ABSTRACT
A 22-year-old man is referred to the orthopaedic surgeon. He has pain, mostly at night, in his proximal right tibia that greatly reduces with NSAIDs. The CT scan shows a focal lucent zone, called a nidus, in the tibia cortex, surrounded by reactive, sclerotic bone. This is typical for an osteoid osteoma, a benign bone tumour.
Subject(s)
Bone Neoplasms/diagnosis , Leg/pathology , Osteoma, Osteoid/diagnosis , Pain/diagnosis , Soft Tissue Neoplasms/diagnosis , Tibia/pathology , Adult , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Bone Neoplasms/pathology , Bone Neoplasms/therapy , Humans , Lower Extremity , Male , Osteoma, Osteoid/pathology , Osteoma, Osteoid/therapy , Pain/drug therapy , Pain/etiology , Sclerosis , Soft Tissue Neoplasms/pathology , Soft Tissue Neoplasms/therapy , Tomography, X-Ray Computed/methods , Young AdultSubject(s)
Lower Extremity/blood supply , Venous Thrombosis/diagnostic imaging , Anticoagulants/therapeutic use , Compliance , Diagnosis, Differential , Humans , Predictive Value of Tests , Recurrence , Ultrasonography , Veins/diagnostic imaging , Veins/physiopathology , Venous Thrombosis/drug therapy , Venous Thrombosis/physiopathologyABSTRACT
BACKGROUND: Accurate diagnosis of acute recurrent deep vein thrombosis (DVT) is relevant to avoid improper diagnosis and unnecessary life-long anticoagulant treatment. Compression ultrasound has high accuracy for a first episode of DVT, but is often unreliable in suspected recurrent disease. Magnetic resonance direct thrombus imaging (MR DTI) has been shown to accurately detect acute DVT. The purpose of this prospective study was to determine the MR signal change during 6 months follow-up in patients with acute DVT. PATIENTS/METHODS: This study was a prospective study of 43 consecutive patients with a first episode of acute DVT demonstrated by compression ultrasound. All patients underwent MR DTI. Follow-up was performed with MR-DTI and compression ultrasound at 3 and 6 months respectively. All data were coded, stored and assessed by two blinded observers. RESULTS: MR direct thrombus imaging identified acute DVT in 41 of 43 patients (sensitivity 95%). There was no abnormal MR-signal in controls, or in the contralateral extremity of patients with DVT (specificity 100%). In none of the 39 patients available at 6 months follow-up was the abnormal MR-signal at the initial acute DVT observed, whereas in 12 of these patients (30.8%) compression ultrasound was still abnormal. CONCLUSION: Magnetic resonance direct thrombus imaging normalizes over a period of 6 months in all patients with diagnosed DVT, while compression ultrasound remains abnormal in a third of these patients. MR-DTI may potentially allow for accurate detection in patients with acute suspected recurrent DVT, and this should be studied prospectively.
