Sonographic evaluation of the plantar fascia in asymptomatic subjects.

PURPOSE: To evaluate the appearance of the plantar fascia in asymptomatic subjects. MATERIALS AND METHODS: Thirty-one asymptomatic subjects were examined by 2 musculoskeletal radiologists. The plantar fascia was evaluated for thickness, echogenicity, vascularity on power Doppler, rupture, fluid adjacent to the fascia, andcalcifications. RESULTS: The study included 14 men and 17 women (age, 17-79 years; mean, 45 years). The mean thickness of the plantar fascia in men was 3.7 mm (range 2.5-7 mm), and in women 3.5 mm (range, 1.7-5.1 mm). The thickness was greater than 4 mm in 4 men (bilateral in 2). The mean thickness of fascias thicker than 4 mm in men was 5.4 mm (range, 4.3-7 mm). The thickness was greater than 4 mm in 5 women ( bilateral in 4). The mean thickness of fascias thicker than 4 mm in women was 4.7 mm (range, 4.2-5.1 mm). There was no statistically significant difference between men and women and between both heels. Hypoechogenicity was observed in 3 men (bilateral in 2), and in 5 women (bilateral in 6). Hypervascularity, rupture, fluid adjacent to the fascia, and calcifications were not observed. CONCLUSION: A thickness greater than 4 mm and hypoechogenicity, are common in the plantar fascia of asymptomatic subjects. Findings that were not seen in asymptomatic subjects include a thickness greater than 7 mm, hypervascularity on power Doppler, rupture, fluid adjacent to the fascia, and calcifications.

A bare area of the glenoid misdiagnosed as a cartilage ulceration.

We report on a 17-year-old girl who developed shoulder pain after a fall on an outstretched arm. CT arthrography and MR imaging demonstrated a cartilage defect centrally located in the glenoid. This was accompanied by an eroded appearance of the underlying bone. Since symptoms persisted over several months it was initially thought this represented a cartilage injury. Subsequently arthroscopy was performed and the abnormality was identified as a bare area of the glenoid. A tear of the superior glenohumeral ligament was depicted and was repaired. The bare area is an oval area denuded of cartilage that is probably developmental and that should be differentiated from true cartilage injuries to avoid unnecessary interventions. An eroded appearance of the underlying bone may occur on imaging, a finding that has not been previously reported.

Pigmented villonodular synovitis of the midfoot.

A 60-year-old man presented with a longstanding slowly growing swelling at the dorsal aspect of the left midfoot. The lesion was imaged with CT, ultrasound, and MR. On CT bony erosions were evident. On MR the lesions appeared bifocal and one component was hypointense on T2 weighted images suggesting hemosiderin deposits. The other component was hyperintense on T2 which is more unusual for PVNS. Imaging findings, however, suggested PVNS which was pathologically confirmed. A unique finding in this case is the late age of presentation of the disorder. Also the bifocal nature of the lesion is relatively uncommon.

An unusual case of cat-scratch disease of the knee: case report and differential diagnosis.

We present a case of a 16-year-old boy with a painful swelling in the popliteal fossa, slight fever, articular and muscle pain of 3 weeks duration. Plain radiography and MR examination were performed in order to characterize the lesion. Additionally to the poorly defined mass, 2 satellite nodules were shown. Subsequent biopsy revealed a granulomatous process and 2 satellite lymphadenopathies highly suggestive of cat-scratch disease. This case shows that the differential diagnosis of a soft tissue mass of the knee should not only include tumoral processes or pseudotumoral lesions, but also granulomas from infectious or non-infectious origin. Knowledge of the patients contact with cats and the detection of skin scratches is usually the clue to the correct diagnosis.

Proceedings of the SRBR-KBVR osteoarticular section meeting of June 29, 2004 in Antwerp. Cystic adventitial disease.

The purpose of this paper is to give a short review of the pathogenesis, imaging characteristics, differential diagnosis and current treatment of cystic adventitial disease.

MR imaging findings of bone marrow changes in patients with cystic fibrosis.

The purpose of this work was to evaluate bone marrow abnormalities in the lower limbs of patients with cystic fibrosis by means of MR imaging. Eight patients with cystic fibrosis ranging in age from 16 to 35 years (average age 25.1 years) were evaluated with MR imaging of the lower extremities. T1 weighted spin echo sequences were obtained in all patients. Pelvis, femora and tibia were imaged in the coronal plane whereas the feet were imaged in the sagittal plane. The studies were independently evaluated by two musculoskeletal radiologists. The images were not mixed with disease-free images, but the readers were completely unaware of clinical data. Distribution of haematopoietic and fatty marrow was graded on a 5-point scale. In five patients, both observers considered marrow distribution as probably or definitely abnormal relative to their age. Although our findings are very preliminary, our investigation suggests that cystic fibrosis may be added to the list of disorders in which bone marrow abnormalities may be observed.

Can bone marrow edema be seen on STIR images of the ankle and foot after 1 week of running?

PURPOSE: To evaluate whether initiation of running in sedentary individuals would lead to bone marrow edema on MR images, within the time span of 1 week. MATERIALS AND METHODS: The feet of 10 healthy volunteers were imaged by MR imaging before and after running during 30 min a day for 1 week. The images were evaluated by consensus of 2 musculoskeletal radiologists who graded the presence of bone marrow edema on a 4-point scale. Edema scores and number of bones involved before and after running were compared statistically. RESULTS: Edema was present on the baseline images in 3 subjects. After running edema showed an increase or was present in 5 subjects. The changes after running were statistically significant. Bones involved were the talus, calcaneus, navicular bone, cuboid bone, and 5th metatarsal. CONCLUSION: Edema patterns can be seen in the feet of asymptomatic individuals. During initiation of running an increase of edema or development of new edema areas can be seen.

MR imaging of meniscal cysts: evaluation of location and extension using a three-layer approach.

PURPOSE: To analyze the extension of medial and lateral meniscal cysts relative to the capuloligamentous planes of the knee. MATERIALS AND METHODS: The MR images of 32 patients with meniscal cysts were reviewed. The location and extension of the meniscal cysts with reference to the capsule and ligaments were recorded. RESULTS: Most medial meniscal cysts were located posteromedially. Posteromedial meniscal cysts usually penetrated the capsule and were located between layer I and the fused layers II+III. From this site some extended anteriorly and then became located superficial to the superficial MCL. The location of lateral meniscal cysts was more varied. Anteriorly the cysts were located deep to the iliotibial band, whereas posterolateral cysts were located deep to the lateral collateral ligament. CONCLUSION: Although the site of capsular penetration of meniscal cysts is determined by the location of meniscal tears, the possible pathways of extension appear to be determined by the capsuloligamentous planes of the knee.

Arthrographic and CT arthrographic findings in dorsal peripheral detachment of the triangular fibrocartilaginous complex.

Arthrography and CT arthrogram were evaluated in the diagnosis of dorsal peripheral detachment of the triangular fibrocartilaginous complex (TFCC) in the wrist. The imaging findings and medical records of 19 patients, who underwent surgical repair of a dorsal peripheral detachment of the TFCC, were retrospectively studied. Diagnoses were based on the results of the arthrography and CT arthrogram as well as on the clinical examination. The arthrographic features assessed included abnormal filling of the tendon sheath of the extensor carpi ulnaris (ECU) and irregular contrast extravasate in the dorsal ulnar and peristyloid region. The findings on arthrography and CT arthrography were correlated with the arthroscopic results. In conclusion, the arthrographic signs seem to be reliable findings in the diagnosis of dorsal detachment of the TFCC.

Tarsal tunnel syndrome: ultrasonographic and MRI features.

Tarsal tunnel syndrome is a well-known but rare entrapment neuropathy involving the posterior tibial nerve in the tarsal tunnel, a fibro-osseous channel extending from the medial aspect of the ankle to the midfoot. Posttraumatic fibrosis, ganglion cyst, tenosynovitis, tumor of the nerves or other structures, dilated or tortuous veins can cause significant nerve compression in this anatomic region. Herein, we present the typical ultrasonographic and magnetic resonance features of this disorder in patient with a ganglion cyst.

Deep benign fibrous histiocytoma of the knee: CT and MR features with pathologic correlation.

Magnetic resonance imaging and pathologic findings in a 28-year-old patient with a giant deep benign fibrous histiocytoma in the popliteal fossa of the right knee are described. The MR imaging findings include a well-delineated oval mass with low signal intensity on T1-, and high signal intensity on T2-weighted, images, and marked peripheral contrast enhancement. To the best of our knowledge, this is the first report on the MR findings in this entity.

Calcium hydroxyapatite deposition disease of the neck: finding in three patients.

Calcium hydroxyapatite deposition disease may occasionally involve the superolateral portion of the longus colli muscle. Clinical symptoms include headache, neck pain, and dysphagia. Characteristic prevertebral calcifications with the epicenter at the C1-C2 level are depicted on lateral radiographs of the cervical spine.

Glenoid dysplasia: radiographic and CT arthrographic findings.

A 60-year-old man with dysplasia of the glenoid and a rotator cuff tear is reported on. Because of the tear, CT arthrography was performed, offering an opportunity to evaluate the various soft tissue abnormalities accompanying glenoid dysplasia. Marked thickening of the glenoid cartilage and labrum was apparent, as well as an abnormal posterolateral orientation of the glenoid cavity. A deep notch was observed along the central portion of the glenoid cartilage. Furthermore the middle glenohumeral ligament appeared thickened and cordlike.

Subcutaneous granuloma annulare: MR imaging findings.

We present a case of subcutaneous granuloma annulare evaluated with MR imaging. The mass was poorly defined and showed thickened interconnecting strands with low signal intensity on T1- and T2-weighted MR images. When a poorly defined subcutaneous mass with low signal intensity on both T1- and T2-weighted MR images is observed in an otherwise healthy child, subcutaneous granuloma annulare should receive serious consideration. Subcutaneous granuloma annulare should be added to the list of tumors with short T2.

MRI of extrapancreatic gastrinomas.

Preoperative diagnosis of gastrinoma--especially extrapancreatic gastrinoma--is very difficult. At the moment octreotide scintigraphy is considered the method of choice to detect gastrinomas. However, MRI may play a major role in the diagnostic imaging of gastrinoma.

Unusual location of an ovary: ultrasonographic features and surgical correlation.

We present a case of ectopic ovary in a 5-month-old baby presenting a firm nodule in the left labia majora. Ultrasonography was performed and revealed an ectopic ovary. The ectopic ovary was surgically returned in adnexial location. We describe the typical findings of this entity.

Benign papilloma of the bladder in a young adult.

Ultrasonographic and pathologic findings in a 26-year-old patient with a benign papilloma of the bladder are described. Ultrasound features include an irregular polypoid mass extending from the bladder wall.

Giant cell tumor of the tendon sheath in the knee.

The clinical, imaging and pathologic findings in a 28-year-old patient with a giant cell tumor of the tendon sheath in the knee are reported.

[A "good choice" of diagnostic imaging examinations: the knee]. / Le "bon choix" des investigations en imagerie médicale: le genou.

A medically sound and cost-effective choice of diagnostic imaging investigations in knee pathology must be supported by a good evaluation of the respective strong and weak points of the available methods. These are: conventional radiology, C.T., arthrography, arthro C.T., ultrasound, scintigraphy and magnetic resonance imaging. Based upon that analysis, decisional algorithms are proposed, in function of the clinically suspected pathologies.