Knee magnetic resonance imaging in childhood chronic monarthritis.

OBJECTIVE: To describe the usefulness of magnetic resonance imaging (MRI) of the knee in the evaluation of chronic monarthritis of uncertain cause in childhood. METHODS: We retrospectively reviewed 21 children referred to our clinic with a putative diagnosis of chronic inflammatory monarthritis of the knee who had MRI performed between May 1993 and June 1997. The median age was 13 years (range 2-17) and 11 were girls. RESULTS: The clinical diagnosis prior to MRI assessment was inflammatory arthritis in 16 patients, and a primary noninflammatory cause in 5. MRI was done in the patients with presumptive inflammatory arthritis when there were atypical symptoms, signs, or radiographs (n = 14), or when they failed to respond to therapy (n = 2). In the patients with a presumptive noninflammatory diagnosis, MRI was performed to clarify the diagnosis. Twelve children (57%) had MRI evidence of a noninflammatory diagnosis. In 4 children (19%) the MRI study indicated the presence of arthritis, and in 5 children (24%) the MRI studies were normal. The noninflammatory diagnoses included: lipoma arborescens (n = 1), vascular malformation [intraarticular (n = 1), extraarticular (n = 1)], synovial chondromatosis (n = 2), partial anterior cruciate ligament tear (n = 2), traumatic bone contusion (n = 2), possible meniscal tear (n = 1), osteochondritis dissecans (n = 1), and a soft tissue mass of uncertain significance in the suprapatellar pouch (n = 1). CONCLUSION: Inflammatory arthritis is usually diagnosed by clinical assessment alone. Uncommonly, when a single joint is involved, and atypical features are identified by a pediatric rheumatologist, other causes of chronic pain and swelling need to be excluded. In this selected patient population, MRI is a useful tool either to confirm the presence of inflammatory arthritis or to investigate a wide range of pathology that can mimic knee joint arthritis.

Quality of mucosal coating in double-contrast barium enema studies: comparison of two barium preparations.

To determine which of two types of barium preparation, a dry powder (AC-14, E-Z-EM, Montreal) or a premixed suspension (Liquid Polibar Plus, E-Z-EM), gives better mucosal coating for double-contrast enema studies, the authors compared the results of two series of 80 examinations each, one for each of the preparations. The films were retrospectively reviewed by two independent observers, who did not know which preparation had been used for a given examination. Mucosal coating was graded on a five-point scale and the amount of barium on a three-point scale. Each area of the colon--the cecum, the ascending, the transverse and the descending colon and the rectosigmoid--was rated separately. The premixed barium suspension yielded significantly better mucosal coating than the dry powder in all areas of the colon (p < 0.01). There was no significant difference between the two preparations in the amount of barium deposited in any region of the colon (p > 0.05) or in the proportion of unsatisfactory examinations (p > 0.05). The authors conclude that the premixed suspension yielded better-quality mucosal coating than a suspension made from the dry powder and resulted in a similar high proportion of technically satisfactory studies.