Ultrasound and MRI measurements of joint cartilage in healthy children: a validation study.

PURPOSE: In juvenile idiopathic arthritis (JIA), proliferative changes in the synovium and synovial fluid accumulation are pathological findings responsible for damage to the cartilaginous tissue and periarticular bone, which are late radiographic findings in conventional radiography. Early detection of these joint changes would allow the clinicians to initiate relevant therapies as is essential for the long-term outcome of JIA. Ultrasonography (US) has shown great potential for this purpose but validation in a pediatric setting is needed. The objective of this study was to validate US measurements of cartilage thickness in target joints in healthy children by comparing them with MRI. MATERIALS AND METHODS: Twenty-five healthy Caucasian children (17 boys/ 8 girls), mean age 11.33 years, were examined with MRI (1.5 T, fat-suppressed T 1-weighted 3D sequences) and US (real-time Hitachi EUB 6500 CFM, B-mode 6 - 14 MHz linear transducer) in the right knee, ankle, wrist, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. US was obtained according to the EULAR standard scans. RESULTS: All differences in cartilage thickness measurements between MRI and US were less than 0.5 millimeters. The coefficient of variation (CV) was found to be good (16 %) except for in the case of the wrist joint (20 %). CONCLUSION: We found a good level of agreement and no significant systematic joint size-related differences in cartilage thickness measurements between MRI and US. US appears to be a feasible method for evaluating cartilage thickness in JIA target joints, especially when age and sex-related references are defined.

The occurrence of sinusitis in HIV-infected patients with fever.

Sinusitis is commonly occurring in patients infected with Human Immunodeficiency Virus I (HIV), but the occurrence and etiology have not been established. The purpose of this study was prospectively to determine the occurrence, site and type of paranasal sinus abnormalities seen on MRI in HIV-infected patients with fever, to relate the abnormalities to clinical and immunological parameters, and to determine the microbiological agents found in the sinus aspirates. MRI was performed in 54 HIV-infected patients with 70 evaluable episodes of fever. Patients receiving antibiotics were excluded. Bactrim was permitted, when given as prophylaxis of Pneumocystis carinii pneumonia. If abnormalities were found on MRI, sinus aspiration was performed and the aspirate investigated. MRI abnormalities were found in 54.3% of the patients with a significantly higher occurrence of pathological changes in AIDS patients compared with HIV-infected without AIDS. In approximately 2/3 of the aspirates a probable, etiologic agent was found. However, 1/3 of these agents were atypical such as cytomegalovirus and mycobacteriae; in one patient Non-Hodgkin's lymphoma was found. The high occurrence of sinusitis in HIV-infected patients and the atypical findings in the sinus aspirates stress the importance of searching for sinusitis and the etiology to ensure the correct treatment.

Structural brain abnormalities in unselected in-patients with major depression.

OBJECTIVE: Several studies have indicated an increased frequency of cerebral atrophy and white matter lesions in patients with major depression, especially in older age groups. METHOD: Forty-four representative in-patients with major depression in which neurological disorders were clinically excluded, and 49 age- and gender-matched controls were MR scanned. RESULTS: Unexpectedly, two of the patients had severe brain pathology which could account for their psychiatric symptoms. Analysis of the remaining patients (mean age 42 years) did not reveal an increased frequency of cerebral atrophy. The number of white matter lesions increased with age to an odds ratio greater than 3 for patients aged 50, but this was not statistically significant. CONCLUSION: Brain atrophy and white matter lesions did not occur with significantly increased frequency in these relatively young unselected depressives, but the finding of severe brain pathology stresses the importance of brain imaging in late-onset psychiatric disorders.

Incidence and growth pattern of vestibular schwannomas in a Danish county, 1977-98.

During a period of 21 years 162 acoustic neuromas or vestibular schwannomas (VS) were diagnosed in the county of Aarhus. During this period the incidence increased gradually, probably due to improvement of the quality of computed tomography imaging (CTI), and more widely available access to magnetic resonance imaging (MRI). Sixty-four patients were followed up by repeated CTI or MRI, whereas the remaining patients were referred for immediate operation. Six of the observed patients had their tumours removed after demonstration of continuous tumour growth. The observation of 64 tumours over periods between 5 months and 15 years provided useful information on the natural history of sporadic VS. Our results showed that 14 VS (22%) regressed, 35 VS (55%) did not grow or had only minimal growth (growth rate up to 1 mm/year), whereas 15 VS (23%) grew > 1 mm/year. All VS with positive growth had regular growth patterns.

The prevalence and significance of incidental paranasal sinus abnormalities on MRI.

Morphological changes in the paranasal sinuses are regularly noted on MRI, but little is known about the incidence and significance of these changes in the general population. The purpose of this study was 1) to classify the morphological changes in the paranasal sinuses seen on MRI 2) to investigate the prevalence, site and type of paranasal abnormalities and 3) to evaluate the significance of the findings by relating them to the presence of sinusitis symptoms, allergy, smoking habits and seasonal variations. In a one-year period, 404 patients referred to MRI for suspected intracranial neurological pathology were prospectively investigated. Before undergoing the scan the patients completed a questionnaire. The observed morphological conditions were classified so that mucous thickening < 5 mm was recorded as normal; > or = 5 mm, total sinus opacification or fluid and polyps as pathological. According to this classification 31.7% of the patients had pathological findings in the sinuses. A significantly higher incidence was found in the winter period and in patients with symptoms associated to sinusitis. "Blocked nose" was the only symptom occurring significantly more often in patients with pathological changes. There was no significant relationship between paranasal sinus abnormalities and sex, age, allergy, smoking habits, previous events of sinusitis or frequent events of colds. Criteria for pathological MRI findings in the paranasal sinuses are desirable and might improve the basis for a decision on the correct medical or surgical treatment.

Investigations into the natural history of vestibular schwannomas.

In the period from 1977 to 1996 143 vestibular schwannomas were diagnosed in 138 patients in the County of Aarhus, Denmark. The natural history of vestibular schwannomas was observed in 50 patients with 52 tumours who did not undergo immediate surgical removal of their tumour due to small tumour size, advanced age, poor general health and the patients' refusal of surgery. The management included serial CT- or MR-imaging and complete otoneurological evaluation. The imaging interval was between 6 months and 2 years and depended on the recorded growth rate. Thirty-three (64%) of the tumours showed continuous growth with a mean growth rate of 1.6 mm/year. In 11 (21%) of the tumours the size was unchanged and eight (15%) remitted. The last group consisted mainly of the largest tumours. Among the tumours with positive growth, 15 (45%) had a growth rate of 1 mm/year or less. Generally, our findings showed that approximately two-thirds of all the tumours did not grow, were getting smaller or had a growth rate sufficiently small to be simply watched. Additionally, our results suggest that some symptomatic tumours will grow to a certain point whereupon stagnation or remission occurs.

The size of acoustic neuromas: CT and MRI.

The growth rate of acoustic neuromas is very variable: some tumours grow rapidly, some do not grow and some even get smaller. When making treatment decisions, it may be important to have an idea of the growth rate of the individual tumour, and this is only possible when there are comparable examinations. We performed both CT and MRI on 15 patients. Two radiologists estimated the size of their acoustic neuromas. There was a significant difference between the two examiners' calculations of tumour volumes on CT and between the first examiner's CT and MRI volume calculations. No difference was found between the two MRI volume estimations or the second examiner's estimation of volumes on CT and MRI. Measurements of the maximal tumour diameter along the pyramid showed good concordance. We conclude that measurement the size of acoustic neuromas is reproducible with MRI and the measurement of the maximal tumour diameter is in practice a better parameter for comparison than calculation of real volume.

Width of the medial tibiotalar joint.

PURPOSE: To determine the extent to which the width of the space in the medial tibiotalar joint depends on plantar flexion. MATERIAL AND METHODS: Thirty healthy volunteers were studied by means of a.p. roentgenograms of the left ankle both in a neutral position and in plantar flexion. RESULTS: The medial joint space showed significant widening (average 0.65 mm) between the neutral position and plantar flexion. CONCLUSION: When ankle joint injuries are studied on radiographs, the position of the foot must be taken into consideration.

Spinal epidural lipomatosis. Case report and review of the literature.

Spinal epidural lipomatosis (SEL) is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It is most frequently seen in patients on chronic glucocorticosteroid therapy for a variety of medical problems. This is a case report of lumbar epidural lipomatosis in a bodybuilder with radiculopathy supposedly induced by anabolic steroid intake.

[Indication for radiological examination in acute ankle distorsion]. / Indikation for røntgenundersøgelse ved akut ankeldistorsion.

Inversion injuries of the ankle are a common cause of presentation to accident and emergency units. They impose a major load on radiological services. A prospective study was carried out to test the hypothesis that a thorough physical examination can eliminate the need for a large number of radiographs obtained in patients with acute ankle trauma. Two hundred and one patients were seen in the emergency department for acute ankle trauma. All patients were assessed clinically, then examined radiographically. Sensitivity and specificity of various clinical signs were calculated. Swelling, focal bony tenderness on the lateral malleollus, and decreased ability to bear weight were found to be the most important predictors, especially if present simultaneously. According to this material bimalleolar distance ratio cannot be used as predictor.

[Size of acoustic neurinomas assessed by CT and magnetic resonance scanning]. / Størrelsen af acusticusneurinomer bedømt ved CT og magnetisk resonansskanning.

Some acoustic neuromas do not grow or grow very slowly. It is therefore of value to compare the results of measuring the size of acoustic neuromas by either CT or Magnetic Resonance Imaging (MRI) scanning with a view to being able to observe the growth rate of these tumours. Fifteen patients with acoustic neuromas had both CT- and MRI-scans performed. Two trained radiologists evaluated the size of the tumours in a blinded fashion. There was a significant difference between one observer's calculations from the CT- and the MRI-scans, and also a significant difference between the two observers' calculations from the CT-scans. No difference in calculating tumour size was found between the two observers' calculations from the MRI-scans. It is concluded that the size of acoustic neuromas i evaluated more equally by two observers using MRI-scans than when using CT-scans. By the use of repeated MRI-scanning it is possible to keep patients with acoustic nouromas under observation and avoid operation in those patients where the tumour does not grow.

[Intracranial distribution of iohexol and iotrolan after cervical myelography]. / Intrakranial fordeling af iohexol og iotrolan efter cervikal myelografi.

Twenty-eight consecutive patients undergoing cervical myelography were examined with either iohexol (14) or iotrolan (14). Just before the myelography a cranial CT was performed and control CT (3-5 slices) examinations were performed three, six, 24 and 48 hours afterwards. In all 28 patients CT showed intracranial contrast medium distribution after cervical myelography. The contrast medium distributed mainly in the subarachnoid space, first to the basal cisterns and the insular fissures, and to the 4th ventricle. The densities in the subarachnoid spaces were significantly higher after iotrolan than iohexol in the basal cisterns three and six hours after myelography, and in the 4th ventricle. The subcortical density was still increasing 48 hours after iotrolanmyelography while the subcortical density reached the maximum 24 hours after iohexolmyelography. Following cervical myelography the contrast media iohexol and iotrolan distribute intracranially and iotrolan seems to be eliminated more slowly than iohexol.

Intracranial iotrolan distribution following cervical myelography. Postmyelographic registration of adverse effects, psychometric assessment and electroencephalographic recording.

Following iotrolan cervical myelography 14 consecutive patients were evaluated with respect to intracranial contrast distribution and elimination, side effects, EEG-changes and psychometric assessments. The contrast medium is distributed in the subarachnoid space, in the ventricles and finally extracellularly in the cortex. Headache was the most prevalent side effect, occurring in half of the patients, 43% of "severe" grade. Eight patients showed mild nonspecific EEG-changes and all patients showed neuropsychologic disturbances.

Muscular hamartoma of the breast. A case report.

A case of a muscular hamartoma of the breast in a 47-year-old woman is presented. Tumors containing smooth muscle are rare in the breast. Radiologically it appears as a circumscribed tumor with homogeneous or varying density. Histologically these lesions are composed of ducts, lobules, stroma prominently adipose, and smooth muscle.

Renal artery aneurysm detected by pulsed Doppler ultrasound.

A case of a right renal artery in a 70-year-old man is presented. Ultrasound shows an anechoic lesion surrounded by hyperechoic areas in the kidney and pulsed doppler ultrasound (US) provides a noninvasive diagnosis of a renal aneurysm.

[Scheuermann's disease]. / Scheuermann's sygdom.

Scheuermann's disease is most frequently diagnosed in patients between 13 and 17 years and is subdivided into high, long and low kyphoses. The symptoms consist of pain which may be aggravated by physical exertion. Pain is most frequent and most severe in the long and low kyphoses. The etiology and pathogenesis are not entirely elucidated but it is probable that there is a genetic component, that the condition is not unifactorial and that it may be due to weakness in the epiphyseal plates of the vertebrae. Radiography reveals irregularities of the end-plates of the vertebrae, frequently with Schmorl's impressions, narrowing of the intervertebral spaces, one or more wedge-shaped vertebral bodies and increased kyphosing. No effective symptomatic treatment is known but the patients should be advised about choice of career and work. In order to avoid hyperkyphosis and chronic pain, back and abdominal musculature must be strengthened and mobility in the spine improved. Gymnastics, swimming and cycling on stationary bicycles may be recommended but sports associated with jumping and marked stress for the spine must be warned against. In few and severe cases, treatment with a corset or operation may be necessary.

Internal Richter's hernia due to congenital peritoneal defect. Case report.

A case of internal Richter's hernia due to a congenital defect of the peritoneum in a 17-year-old girl is described.