MRI findings of spinal accessory neuropathy.

AIM: To characterise the magnetic resonance imaging (MRI) appearance of patients with spinal accessory nerve (SAN) denervation. MATERIAL AND METHODS: Twelve patients who had SAN denervation on electromyography (EMG) were included. The sternocleidomastoid and trapezius muscles and the SAN were assessed using MRI. RESULTS: Trapezius muscle atrophy was seen in 11 (92%), and of those patients, T2/short tau inversion recovery (STIR) signal hyperintensity was also demonstrated in seven (58%). All three patients with prior neck surgery had scarring around the SAN, and one of these patients demonstrated a neuroma, which was confirmed surgically. CONCLUSION: Features of SAN neuropathy on MRI include atrophy and T2/STIR signal hyperintensity of the trapezius, and in patients who have had posterior triangle neck surgery, scarring may be seen around the nerve.

Bone sarcomas in Paget disease.

The most serious complication of Paget disease is the development of sarcoma. Forty-one cases of bone sarcoma in Paget disease, which represented our institution's entire experience, were reviewed. The relative frequency of sarcomatous degeneration was 0.9%. Histologically, 35 of 41 lesions were osteogenic sarcomas, and six were fibrosarcomas. The distribution of lesions was similar to that expected with uncomplicated Paget disease, except for a disproportionately high number of lesions in the humerus; only one lesion involved the vertebrae. The tumors were categorized radiographically as lytic, mixed, and sclerotic, in descending order of frequency. The vast majority of lesions occurred in the pelvis, humerus, and femur. Overall prognosis for these patients was poor, with a five-year survival of 8%. Finding areas of cortical destruction is particularly useful in the detection of malignant degeneration. The radiologist must maintain a high index of suspicion when evaluating radiographs of patients with Paget disease, especially of those who present with pain or a palpable mass.

Sarcomas of bone complicating osteitis deformans (Paget's disease): fifty years' experience.

Osteitis deformans (Paget's disease of bone) may be complicated by osseous cancer. Of 3964 patients between 1927 and 1977, 38 had primary malignant bone tumors. This represents an incidence of sarcomatous change of 0.95%. The bones of the pelvis were most often involved; the humerus and the femur were next in frequency. No region of the skeleton was spared, with the exception of the forearms and hands. Of the 38 tumors, six were fibrosarcomas and 32 were osteosarcomas. Irrespective of the site of involvement, the histopathologic extremely poor. The 5-year survival rate was 7.9%, with a mortality rate of 86.8% 36 months after diagnosis. The main cause of death was pulmonary metastasis or local extension of tumor growth. Three patients were long-term survivors, but no clinical or pathologic elements could be identified which differentiated these survivors from the other patients in the study.