The role of chemical shift magnetic resonance imaging in differentiating osteoporotic benign and malignant vertebral marrow lesions.

PURPOSE: To evaluate the usefulness of chemical shift imaging (CSI) in differentiating benign osteoporotic and malignant vertebral marrow lesions. MATERIAL AND METHODS: Patients undergoing spinal magnetic resonance imaging (MRI) for back pain, which showed altered marrow signal intensity on conventional MRI sequences, were included in the study. Patients with acute traumatic vertebral fractures, infective spondylodiscitis, paravertebral collections, etc. were excluded. The patients underwent CSI. In-phase and opposed-phase images were taken to calculate the signal intensity ratio (SIR) of the abnormal vertebra. The SIR of the mean signal intensity measured on opposed-phase to mean signal intensity measured on in-phase images was measured and recorded. RESULTS: The studied population included 30 patients, in whom 58 vertebrae were accessed, which included 38 dorsal, 18 lumbar, 1 sacral, and 1 cervical. Out of 58 vertebrae, 46 (79%) were malignant and 12 (20%) were benign. The mean CSI/SIR of malignant lesions was 0.96 and the mean SIR of benign lesions was 0.76. CONCLUSIONS: Conventional MRI sequences cannot always differentiate between benign and malignant lesions. So newer sequences like CSI have been developed. CSI SIR can be used as a new tool in differentiating benign osteoporotic and malignant vertebral marrow lesions.

Evaluation of plantar fascia using high-resolution ultrasonography in clinically diagnosed cases of plantar fasciitis.

PURPOSE: The aim of this study was to assess the efficacy of high-resolution ultrasonography in the assessment of plantar fascia in individuals with heel pain, before and after treatment. MATERIAL AND METHODS: This study was conducted from 2016 to 2019, during which time 44 clinically diagnosed patients of plantar fasciitis were compared to 50 normal volunteers. There were 25 males and 25 females in the control group and 42 females and two males in the study group. Thirty-eight patients had unilateral disease, and six patients had bilateral disease. The thickness of the plantar fascia was measured just anterior to its calcaneal attachment using ultrasonography. Body mass index (BMI) was also calculated in both groups. RESULTS: The plantar fascia was 2-4 mm thick in the control group whereas it was > 4 mm thick in 48 heels in the study group. With cut-off of > 4 mm as diagnostic of plantar fasciitis, this study had a sensitivity of 96%, specificity of 100%, and accuracy of 98%. BMI was increased in 60% of female patients. All patients were treated with local infiltration of corticosteroid. In 37/42 patients (43 heels) who had improved clinically, the thickness of plantar fascia was reduced to < 4 mm when assessed after six weeks of corticosteroid injection. CONCLUSIONS: Diagnosis of plantar fasciitis can be easily verified by ultrasonography with plantar fascia thickness > 4 mm being suggestive of plantar fasciitis. Ultrasound can also be used to evaluate treatment response. Ultrasono-graphy helps the clinician in confirming the diagnosis of plantar fasciitis and also in assessing the response to treatment.

Accuracy of high-resolution ultrasonography in establishing the diagnosis of carpal tunnel syndrome.

BACKGROUND: The aim of this study was to evaluate the accuracy of high-resolution ultrasonography in the diagnosis of carpal tunnel syndrome (CTS). METHODS: It included 50 patients with signs and symptoms suggestive of CTS and 50 individuals as control group. Cross-sectional area of median nerve at the inlet of carpal tunnel was measured in control as well as symptomatic group by ultrasonography. In addition, nerve conduction studies (NCS) were carried out in the symptomatic group. Radiologists performing the ultrasonography were blinded to the results of NCS. Sensitivity, specificity and accuracy of ultrasonography and NCS in the diagnosis of CTS were calculated and compared. RESULTS: In control group, cross-sectional area of the median nerve ranged between 5 and 7.3 mm2 , whereas in the symptomatic group it varied from 8.4 to 16.5 mm2 . It was >9 mm2 in 47 patients. With a cut-off of 9 mm2 , sensitivity, specificity and accuracy of ultrasonography in diagnosing CTS were 95%, 100% and 97%, respectively. NCS was diagnostic of CTS in 48 (96%) patients. CONCLUSION: Ultrasonographic examination gives similar results to NCS in establishing diagnosis of CTS and can be used as a screening modality with further use of NCS in cases where ultrasonography is non-diagnostic.

May-Thurner syndrome: an uncommon and incidental finding in a postpartum female.

May-Thurner syndrome or Cockett syndrome is a pathological condition that arises due to extrinsic compression on iliocaval venous territory, leading to venous outflow obstruction. Here, author presents an incidental finding of left common iliac vein extrinsic compression by right common iliac artery with collateral vessels in the pelvis in a postpartum female.