effective methods for noninvasively evaluating meniscal abnormalities in the acutely injured knee. The protocol for CT and MRI meniscus imaging as well as interpretation are presented in addition to their relative roles with respect to arthrography and arthroscopy.

Bucket-handle tears of the meniscus: appearance at CT.

Before undergoing arthroscopy, 222 patients with acute, unilateral knee injuries and strong clinical evidence of a meniscal tear underwent axial computed tomography (CT) of the knee. In 53 patients, a bucket-handle meniscal tear was found, and it was repaired at arthroscopy. In 92.5% (49 of 53) of these knees, CT accurately depicted the type, location, and extent of the tear. CT also demonstrated the displaced meniscal fragment with its relationship to the attached remnant.

CT follow-up of hepatic and splenic fungal microabscesses.

Three patients with acute myelogenous leukemia underwent abdominal computed tomographic (CT) examination for recent deterioration in clinical status. The diagnosis of hepatic and splenic microabscesses was correctly suggested in each patient on the basis of this study. In addition, CT accurately assessed the efficacy of antifungal therapy on follow-up studies. In this limited series of patients, CT was superior to clinical and laboratory evaluation in predicting the degree of parenchymal infection in the liver and spleen during treatment, confirmed by histologic specimens.

Pathways of tumor spread through the lung: radiologic correlations with anatomy and pathology.

The pathways of tumor spread through the lung are described and their significance for radiographic interpretation is illustrated. A key to understanding the spread of bronchogenic carcinoma is the realization that although the normal flow of lymph in the pulmonary lymphatics is centripetal, lymphatic obstruction can cause reversal of flow. As a result, tumor cells are commonly carried centrifugally to the periphery in lymphatics or the connective tissue around them, and remote pleural involvement, secondary parenchymal masses, or satellite nodules may develop. Failure to appreciate peripheral spread of tumor has negative consequences for tumor staging, surgery, and radiotherapy. In the absence of hilar node involvement causing obstruction, long line shadows more than 0.5 inch (1.25 cm) in length proximal to a peripheral mass very infrequently represent tumor.

Renal arteriovenous malformation presenting as a mass lesion.

Arteriovenous malformations of the kidney are definitively diagnosed by selective arteriography (1). The following case is unique in that it presented as an avascular mass and the lesion itself could not be demonstrated angiographically.