CT of preoperative and postoperative acetabular fractures revisited.

OBJECTIVE: We compared preoperative and postoperative computed tomography (CT) versus radiographic imaging in the evaluation of acetabular fractures (AFs). METHODS: Fifty-four patients who underwent imaging for AFs were retrospectively evaluated. Postoperative reduction quality was assessed on radiographs and CT scan by 2 observers. Rate of reintervention was noted. Radiation exposure from CT was calculated. RESULTS: After reduction, 24 patients had significant findings on postoperative CT. Five patients required reintervention, all of whom had significant postoperative CT findings and complex fractures. Notably, only 1 of the 5 patients had an indication for reintervention based on radiographs alone.The average dose for preoperative/postoperative CT study was 11.5/12.3 mSv, respectively, with a cumulative average dose of 23.8 mSv. CONCLUSIONS: Although reoperation rate is low after fixation of AFs, CT is required to identify those requiring reintervention. However, postoperative CT should be used judicially, only in patients presenting with complex acetabular fractures.

Progressive neurolymphomatosis with cutaneous disease: response in a patient with mycosis fungoides.

Peripheral neurolymphomatosis is a rare manifestation of advanced lymphoproliferative disorders. It is often associated with B cell lymphomas and rarely with cutaneous T cell lymphomas, such as mycosis fungoides and Sézary syndrome. In this case report, we present a 78-year-old male with a long-standing history of mycosis fungoides. The patient initially presented with chronic peripheral neuropathy in an ulnar nerve distribution. After an unsuccessful ulnar nerve transposition, the ulnar nerve was re-explored and a mass consistent with diffuse lymphomatous infiltration was diagnosed. Magnetic resonance (MR) imaging of the left brachial plexus and later of the sacral plexus demonstrated diffuse thickening and peripheral nodularity in keeping with neurolymphomatosis. The patient's clinical course rapidly deteriorated thereafter and the patient succumbed to his disease. Although uncommon, neurolymphomatosis may be considered in patients with chronic peripheral neuropathy and an underlying history of a lymphoproliferative disorder. US and MR may serve as helpful non-invasive adjuncts in making the diagnosis and identifying sites for biopsy.

Magnetic resonance imaging of muscle disease: a pattern-based approach.

Magnetic resonance imaging (MRI) is a powerful tool to assess the severity, distribution, and progression of muscle injury and disease. However, a muscle's response to a pathological insult is limited to only a few patterns on MRI, and findings can be nonspecific. A pattern-based approach is therefore essential to correctly interpret MR studies of abnormal muscle. In this article we review the anatomy, function, and normal MRI appearance of skeletal muscle. We present a classification scheme that categorizes abnormal MR appearances of muscle into 4 main pattern descriptors: (1) distribution; (2) change in size and shape; (3) T1 signal; and (4) T2 signal. Each category is further subdivided into the various patterns seen on MRI. Such an approach allows one to systematically assess abnormal findings on muscle MRI studies and ascertain clues to the diagnosis or differential diagnosis, particularly when findings are correlated with the clinical context.

MR and CT arthrography of the knee.

MR and CT arthrography are important imaging modalities for the assessment of the knee in certain situations. Indications for MR arthrography of the knee include assessment of the postoperative meniscus, the presence of chondral and osteochondral lesions, and the presence of intra-articular bodies. The major indication for CT arthrography is evaluating suspected internal derangement in patients who are unable to undergo MRI. In addition to reviewing the established clinical indications for MR and CT arthrography of the knee, the commonly used techniques, normal variants that can simulate disease, and the most commonly found pathologies that can be diagnosed with these modalities are discussed. Potential indications that are not currently well established in the literature including the evaluation of anterior cruciate ligament injury and autologous chondrocyte implants are examined. Where appropriate, the literature on controversial topics or diagnoses is reviewed. The use of conventional imaging versus CT and MR arthrography is also compared.