Meniscal tears--comparison of arthrography, CT, and MRI.

A total of 1750 knees were prospectively evaluated using a high-resolution noninvasive axial computed tomography (CT) scanning technique. A total of 203 knees underwent subsequent arthroscopic or arthrographic evaluation. In this group, the sensitivity of CT for the detection of a torn meniscus was 88.5%; the specificity was 95.5%; and the accuracy was 91.5%. An additional 270 knees were prospectively evaluated by both CT and magnetic resonance imaging (MRI) to determine the ability of both techniques to characterize knee menisci in patients believed to have meniscal tears. Of these knees, 94 were subsequently examined by arthroscopy. In this group, the overall accuracy of MRI for detecting a torn meniscus was 89.5% and for CT it was 92.2%. Properly performed, both CT and MRI are accurate and effective methods for noninvasively evaluating meniscal abnormalities in the acutely injured knee. The protocol for CT and MRI meniscus imaging as well as interpretation are presented in addition to their relative roles with respect to arthrography and arthroscopy.

Bucket-handle tears of the meniscus: appearance at CT.

Before undergoing arthroscopy, 222 patients with acute, unilateral knee injuries and strong clinical evidence of a meniscal tear underwent axial computed tomography (CT) of the knee. In 53 patients, a bucket-handle meniscal tear was found, and it was repaired at arthroscopy. In 92.5% (49 of 53) of these knees, CT accurately depicted the type, location, and extent of the tear. CT also demonstrated the displaced meniscal fragment with its relationship to the attached remnant.

Noninvasive evaluation of knee meniscal tears: preliminary comparison of MR imaging and CT.

One hundred twenty knees were examined prospectively with both axial computed tomography (CT) and magnetic resonance (MR) imaging to compare the value of these techniques in patients with clinical evidence of meniscal tears. Sixty-four of these knees were subsequently evaluated with diagnostic arthroscopy. In this group, CT was superior to MR imaging for meniscus evaluation in 29.7% of the knees, equal to MR in 54.7%, and inferior to MR in 15.6%. Although surface-coil MR imaging shows great promise and has numerous advantages over more conventional techniques, this preliminary experience suggests that, at least with certain imaging equipment and techniques, CT may be slightly more efficacious than 0.5-T MR imaging in meniscus evaluation. However, further comparative studies at higher field strengths are needed before the relative roles of CT and MR imaging can be established.

Diagnosis of meniscal tears using high-resolution computed tomography. Correlation with arthroscopy.

Four hundred and fifty patients (840 knees) underwent axial computed tomography of the knee in a prospective study to evaluate the ability of this technique to identify and characterize meniscal tears. One hundred and thirty-three of the knees subsequently had diagnostic arthroscopy. When compared with the findings at arthroscopy, the sensitivity of computed tomography was 96.5 per cent, the specificity was 81.3 per cent, and the accuracy was 91.0 per cent. The precise protocol for the method of computed tomographic scanning that was employed and the criteria that were used to interpret the images are presented. We found computed tomography to be a valuable non-invasive method for the detection and characterization of meniscal tears.

Fetal small bowel simulating an abdominal mass at sonography.

A focal, well-marginated, homogeneous hyperechoic mass was identified within the fetal abdomen of five early gestations varying in age from 16 to 20 weeks ECA (estimated conceptual age). Initially, the possibility of a congenital abdominal tumor mass was raised. Serial sonography subsequently demonstrated progressive dissolution of the masses, each of which assumed the characteristic appearance of normal small bowel by 30 weeks ECA. The recognition of this normal fetal small bowel maturation pattern is important lest it be confused with congenital retroperitoneal or gastrointestinal tract abnormalities.

Meniscus tears of the knee: prospective evaluation with CT.

A total of 209 patients underwent prospective axial computed tomography (CT) examinations of the knee to evaluate the ability of this technique to identify and characterize knee menisci in patients believed to have meniscus tears. Of the 359 knees examined, 105 subsequently underwent arthrography, arthroscopy, or arthrography and arthroscopic surgery. In this group, the sensitivity of CT was 88.5%, specificity was 95.5%, and accuracy was 91.5%. Although axial CT is a sensitive and effective method for the detection and characterization of tears involving the medial and lateral menisci, purely horizontal or nondisplaced peripheral tears may be difficult to demonstrate.

Splint therapy evaluation with direct sagittal computed tomography.

Splint therapy is often the initial nonsurgical treatment selected to manage patients who have anterior displacement of the temporomandibular joint (TMJ) meniscus. It is usually effective if the splint restores normal meniscocondylar relationships. An accurate method for assessing meniscocondylar relationships by means of direct sagittal computed tomography (CT) is described. The precise protocol for this noninvasive CT method and the criteria used to interpret the CT images are presented.

Internal derangements of the temporomandibular joint evaluated with direct sagittal CT: a prospective study.

Direct sagittal computed tomography (CT) was performed in 454 patients thought to have internal derangement of the temporomandibular joint (TMJ). Of 905 joints examined, 71 were subsequently studied using arthrography and/or surgery. Sensitivity was 91.8%, accuracy 87.3%, and the positive predictive value 93.3%. Degenerative joint disease was detected in 33.6% of joints with anterior meniscal displacement but no reduction, 15.3% of those with displacement and reduction, and 5.0% of those with no identifiable meniscal abnormality. It is concluded that direct sagittal CT is a sensitive and effective method of detecting and characterizing displacement of the TMJ meniscus as well as underlying degenerative joint disease.

Manometrically guided colon insufflation during double-contrast barium enemas.

The double-contrast enema's potential for high accuracy depends in part on consistently good inflation of the colon. However, optimal inflation is often not obtained because of deflation during filming, underinflation because of fear of perforating the colon, or patient discomfort. To help meet the dual requirements of ensuring consistently good bowel inflation while avoiding over-inflation, we have designed a modified insufflator which incorporates a manometer and allows accurate readings of intraluminal large-bowel pressures during or following insufflation. In more than 3000 examinations using this method we have experienced no complications.

Computed tomography of macroglossia secondary to amyloidosis.

Computed tomography of the tongue base and floor of the mouth is an effective means for evaluating and characterizing deep lingual masses. We report two cases of macroglossia secondary to amyloidosis. The findings at CT and differential diagnosis are discussed.

Insufficiency fractures of the tibial plateau.

An insufficiency fracture of the tibial plateau may be the cause of knee pain in patients with osteoporosis. The diagnosis is usually not suspected until a bone scan is done, as initial radiographs are often negative or inconclusive and clinical findings are nonspecific and may simulate osteoarthritis or spontaneous. In five of 165 patients referred for bone scans due to nontraumatic knee pain, a characteristic pattern of intense augmented uptake of radionuclide confined to the tibial plateau led to a presumptive diagnosis of insufficiency fracture, later confirmed on radiographs.

Renal cyst wall thickening following percutaneous aspiration.

Computed tomography (CT) is an accurate and efficient means for evaluating and characterizing renal masses. Using established criteria, benign cortical cysts may be accurately differentiated from complex cysts or solid renal lesions. We report a case of cyst wall thickening simulating a cystic tumor that occurred after percutaneous aspiration of a simple renal cyst.

Prominent iliopsoas muscles producing a gourd-shaped deformity of the bladder.

Hypertrophied iliopsoas musculature should be considered seriously in the evaluation of young muscular male patients presenting with gourd-shaped bladder deformities. The recognition of this nonpathologic gourd deformity during excretory urography and subsequent confirmation by computerized tomography allow an accurate efficient diagnosis, sparing the patient a needless, more extensive investigation.