Roentgenographic assessment of acromial morphologic condition in rotator cuff impingement syndrome.

Patients with an isolated diagnosis of rotator cuff impingement syndrome were prospectively entered into the study. Each of the 23 subjects was refractory to conservative therapy, had preoperative roentgenograms, and underwent an open acromioplasty. The roentgenograms included anteroposterior, axillary, 30 degrees caudal tilt, and supraspinatus outlet views. The roentgenograms were measured by four independent readers. The separate views were then scored for reliability, and the correlation of the measurements with intraoperative acromial measurements was assessed. Interobserver reliability was highest for the caudal tilt view (0.84) and lowest for the axillary view (0.09). The supraspinatus and caudal tilt views correlated significantly with distinct intraoperative measurements of acromial spur size. We continue to advocate the evaluation of both views for preoperative assessment of the acromial spur in the rotator cuff impingement syndrome.

Comparison of radionuclide bone scans and magnetic resonance imaging in detecting spinal metastases.

A retrospective comparison was made between 99mTc-MDP bone scans and corresponding spine MR images in 35 patients who had complementary studies within 2 mo. Bone scans were performed with planar imaging of the entire body and MRI was performed with a 1.5 tesla signal scanner using standard techniques with T1- and T2-weighted images. There were 18 male and 17 female patients diagnosed with cancer prior to these studies. Cancer diagnoses included 14 prostate, 12 breast, 1 bladder, 2 renal, 2 lung, 1 each of esophagus, melanoma, myeloma and adenocarcinoma of unknown primary cancer. Of the regions compared, 69 were positive for bony metastases by MRI and 63 regions by bone scans. Thirty-eight regions were concordantly positive and 56 regions concordantly negative. No patients with entirely positive bone scans were negative by MRI, but one patient was entirely positive by MRI but negative by a bone scan. At least one region was discordantly read in 21 patients. Distribution of positive regions was similar on bone scan and MRI. The greatest number and proportion of discordant readings occurred in the lumbar regions and more frequently in patients with prostate cancer. Considering its widespread availability and the ease of performing a whole-body survey for metastasis, radionuclide bone scanning remains the study of choice for initial evaluation of patients with cancer. However, MRI is an excellent complementary technique when bone scan findings are inadequate for answering clinical questions. MRI appears to be quite sensitive and probably more specific for metastasis in certain locations of the spine.

Visual imaging in psychiatry.

Although they have not yet profoundly affected the clinical practice of psychiatry, five new imaging techniques--computed tomography, brain electrical activity mapping, cerebral blood flow techniques, positron emission tomography, and nuclear magnetic resonance--show promise for furthering knowledge of the pathophysiology, diagnosis, and treatment of psychiatric patients. Through a survey of the literature, the authors discuss the applicability of each technique to the study of certain mental disorders, such as schizophrenia; the latest research findings produced by studies using the techniques; the advantages and disadvantages, if any, of each technique; and the potential role for each technique in the field of psychiatry.

Quantification of gray/white matter in neonates and adults.

Quantitation of gray/white matter is important in evaluation of cerebral blood flow, atrophy, and development of the brain. First-order statistical analysis of neonatal computed tomographic (CT) images revealed that there was only a 6 Hounsfield unit (H) difference between gray and white matter compared with the observed 3 H for the standard deviation over the field of a skull water phantom. Scene segmentation methods based on first-order statistics proved unsuccessful in separating gray and white matter. A new regional clustering algorithm based on local textural properties was developed for separation of these structures.