[Transient regional osteoporosis]. / Le osteoporosi transitorie regionali.

Transient osteoporosis of the hip and regional migratory osteoporosis are uncommon and probably underdiagnosed bone diseases characterized by pain and functional limitation mainly affecting weight-bearing joints of the lower limbs. These conditions are usually self-limiting and symptoms tend to abate within a few months without sequelae. Routine laboratory investigations are unremarkable. Middle aged men and women during the last months of pregnancy or in the immediate post-partum period are principally affected. Osteopenia with preservation of articular space and transitory edema of the bone marrow provided by magnetic resonance imaging are common to these two conditions, so they are also known by the term regional transitory osteoporosis. The appearance of bone marrow edema is not specific to regional transitory osteoporosis but can be observed in several diseases, i.e. trauma, reflex sympathetic dystrophy, avascular osteonecrosis, infections, tumors from which it must be differentiated. The etiology of this condition is unknown. Pathogenesis is still debated in particular the relationship with reflex sympathetic dystrophy, with which regional transitory osteoporosis is often identified. The purpose of the present review is to remark on the relationship between transient osteoporosis of the hip and regional migratory osteoporosis with particular attention to the bone marrow edema pattern and relative differential diagnosis.

Renal infarction: an uncommon mimic presenting with flank pain.

A 39-year-old woman arrived to the emergency department complaining of a constant, progressive, left flank pain, with no beneficial effect from spasmolytic and nonsteroidal antiinflammatory drugs. Two years before, she suffered another episode of right flank pain and stranguria, but instrumental examinations (ultrasonography, urography) remained negative. Besides a mild tenderness in the left flank, physical examination was normal. Blood chemistry panel showed leukocytosis (17.2 x 10(3) mL, neutrophils 82.8%) and a slight increase of serum lactate dehydrogenase (LDH) (543 U/L versus 230 to 460 U/L). Urinanalysis showed a slight hemoglobinuria (0.5 mg/dL), and sediment contained some red cells and leukocytes. Diagnostic examinations (ultrasonography, computed tomography) showed a left renal nonhomogeneous space-occupying lesion, orientative for renal malignancy. She was transferred to the urology department and operated. Both intraoperatory and histological diagnosis was ischemic infarction and, after exclusion of all possible underlying causes, final diagnosis was idiopathic renal infarction. Diagnostic procedures and literature reports are discussed.

Rheumatoid arthritis: sequences.

OBJECTIVE: Rheumatoid arthritis (RA) is an autoimmune disorder of unknown etiology characterized by symmetric, erosive synovitis and sometimes multisystem involvement. It affects 1% of the adult population and exhibits a chronic fluctuating course which may result in progressive joint destruction, deformity, disability and premature death. We review the literature data relative to the peculiar pathologic features of the disease shown by diagnostic imaging techniques. METHODS: All our patients were classified according to the diagnostic criteria of the American Rheumatism Association (1987). Plain radiography remains the diagnostic technique of choice, but ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are also used. RESULTS: Clinically articular involvement presents as pain, swelling, stiffness and motion impairment. The patients with positive rheumatoid factor are > 70% likely to develop joint damage or erosions within 2 years of disease onset. Any joint can be involved, but the proximal interphalangeal and metacarpophalangeal joints of the hand and the wrist are preferential sites, as well as the metatarsophalangeal joint of the foot, the knee and the joints of the shoulder, the ankle and the hip. Symmetry is the hallmark of joint involvement. The synovium of bursae and tendon sheaths is also affected. Soft tissue (subcutaneous nodules), muscles (weakness and atrophy) and vessels (vasculitis) may also be involved. Systemic involvement may result in Felty's syndrome, metabolic bone disorders (i.e. osteoporosis), Sjögren syndrome and pleuropulmonary abnormalities (pleural effusion, fibrosing alveolitis, constrictive bronchiolitis). The earliest abnormalities consist in synovial proliferation, soft tissue swelling, and osteoporosis. At a slightly later stage, the inflamed synovial tissue ('pannus') extends across the cartilage surface, leading to chondral erosions and small bone erosions at the joint margin (bare areas). Marginal and central erosions follow in advanced stages and finally fibrous ankylosis, joint deformities (subluxations and dislocations), fractures and fragmentations are typical findings of more advanced RA. CONCLUSION: RA is a frequent joint disorder with a characteristic radiographic picture. Joint involvement patterns are sufficiently common to permit accurate diagnosis, especially when fusiform soft tissue swelling, regional osteoporosis, marginal and central erosions and diffuse loss of interosseous space are present. Conventional radiography remains the standard imaging technique for joint studies in the patients with suspected RA. US is recommended to diagnose soft tissue involvement (joint effusion). CT is very useful for showing abnormal processes in complex joints (sacroiliac and temporomandibular joints and craniocervical junction) which are difficult to depict completely with conventional radiography. Magnetic resonance applications include the assessment of disease activity: in particular, this technique may be the only tool differentiating synovial fluid and inflammatory pannus.

[Periodontal disease in patients with HIV infection. Radiographic study]. / La malattia parodontale nei pazienti con infezione da HIV. Studio radiografico.

A painful and rapidly progressive form of periodontitis--involving both soft tissue and bone, with gingival bleeding and loss of teeth--was observed in HIV-patients in the mid-80's. Today, there are few reports regarding the real incidence of periodontitis in HIV populations: however, it seems not as high as first supposed on discovering the disease, and bacterial plaque is moderate, compared with "conventional" periodontitis. Since there are few radiologic studies, the Authors report on the clinical-radiographic patterns of periodontitis in 20 HIV patients, compared to 20 normal controls. All the subjects were submitted to clinical-instrumental investigations (clinical tests, periodontal sampling, DMF index), and panoramic radiography. To assess periodontal disease severity, bone pocket depth is investigated radiographically, defined as the distance between the highest point of alveolar bone and root apex, at the mesial and distal aspects of all the teeth. We measured four alveolar quadrants, from the first premolar to the second molar. Statistical analysis was carried out with one way ANOVA test and non-parametric Kruskal-Willis's test; statistical significance is accepted at the probability level p < 0.05. Clinical-radiographic results demonstrated minimal bone loss and little teeth mobility, in the early stage of disease; involvement of total gingival attachment with partial bone sequestration at muco-gingival line, in the moderate stage; severe bone loss with soft tissue necrosis and risk of teeth exfoliation, in the advanced stage. Gingival tartar was also found. A significant statistical difference was demonstrated between the two examined populations. HIV-related periodontitis may represent one of the various features of the clinical picture of HIV infection, which must not be underestimated and mistaken for "conventional" adult periodontitis. If the diagnosis of periodontic disease is essentially clinic, radiography remains nevertheless important, because it yields data on bone status, integrity of lamina dura and morphology of roots, which data help make diagnosis and prognosis more reliable.

[Diagnostic imaging of osteoid osteoma]. / Diagnostica per immagini dell'osteoma osteoide.

Conventional radiography, bone scintigraphy and Computed Tomography (CT) are the most useful tools to identify osteoid osteomas. We examined 26 patients (14 men and 12 women) with osteoid osteoma in different skeletal sites (13 femora, 3 tibiae, 3 hands, 2 peroneal bones, 2 humera, 2 spines and 1 talus) and compared the diagnostic yield of the above techniques. The fundamental radiographic findings in this benign bone lesion are the presence of a "nidus", with or without calcifications, perilesional sclerosis and periosteal new bone formation. Four patients in our series had soft tissue edema. In the majority of cases, conventional radiography is the imaging method of choice, because it is easily available and its diagnostic yield is adequate (17 patients in our series), especially if combined with bone scintigraphy-whose high diagnostic sensitivity was proved in all of our patients. CT is recommended for its better spatial resolution, in view of surgery, especially when soft tissues are involved. MRI is a highly valuable tool in bone tumor staging because it demonstrates cortical involvement and intramedullary and soft tissue spread. However, MR findings might be misinterpreted as indicating a more aggressive pathologic process.

[Radiographic manifestations in teeth and jaws in chronic kidney insufficiency]. / Manifestazioni radiografiche dei denti e dei mascellari nell'insufficienza renale cronica.

Forty-five patients affected with chronic renal failure (29 men and 16 women; mean age: 47.8 years), treated with hemodialysis for 4 to 245 months (mean: 66.9 months) were examined with panoramic and skeletal radiographs-the latter of the skull, hands, shoulders and clavicles, pelvis and spine. The control group (45 subjects with no renal diseases) was examined only with panoramic radiography. Dental and skeletal radio-graphs were given an 0-6 score and then compared to assess a possible relationship between skeletal and dental changes at radiography. Twenty-six dialysis patients (57.7%) had radiographic abnormalities in the maxillary bones-i.e., osteoporosis (100% of patients), focal osteosclerosis adjacent to the roots (11.5%), lamina dura reduction or loss (26.9%), calcifications of soft tissues or salivary glands (15.3%) and brown tumors (7.6%). In the teeth of dialysis patients, the dental pulp chamber was narrowed in 11.1% and hypercementosis of the roots was observed in 4.5%. Radiographic abnormalities in the hand, shoulder and pelvis were depicted in 51.1% of dialysis patients-in 86.9% of them with maxillary lesions. In the control group, 15.5% had mandibular bone lesions-i.e., osteopenia, cortex reduction at the mandibular angles and cyst-like lesions -but the evidence of caries and periodontal disease did not differ from that in the dialysis group. The diagnosis and follow-up of dialysis patients are currently made with serum biochemistry, radiography and histology. The purpose of skeletal radiology is to monitor the progression or regression of musculoskeletal abnormalities. Panoramic radiography might be useful in monitoring renal osteodystrophy, especially to assess the response to therapy-i.e., parathyroidectomy, calcium or vitamin-D therapy and renal transplant.

Colon involvement in systemic sclerosis: clinical-radiological correlations.

About one third of all patients with systemic sclerosis (SS) presents colon abnormalities, although these may be underestimated because they frequently remain asymptomatic for a long time. Thirty-five patients (33 women and 2 men; mean age 56.5 years; mean disease duration 11.9 years) affected by SS (25 with limited and 10 with diffuse pattern of skin involvement) were investigated using barium enema to detect radiological changes in the colon, and to correlate them with other visceral involvement, autoantibody profile, abdominal symptoms and duration of the disease. Ten patients (28.6%) showed X-rays abnormalities (excluding isolated diverticula), wide-mouthed sacculations being the most frequent finding. Our data confirm that the colon is frequently involved in SS, even in the limited form of the disease. The most relevant finding was the dissociation between clinical symptoms and radiological features which proved to be more evident among the patients with limited SS. No correlations were found between the radiological picture and any other parameter, thus suggesting that careful evaluation of the colon should be performed in any patient suffering from the disease.

[Monoarthritis]. / Le monoartriti.

By definition, monoarticular arthritis means one-joint involvement, even though, in fact, such a condition is often an oligoarthritis because as many as two or three separate joints will be involved. Arthritis is often limited and may regress, so that it is frequently misdiagnosed. Sometimes, a monoarticular condition may be a polyarthritis onset (i.e., rheumatoid arthritis). Monoarticular arthritis can be caused by many factors, such as infections (septic arthritis), nonspecific inflammatory processes (reactive arthritis), crystals deposition (gout, CPPD crystal deposition disease), trauma, neoplasm (pigmented villonodular synovitis), immunologic conditions (amyloidosis) and hormonal changes (parathyroid disease). Its onset is usually acute and sometimes dramatic, with fever, pain and joint swelling, so that a decision must be made promptly to stop rapid illness evolution and to prevent the irreversible destruction of cartilage and bone (especially in septic arthritis). Diagnostic studies are performed with mono-bilateral radiographs of the joint. Radiographic findings (i.e., soft tissue swelling, joint effusion, widening and thinning of joint spaces, bone erosions and destruction of bone surface) are typical of the disease, but some findings (e.g., type of evolution and progression), laboratory tests, synovial biopsy and arthroscopy can differentiate infectious from inflammatory forms. Scintigraphy can depict isotopic joint uptake, before articular abnormalities are demonstrated with radiography, thanks to its high sensitivity; nevertheless, because of its low specificity, scintigraphy may miss some kinds of lesions (including osteoarthritis) and cannot easily differentiate osteomyelitis from septic arthritis. CT and MRI play a secondary, though not negligible, role, especially to study such deep infections as psoas abscesses, which may mimic arthritides.

Association between diffuse idiopathic skeletal hyperostosis and multiple myeloma.

OBJECTIVE: To determine whether an association exists between multiple myeloma and diffuse idiopathic skeletal hyperostosis (DISH). DESIGN AND PATIENTS: Radiologic studies were performed over a 26-month period in a series of 97 consecutive patients with multiple myeloma (56 male and 41 female, aged 42-91 years). RESULTS: Both myelomatous bone lesions and hyperostosis similar to DISH were found in these patients. The prevalence of DISH in association with multiple myeloma (21 male and 8 females patients) was higher (29.8%) than in our control group (973 patients, 449 male and 524 female) or in the general population (15-20%). The involved segments of the column were thoracic in 11 males and 7 females, cervical in 8 males and 2 females, and lumbar in 5 males and 4 females. Ossifying enthesopathy in the pelvis ("whiskering") was observed in 7 males and 1 female. CONCLUSIONS: The pathogenesis of hyperostosis remains unknown. It is possible that the coexistence of DISH and multiple myeloma is merely an association. For this reason, it is important for the real prevalence of DISH in the general population to be defined.

[Skeletal changes in the kidney transplant patient]. / Alterazioni scheletriche nel paziente con trapianto renale.

The skeletal status was investigated with noninvasive diagnostic procedures in 44 renal transplant patients (mean time since intervention: 5 to 195 months) treated with steroid and azathioprine (21 cases) or with steroid, azathioprine and cyclosporine (23 cases). 38.6% of the patients had reduced renal function (creatininemia: 1.6-3.0 mg/dl). Our patients underwent biochemical and hormonal tests of bone metabolism, digital radiographs of the skeleton and bone mineral density measurement with dual-energy X-ray absorptiometry (DXA, Hologic QDR 1000). All the patients exhibited moderate to severe osteopenia at both radiographic and densitometric investigations; the risk of fracture was high in 47% of cases. Radiographic signs of vertebral fractures were observed in 4.5% of cases. Other major radiographic patterns were the aseptic necrosis of femoral head (9%), of carpal bone (4.5%) and of humeral head (2.2%). Fibrous osteitis was demonstrated in three patients. Geodes in the wrist were also observed. The correlation of bone densitometry values and time since renal transplantation was statistically significant (r = 0.381; p < 0.01). Moreover, the grade of osteopenia correlated with serum levels of calcitonin and calcitriol--the latter especially in the patients with severe osteopenia.

Platyspondyly in treated beta-thalassemia.

Flattening of the vertebral bodies with a platyspondyly appearance is described in 14 patients selected for evaluation of short stature from 106 patients affected by thalassemia major, who received an intensive transfusion regimen combined with continuous chelation therapy. The vertebral body height/width ratio was decreased at the level of all the investigated tracts, namely, cervical and/or dorsal and/or lumbar. The flattening of the vertebral bodies may be due to suppression of intramedullary hematopoiesis by a high transfusion regimen. The reduced intravertebral pressure due to disturbed hemopoiesis could cause weight-bearing and other biological stresses to provoke a reduction in vertebral body height.

[The evolutionary effects of therapy on the skeletal lesions in beta-thalassemia]. / Effetti dell'evoluzione della terapia sulle lesioni scheletriche nella beta-talassemia.

Up to the mid-1960s, beta-thalassemia was treated with blood transfusions as frequent as needed to keep symptoms under control and to prevent transfusional hemosiderosis. In the following years, high transfusion regimens and iron chelation therapy with desferrioxamine were used. Because of these different treatment modalities, skeletal findings in thalassemia have markedly changed. In the past, thalassemic patients treated with a low transfusion regimen and without chelation therapy developed osteopenia--with widened medullary spaces, cortical thinning and trabecular atrophy--secondary to chronic expansion of red marrow, due to increased erythropoietin response to chronic anemic hypoxia. Typical radiographic patterns in the skull included widened diploic space, atrophic-especially outer--tables and, in some patients, the "hair-on-end" pattern. As for the face, obliteration of the paranasal sinuses and the typical "rodent facies" were observed. In the ribs, bulbous expansion of the posterior and anterior segments and the "rib within a rib" patterns were observed. As for the spine, coarse trabecular arrangement was seen. The "cobweb" pattern was seen in the pelvis and finally the lack of the normal concave outline was observed in the long bones. In the patients treated with high transfusion regimens and iron chelation therapy over the last 30 years, both skull anomalies and disfigurement are less frequent. The skull is almost normal, with the exception of osteopenia and thickened diploic space in the frontal bone only; the paranasal sinuses are usually not obliterated. The hands and rib are normal, just like long bones, pelvis, scapulae and vertebral bodies. Nevertheless, in some adequately treated patients new skeletal features have been recently observed in the long bones, which are similar to those occurring in rickets and/or scurvy, and in the vertebral bodies, resembling platyspondylia. These abnormal features might be caused by several factors--i.e., marrow expansion, transfusion regimens, direct/indirect effects of desferrioxamine, iron load, endocrine abnormalities, deficiency of some minerals and finally dysvitaminoses. Nevertheless, osteopenia remains the main negative factor of thalassemia.

[Anomalies of the masticatory apparatus in beta-thalassemia. The present status after transfusion and iron-chelating therapy]. / Anomalie dell'apparato masticatorio nella beta-talassemia. Stato attuale dopo terapia trasfusionale e chelante del ferro.

Fifty-four homozygous beta-thalassemic patients (26 men and 28 women) aged 7 to 24 years, who had been treated with high transfusion regimen (Hb levels = 9-10 g/dl) and chelation therapy (desferrioxamine, 35-50 mg/kg), underwent clinical and radiographic investigations. This study was aimed at assessing the clinical and radiographic changes in the stomatognathic system (teeth, mandible and maxilla, occlusion relationship and dental bases). All patients underwent orthopantomography and teleradiography of the skull, in the lateral view. Twenty thalassemic patients (13 men and 7 women) of the same age but treated with low transfusion regimes (Hb levels = 5-6 g/dl) were examined as a control group. Our results indicate that: 1) in the control group, osteopenia is the specific lesion of anemia, in both the alveolar process and the mandible, following marrow expansion. Consequently, diastema of incisors and several types of malocclusion follow--i.e., overjet, anterior open-bite and crossbite, nearly all of them associated with II dental and skeletal patterns of Angle's classification. 2) In adequately transfused patients, no lesions are observed in 55% of cases, in both the teeth and the facial skeleton. This means that current treatment methods can prevent bone abnormalities, especially if transfusions begin at birth. Nevertheless, osteopenia of the mandible (31.4%) and dental and/or skeletal malocclusions (40.7%) remain in many cases, because of persistent marrow expansion, which usually follows incorrect treatment. 3) General dental diseases--e.g., caries, paradentosis, gingivitis, etc.--affect both populations with the same incidence.

Continuing loss of vertebral mineral density in renal transplant recipients.

This cross-sectional study examined bone abnormalities by digital radiography, bone densitometry and biochemical tests in 44 clinically asymptomatic renal transplant recipients 6-195 months after renal transplantation. Abnormal radiographs were obtained in 40 of the 44 patients. Dual-energy X-ray absorptiometry (DXA) performed at the lumbar spine (L2-L4)/showed a negative Z score in all patients, ranging from -1 to -1.9 in 28 patients and less than -2.0 in 16 patients. The severity of osteopenia increased with the length of time after transplantation and there was a significant correlation with parathyroid hormone values in patients with normal and low glomerular filtration rates. Our data suggest that decreased bone density values (Z score less than -2) are present in about one-third of patients with renal transplants. Bone loss appears to continue after transplantation. Steroid therapy and immunotherapy are probably the cause of this bone loss. Bone mineral measurements alone are helpful in identifying asymptomatic patients with low bone mass after transplantation.

[Cephalometry and digital radiography. Technical note]. / Cefalometria e radiografia digitale. Note di tecnica.

Conventional and digital lateral teleradiographs of the skull were performed on 6 consecutive patients (3 men and 3 women). The study was aimed at comparing the diagnostic capabilities of the two imaging techniques to measure points and angles, as derived from different cephalometric analyses (see text for details). These variables were analyzed by three different operators: for both techniques, 18 cephalometric tracings were made, including a total of 414 points and 36 angles. Correlation coefficients between the two types of measurements (points and angles) were calculated; Wilcoxon's non-parametric test was also used. This study demonstrates digital radiography to be superior to conventional radiography to detect cephalometric landmarks, which is especially evident in the evaluation of the so-called "questionable" landmarks: the latter were 15 of 23 with conventional radiography and 9 of 23 with digital radiography. On the other hand, correlation coefficients and significance of the values of the considered angles were in close agreement with the two techniques. Therefore, its simultaneous demonstration of anatomical structures of different thickness--i.e., bone and soft tissues--and its lower exposure dose make digital radiography the diagnostic procedure of choice in cephalometrics, especially in the pediatric age, as well as in monitoring the patients.

[The temporo-mandibular joint in pathologic conditions: rheumatoid arthritis and seronegative spondyloarthritis]. / L'articolazione temporo-mandibolare nelle condizioni patologiche: artrite reumatoide e spondiloartriti sieronegative.

Pain and dysfunction of the temporomandibular joint (TMJ) are major clinical problems, especially in arthritides and allied conditions. In the last 10 years, such new imaging methods as arthrography, CT and MRI have been developed, but many problems are still to be solved. This study was aimed at reporting the radiographic patterns of lesions in TMJ rheumatoid arthritis and seronegative spondyloarthropathies and at investigating the role of conventional radiology in the assessment of these disorders. Digital hypocycloidal tomography of the TMJ was performed on 44 patients affected with rheumatoid arthritis, on 2 with Sjögren's syndrome, 2 with ankylosing spondylitis, 4 with psoriatic arthritis and 1 with Reiter's syndrome. CT, with sagittal and coronal scans, was performed only on 9 patients (18 joints) whose clinical and radiographic findings were particularly severe. The radiographic features of the lesions--i.e., erosions, osteophytes, subchondral bone sclerosis and condylar-glenoid fossa remodelling--cannot be distinguished from one another and from the so-called allied conditions; nevertheless, in rheumatoid arthritis abnormalities are usually bilateral and symmetric, whereas in seronegative arthropathies joint involvement is usually unilateral. In the first stage of the disease, these lesions are better demonstrated by CT than by tomography, thanks to better contrast and spatial resolution of the former, especially on the lateral and medial aspects of the joint. The most common findings were: erosions (68.2%), osteophytes (31.8%), subchondral bone sclerosis (28.6%) and condylar-glenoid fossa remodelling (9.1%). In the clinical practice sagittal multidirectional tomography remains today the method of choice because it can demonstrate several areas on the condylar surface, with finer anatomical detailing, and it can solve most diagnostic problems in TMJ disorders. Thus, CT is recommended only in the patients whose diagnosis remains questionable with the above techniques.

Clinical and radiological features of bone disease in long-term (15 or more years) hemodialysis patients.

Fifteen patients on regular dialytic treatment for more than 15 years were given X-rays of the skull, spine, shoulders, wrists, pelvis and knees with the purpose of studying the principal skeletal and articular alterations due or not due to the uraemic status. Serum calcium, phosphorus, parathyroid hormone, alkaline phosphatase and basal aluminium were recorded. Osteopenia was evident in all the patients. Ten of whom (67%) showed alterations due to hyperparathyroidism. Nine patients presented the marks of dialysis spondyloarthropathy; in 14/15 cases geodes were present in the wrists, humeral heads or hip-joints; in ten patients there were multiple amyloid lesions. Two patients with serum basal aluminum above 100 micrograms/L showed the typical radiographic marks of osteomalacia. The majority of the long-term survivors showed multifactorial osteo-articular alterations resulting mainly from the combination of hyperparathyroidism and dialysis-related amyloidosis. The less frequent joint alterations were represented by arthrosis, enthesopathy and chondrocalcinosis. Disability and decreased articular mobility resulted in being mainly due to amyloid osteo-arthropathy.

[The hand in hematologic diseases]. / La mano nelle malattie ematologiche.

Radiography of the hand often reflects the picture of generalized diseases, affecting both the muscolo-skeletal system and the others. Some of the most common hematologic disorders may be detected in roentgenograms of the hand, especially in the anemias, but also in plasma cell dyscrasias and proliferative malignant diseases (i.e., lymphomas and leukemias). On the basis of their experience, the authors have reviewed and discussed the radiographic "pattern" of the hand in several hematologic conditions (i.e., anemias; thalassemias; sickle-cell disease; lymphomas; multiple myeloma; etc.), and their pathogenesis. Radiographies of both the hands, in antero-posterior view, were performed using Kodak-Min R film; xeroradiography was performed--in the same projection--using Rank Xerox plate, developed always in "positive mode" in 125 Rank Xerox System, conditioned with contrast "D", for emphasizing osseous details. Recently, digital radiography--employing PCR system--has substituted xeroradiography, because of its well-known properties and diagnostic advantages: in this manner, changes in bone and soft tissue are demonstrated on the same image, with augmentation of diagnostic information, with reduced dose to patient. In our series, hand is always involved (100% of cases) in thalassemias: lesions are characterized by diffuse osteopenia (washed out melted appearance), with widening of bone marrow space, diaphyseal convex aspect of the long bones, thinning of the cortex, and cyst-like changes (rain drops). Lesions disappear completely after the hypertransfusion regimen (HTR). Following chelation therapy, lesions of the wrist and hand are similar to those described in rickets and/or scurvy. Sometimes, the hand is characteristically affected in sickle-cell disease--particularly in the so called hand-foot syndrome--as "cone-deformity". In multiple myeloma incidence of hand involvement is 2.9%: lesions reflect general abnormalities observed in other skeletal sites, and they consist in multiple well-circumscribed lytic lesions. In amyloidosis, poorly defined radiolucent areas may be discovered. In non-Hodgkin lymphoma, incidence of hand involvement is less frequent, approximately 0.2%: the radiographic pattern is aspecific (mottled lytic lesions), sometimes simulating multiple myeloma and/or leukemias. In hemophilia, swelling of soft tissues, around the interphalangeal joint, related to intra-articular and/or per-articular hematoma, is observed. The other conditions reflect general radiographic features of anemias, which are of three main types: 1. the over active marrow (i.e., polycythemia); 2. the infarction of bone (i.e., sickle-cell disease); 3. non-specific findings, resulting from chronic illness (delays of maturation; dwarfism; osteopenia; tendency to infection).