The nomenclature and sectional imaging anatomy III: capsular membranes and minor spinal ligaments.

This paper is the third in a series of three that organizes the complex anatomy of the cervical, thoracic, and lumbar spinal ligaments. It describes and color-codes the anatomy and nomenclature of the capsular membranes and minor spinal ligaments. The first two articles describe the dorsal and ventral ligaments, respectively.

The nomenclature and sectional imaging anatomy II: ventral spinal ligaments.

This paper is the second in a series of three that organizes the complex anatomy of the cervical, thoracic, and lumbar spinal ligaments. It describes and colorcodes the anatomy and nomenclature of the ventral ligaments. A prior article has described the dorsal ligaments, and a future article will illustrate the capsular joints and minor spinal ligaments.

The nomenclature and sectional imaging anatomy I: dorsal spinal ligaments.

This article is the first in a series of three that organizes the complex anatomy of the cervical, thoracic, and lumbar spinal ligaments. It describes and color-codes the anatomy and nomenclature of the dorsal ligaments. The following articles will describe the ventral ligaments, and the capsular membranes and minor ligaments.

Postnatal maturation of the sacrum and coccyx: MR imaging, helical CT, and conventional radiography.

OBJECTIVE: The purpose of this paper is to provide a detailed radiologic description of the postnatal developmental anatomy of the sacrum and coccyx as revealed by MR imaging, helical CT, and conventional radiography. MATERIALS AND METHODS: One hundred ten imaging examinations of the sacrococcygeal spine were performed in patients who were newborn to 30 years old. Imaging included conventional radiography (n = 63), three-dimensional gradient-recalled echo MR imaging (n = 10), and helical CT with sagittal and angled coronal reformations (n = 37). A detailed analysis was performed of the ossification and fusion of the primary and secondary ossification centers. RESULTS: The sacrum and coccyx were noted to develop from 58 to 60 sacral ossification centers and eight coccygeal centers, respectively. These centers were noted to ossify and fuse in an organized temporal pattern from the fetal period to the age of 30. CONCLUSION: The sacrum and coccyx are formed by a complex process that fuses primary and secondary ossification centers. Because the maturation process can be asymmetric, an understanding of this process may prove useful for distinguishing physeal plates from fracture lines.

Imaging of the elbow.

The imaging needs for diagnosis of abnormalities in and about the elbow are presently satisfied in most instances by plain film radiography. Arthrography with tomography and CT has enabled us to delineate the joint space and articular surfaces better. The sensitivity of radionuclide imaging allows early detection of disease processes but lacks specificity. The advantages of MR imaging in the musculoskeletal system should allow improved diagnostic imaging capability about the elbow as it has for other joints.

Imaging of peripheral nerve lesions.

The imaging of peripheral nerve lesions remains limited to the radiographic demonstration of secondary skeletal lesions in birth trauma, reflex sympathetic dystrophy, neuropathic arthropathy, leprosy, and congenital indifference to pain. Nerve root avulsions can be imaged directly and the newer imaging modalities now allow delineation of lesions that previously could not be studied using conventional radiography. The ability of ultrasound, CT, and MRI to differentiate soft tissue structures makes it possible, in many instances, to study the primary abnormality in trauma, nerve entrapment syndromes, and tumors. With fractures, the possibility of trauma to adjacent nerves can only be inferred on the radiographs, while the role that peripheral nerve injury plays remains controversial in other entities, such as amputation with replantation. Imaging of peripheral nerve lesions remains in its infancy. With further refinement in the signal-to-noise ratio made possible by advances in MRI technology, we may be optimistic about future imaging of peripheral nerve pathology.

Familial cavernous angiomas: natural history and genetic study over a 5-year period.

In a kindred of 122 individuals we found 5 individuals with cerebral vascular malformation, 3 representing typical cavernous angiomas. The condition was inherited as an autosomal dominant trait with variable expressivity. Forty-three relatives were examined prospectively by cranial computed tomography (CCT) and lesions were found in 15; 7 were followed prospectively with CCT scans for 5 years. Angiography in 5 of these cases failed to demonstrate the lesion. In 3 patients with previously normal CCT scans a change in blood volume or membrane permeability allowed visualization of the lesion on contrast scans. In 2 individuals, both parents of affected children, a normal CCT scan was found. This emphasizes the limitations of CCT in detecting this disorder. Biochemical and red blood cell immunological genetic linkage studies were done in 36 persons. No linkage was found with any of the markers. The natural history of this disorder, characterized by marked clinical and radiographic variation in site of lesion, and the timing and severity of intracranial hemorrhage, make it a useful model for investigating contributing factors and consequences of intracranial hemorrhage in general. For at-risk and affected patients early and sequential CCTs are necessary. Familial cavernous angioma should be included in the differential diagnosis of all young persons presenting with cerebrovascular impairment, seizures, intracranial calcifications or hemorrhage.

Renal consequences of rapid high dose contrast CT.

A retrospective study of renal deterioration after high doses (80 g l) of intravenous contrast medium was done of 286 adult patients. The incidence, duration, and severity of renal deterioration were compared with those reported in a series of 377 similar patients after low dose contrast infusion (43 g l). No statistically significant difference between these groups was seen in nondiabetics with a preinfusion serum creatinine below 4.5 mg/dl. A prospective study of fractional excretions in 35 patients receiving high dose infusion demonstrated no additional subtle renal damage in 34 patients. One patient developed a transient rise in serum creatinine that was identical to the course of renal deterioration after 43 g of iodine. It is concluded that the severity and duration of renal deterioration was not affected by the dose of contrast material (43--80 g iodine).