RESUMO
Ultrasound examination of the brachial plexus, although at first sight difficult, is perfectly feasible with fairly rapid practical and theoretical training. The roots are accurately identified due to the shape (a single tubercle) of the transverse process of C7 in the paravertebral space, and the superficial position of C5 in the interscalene groove. The téléphérique technique allows the roots, trunks and cords to be followed easily into the supraclavicular fossa. In just a few years, ultrasound imaging of the plexus has become a routine anesthesia examination for guiding nerve blocks. In trained hands, it also provides information in thoracic outlet syndromes, traumatic conditions (particularly for postganglionic lesions) and tumoral diseases. Even if MRI remains the standard examination in these indications, ultrasound, with its higher definition and dynamic character, is an excellent additional method which is still under-exploited.
Assuntos
Plexo Braquial/diagnóstico por imagem , Adulto , Plexo Braquial/anatomia & histologia , Plexo Braquial/lesões , Neuropatias do Plexo Braquial/diagnóstico por imagem , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Masculino , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Valores de Referência , Raízes Nervosas Espinhais/anatomia & histologia , Raízes Nervosas Espinhais/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler , Ultrassonografia de Intervenção , Adulto JovemRESUMO
This pilot study aimed to evaluate the correlation between clinical symptoms and cartilage volume through MRI in patients with knee osteoarthritis after 48 weeks of treatment with Structum®. Multicenter, double-blind, placebo-controlled, parallel-group study. Symptomatic knee osteoarthritis patients aged 50-75 years received either Structum® (500 mg twice daily; N = 22) or placebo (N = 21) during 48 weeks. Inclusion criteria were global pain in the target knee ≥30 mm (VAS 0-100) and radiological Kellgren-Lawrence grade 2 or 3. Clinical assessments included Lequesne index and VAS for pain on motion, at baseline, 24 and 48 weeks, and MRI at baseline and at 24 and 48 weeks. Global and compartments cartilage volume, joint cartilage abnormalities, meniscal lesions, ligaments abnormalities, synovitis, synovial effusion, osteophytes, subchondral cysts, popliteal cysts and subchondral oedema were quantified. The quantitative and qualitative reproducibility of MRI was tested by the Spearman correlation coefficient and kappa coefficients, respectively. Treatments were compared by an analysis of covariance with baseline value as covariate. Groups were comparable at baseline for demographics, disease characteristics, and cartilage volumes. A significant inter-readers correlation was seen for the assessment of cartilage volumes, number of cysts, and osteophytes (correlation coefficients from 0.951 to 0.980 within investigator and from 0.714 to 0.957). After 48 weeks, symptoms improved in both groups. The total cartilage volume increased in the Structum® group (+180 mm(3) + SD) which opposed to a loss in the placebo (-46 mm(3) + SD; NS). No statistically significant differences between groups were observed for the other MRI parameters. No correlations were evidenced between key MRI parameters changes and symptoms. The difference in the evolution of cartilage volume between the two groups could reflect a structure modifying effect of Structum®. This pilot study confirms the usefulness of quantitative and qualitative MRI as a sensitive tool to assess a structure modifying drugs in knee osteoarthritis.
Assuntos
Cartilagem/efeitos dos fármacos , Sulfatos de Condroitina/uso terapêutico , Imageamento por Ressonância Magnética/métodos , Osteoartrite do Joelho/tratamento farmacológico , Idoso , Cartilagem/metabolismo , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Osteófito/metabolismo , Projetos Piloto , Placebos , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do TratamentoRESUMO
Infectious spondylodiscitis is an infection of the intervertebral disc and the adjacent vertebral bodies due to the introduction of a pyogen, usually by the haematogenous route. Plain film radiography (which is usually normal in the early stages) shows blurring of the vertebral endplates and a loss of disc height that progresses quickly. MRI is the examination of choice, as it detects oedema within the trabecular bone very early, before the onset of destruction. Injection of a contrast medium with fat signal saturation improves detection and visualisation of the spread of infection in the soft tissue and epidural space. Imaging can also be used to guide a needle aspiration to investigate the infective agent.
Assuntos
Aspergilose/diagnóstico , Infecções Bacterianas/diagnóstico , Candidíase/diagnóstico , Diagnóstico por Imagem , Discite/diagnóstico , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Meios de Contraste/administração & dosagem , Feminino , Humanos , Aumento da Imagem , Lactente , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto JovemRESUMO
Pubalgia is a generic term used to describe groin pain due to a multitude of different etiologies such as skeletal (microtraumatic pubic symphysis arthropathy), muscular (adductor or rectus abdominis disorders), or abdominal wall (inguinal hernia) disorders. Diagnosis relies mainly on MRI for musculoskeletal disorders and ultrasound for abdominal wall disorders.
Assuntos
Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Virilha , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
The evolution to a bipedal mode of locomotion was accompanied by a verticalization of the spine and a modification in the shape of the pelvis: horizontal curvature and sagittal rotation. Phylogenesis meets ontogenesis: flat bones in fetuses similar to the monkey, australopithecus features at birth and "human-like" features by 7 or 8years of age. These anatomical modifications explain the characteristics of human bipedalism: stable, economical, with hip and knee extension in the standing position with little lateral motion. Some pathologies induce a regression to a more archaic mode of bipedal locomotion.
Assuntos
Quadril/crescimento & desenvolvimento , Hominidae , Pelve/crescimento & desenvolvimento , Primatas , Animais , HumanosRESUMO
The purpose of this article is to: 1) describe the main plain film, ultrasound and MR imaging features of peripheral involvement in psoriatic arthritis, 2) describe the advantages of ultrasound and MRI at the early stages of the disease; 3) describe how to use MRI and ultrasound in order to assess response to tumor necrosis factor-alpha blocker therapy.
Assuntos
Artrite Psoriásica/diagnóstico , Imageamento por Ressonância Magnética , Ultrassonografia Doppler em Cores , Ultrassonografia , Articulação Acromioclavicular/patologia , Adulto , Antirreumáticos/uso terapêutico , Artrite Psoriásica/classificação , Artrite Psoriásica/tratamento farmacológico , Feminino , Articulações dos Dedos/patologia , Seguimentos , Articulação do Quadril/patologia , Humanos , Articulação do Ombro/patologia , Sinovite/classificação , Sinovite/diagnóstico , Sinovite/tratamento farmacológico , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
PURPOSE: To evaluate the changes of bone marrow lesions on pelvic and spinal MR in patients with multiple myeloma after high-dose chemotherapy and autologous peripheral blood stem cell transplant. PATIENTS AND METHODS: Pelvic and spinal MR examinations were obtained at presentation (myeloma diagnosis) and 1 year after transplant in 20 patients that were part of a group of 39 patients enrolled in a prospective study. The type of marrow replacement (classified in stages with stage 0: normal; stage 1: salt and pepper; stage 2: focal infiltration; stage 3: diffuse infiltration), the number and size of marrow lesions and the number of vertebral compression fractures were recorded. We have compared the findings prior to and following transplant, with correlation to the response to treatment and the use of biphosphonates. RESULTS: The type of marrow replacement was improved following transplant in 65% of patients (not statistically significant). The number and size of nodules > 20 mm showed significant reduction (p = 0.0224 and p = 0.0237 respectively). Lesions on MR improved in 50% of patients with good response and 75% of patients with poor response to treatment. Patients receiving biphosphonates showed more vertebral compression fractures. CONCLUSION: The evolution of marrow replacing lesions on MR is discordant compared to the biological and clinical response to treatment. Pelvic and spinal MR evaluation at the time of diagnosis does not appear to be a good predictive factor of response to treatment. Biphosphonates do not appear to prevent new vertebral compression fractures. Pelvic and spinal MR provides interesting data in the follow-up of patients with myeloma following autologous transplant, especially in the local evolution of marrow replacing lesions, but our results do not justify its use in routine clinical practice.
Assuntos
Imageamento por Ressonância Magnética , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/terapia , Ossos Pélvicos/patologia , Transplante de Células-Tronco de Sangue Periférico , Coluna Vertebral/patologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/diagnóstico , Estudos ProspectivosAssuntos
Arterite de Takayasu/diagnóstico , Angiografia/métodos , Comportamento de Escolha , Humanos , Imageamento por Ressonância Magnética , Monitorização Fisiológica/métodos , Tomografia por Emissão de Pósitrons , Arterite de Takayasu/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia DopplerRESUMO
PURPOSE: To describe the qualitative and quantitative MR imaging features of normal skin. MATERIALS AND METHODS: Thirty-one normal subjects underwent MR evaluation on a 1.5 Tesla magnet using a dedicated coil. Several skin sites were evaluated (back at the scapular level, posterior calf and inferior heel). Two pulse sequences were acquired: a SE T1W and a gradient-echo sequence (FIESTA). Qualitative and quantitative analysis was performed for all three sites. RESULTS: In normal subjects, the different skin layers (callus, epidermis, dermis, hypodermis and pilosebaceous follicles) can be separated and measured on MR. Epidermis and hypodermis are hyperintense whereas dermis is hypointense. Our results confirm the presence of qualitative and quantitative variations between different skin regions. In some cases, a differentiation between papillary and reticular dermis can be achieved. Pilosebaceous follicles and the deep vascular network were clearly depicted on the FIESTA sequence. Measurements for each skin layer were compared based on sex, site and MR pulse sequence. CONCLUSION: MRI provides evaluation of the different skin layers, epidermis, dermis, and hypodermis, and their different components.
Assuntos
Imageamento por Ressonância Magnética , Pele/anatomia & histologia , Adolescente , Adulto , Desenho de Equipamento , Feminino , Humanos , Imageamento por Ressonância Magnética/instrumentação , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Valores de ReferênciaRESUMO
Plain radiographs usually allow accurate diagnosis. In this paper, the main radiographic projections will be reviewed along with their normal imaging features. In spite of significant advances in imaging of the elbow (multiplanar capabilities of MRI, volumetric CT imaging), conventional radiographs of the elbow remain a firstline imaging technique in the evaluation of disorders of the elbow.
Assuntos
Articulação do Cotovelo/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Úmero/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Pronação/fisiologia , Radiografia , Supinação/fisiologia , Ulna/diagnóstico por imagem , Fraturas da Ulna/diagnóstico por imagem , Lesões no CotoveloRESUMO
The purposes of this paper are: 1) to review the different radiographic projections commonly used to explore shoulder pathology; 2) to propose a practical approach for radiographic evaluation of the shoulder, adapted to the main clinical situations; 3) to recognize the different imaging features of the most frequent shoulder diseases.
Assuntos
Articulação do Ombro/diagnóstico por imagem , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/lesões , Acrômio/diagnóstico por imagem , Idoso , Artroscopia/métodos , Bursite/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Humanos , Fraturas do Úmero/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Masculino , Músculo Esquelético/diagnóstico por imagem , Postura , Radiografia , Amplitude de Movimento Articular/fisiologia , Febre Reumática/diagnóstico por imagem , Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador , Escápula/diagnóstico por imagem , Escápula/lesões , Luxação do Ombro/diagnóstico por imagem , Lesões do Ombro , Dor de Ombro/diagnóstico por imagem , Decúbito DorsalRESUMO
Different interventional radiology techniques used in the management of the painful shoulder will be reviewed in this article. The etiology of shoulder pain is variable, and several image guided procedures are available, from simple to more complex. US and fluoroscopy guided intra-articular and bursal infiltration techniques will be described. Percutaneous needle removal of calcific deposits and capsular distension/infiltration of adhesive capsulitis will be discussed. Cysts in the spinoglenoid or suprascapular notch may cause impingement of the suprascapular nerve and may be aspirated under US guidance. Finally, percutaneous radio-frequency treatment of symptomatic bone metastases under CT guidance may at times be performed. Musculoskeletal radiologists should be familiar with this spectrum of image guided interventional procedures.
Assuntos
Radiologia Intervencionista , Dor de Ombro/terapia , Neoplasias Ósseas/cirurgia , Bolsa Sinovial/patologia , Bursite/terapia , Calcinose/terapia , Ablação por Cateter , Cistos/terapia , Fluoroscopia , Humanos , Injeções , Injeções Intra-Articulares , Artropatias/terapia , Paracentese , Radiografia Intervencionista , Síndrome de Colisão do Ombro/terapia , Dor de Ombro/etiologia , Tomografia Computadorizada por Raios X , Ultrassonografia de IntervençãoRESUMO
The goals of this article are: 1) to review the different radiographic projections commonly used at the time of initial imaging evaluation of patients presenting with traumatic injuries of the shoulder; 2) to review the indications and findings of cross-sectional imaging modalities in the assessment of shoulder trauma; 3) to recognize the main anatomical lesions secondary to traumatic injuries of the shoulder.
Assuntos
Emergências , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Luxação do Ombro/diagnóstico , Fraturas do Ombro/diagnóstico , Tomografia Computadorizada por Raios X , Ultrassonografia , Articulação Acromioclavicular/lesões , Clavícula/lesões , Fraturas Ósseas/diagnóstico , Humanos , Luxações Articulares/diagnóstico , Lesões do Manguito Rotador , Escápula/lesões , Sensibilidade e Especificidade , Síndrome de Colisão do Ombro/diagnóstico , Articulação Esternoclavicular/lesõesRESUMO
Radiology allows to define etiologies of tendon injuries and authorize a most suitable treatment. For that reason, the use of the sonography has been developed from several years and has four main purposes to define the type of injury and to orient the treatment: to confirm the real existence of the tendon tear, to need the exact location the same one, to determine the gravity of the lesion, and finally, to evaluate its acute or chronic character. In this paper, we will try to define the normal pattern of the tendon and describe the more frequent lesions of the shoulder or the ankle: complete or partial tear, tendinopathy, dislocation and enthesopathy.
Assuntos
Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos do Tornozelo/diagnóstico por imagem , Humanos , Lesões do Ombro , Articulação do Ombro/diagnóstico por imagem , UltrassonografiaRESUMO
La radiología médica contribuye ahora a elegir el tipo de lesiones de los tendones, lo que permite establecer el tratamiento más adecuado.La ecografía tiene cuatro funciones principales para definir el tipo de lesión y orientar el tratamiento: confirmar la existencia real de la lesión tendinosa, precisar la ubicación exacta de la misma, determinar la gravedad de la lesión y, por fin, evaluar su carácter activo o de secuela.En este articulo trataremos de definir los aspectos normales del tendón y las lesiones más frecuentes: rupturas completas o parciales, tendinopatías, luxación y subluxación y, por fin, entesopatías. Mostraremos ejemplos demostrativos de lesiones del hombro y del tobillo
Radiology allows to define etiologies of tendon injuries and authorize a most suitable treatment. For that reason, the use of the sonography has been developed from several years and has four main purposes to define the type of injury and to orient the treatment: to confirm the real existence of the tendon tear, to need the exact location the same one, to determine the gravity of the lesion, and finally, to evaluate its acute or chronic character.In this paper, we will try to define the normal pattern of the tendon and describe the more frequent lesions of the shoulder or the ankle: complete or partial tear, tendinopathy, dislocation and enthesopathy
Assuntos
Humanos , Traumatismos dos Tendões , Traumatismos do Tornozelo , Articulação do Ombro , Articulação do Ombro/lesõesRESUMO
A SSFSE sequence is proposed in the sagittal plane for a cine-MRI of the cervical spine in front-line rugby players. Thus one can complete the static study and improve the detection of canal stenosis and the prevention of spinal cord injuries.
Assuntos
Vértebras Cervicais/lesões , Vértebras Cervicais/patologia , Futebol Americano/lesões , Imagem Cinética por Ressonância Magnética , Humanos , Imagem Cinética por Ressonância Magnética/métodosRESUMO
PURPOSE: To describe the sonographic features of entesopathy in patients with psoriatic dactylitis. Materials and methods. Clinical, radiographic and sonographic evaluation of 120 hand joints with clinical abnormality including 20 fingers in 17 patients with rheumatoid arthritis (RA) and 20 fingers in 17 patients with psoriatic arthritis (PA). RESULTS: Forty cases of dactylitis. In patients with RA: 29 cases of synovitis, 15 cases of tenosynovitis, and 2 cases of tendinitis; in patients with PA: 21 cases of synovitis and 3 cases of tenosynovitis. Bone erosions were present in RA patients whereas erosions with bone production were present in PA patients. A total of 60% of RA and PA patients showed erosions on conventional radiographs. Features suggesting entesopathy were present in PA patients only: specific changes of P3, capsular hyperostosis and periarticular periostitis. CONCLUSION: Based on evaluation of PA patients, it seems that sonographic features suggesting entesopathy in patients with dactylitis may be present.
Assuntos
Artrite Psoriásica/diagnóstico por imagem , Articulação da Mão/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , UltrassonografiaRESUMO
PURPOSE: The aim of this study was to report the MRI findings that can suggest a vaso-occlusive crisis in cases of febrile osseous pain in children suffering from sickle cell disease. MATERIALS AND METHODS: MRI (T1 and T2 weighted sequences and T1 weighted sequence with fat saturation before and after gadolinium injection) was performed in 10 children with sickle cell disease, presenting with febrile osseous pain. The diagnosis of vaso-occlusive crisis was made after fast improvement due to symptomatic treatment and negative bacteriological result. RESULTS: MRI was abnormal in all cases. A multifocal localisation was found in 2 cases. Bone marrow abnormalities were constant. In 10 cases, high T1 and T2 signal and metaphyso-diaphysial lesions were noted. Heterogeneous medullar enhancement with "ink stain" feature was constant. Early periosteal abnormalities were noted in 8 cases with inflammatory or stratified features. Cortical thinning was found in 1 case. Soft tissue abnormalities were observed in 5 cases with inflammatory features in 4. CONCLUSION: Multifocal synchronous localisation, medullar abnormalities resulting from hemoglobin degradation, heterogeneous enhancement, early periosteal abnormalities and associated soft tissues swelling are MRI findings suggesting acute vaso-occlusive disease.
Assuntos
Anemia Falciforme/complicações , Doenças Ósseas/etiologia , Imageamento por Ressonância Magnética/métodos , Adolescente , Anemia Falciforme/fisiopatologia , Doenças Ósseas/diagnóstico , Doenças da Medula Óssea/diagnóstico , Osso e Ossos/irrigação sanguínea , Osso e Ossos/patologia , Criança , Pré-Escolar , Meios de Contraste , Feminino , Febre/fisiopatologia , Seguimentos , Gadolínio , Humanos , Masculino , Dor/fisiopatologia , Periostite/diagnóstico , Doenças Vasculares/diagnóstico , Doenças Vasculares/etiologiaRESUMO
We report the case of a neonate with two very rare anomalies: primary chylopericardium and diffuse hypoplasia of the thoraco-abdominal aorta. The presentation on the 16th post-natal day was with dyspnoea and refusal to feed. The initial clinical examination revealed hepatomegaly and weak femoral pulses. 2D ultrasound gave a diagnosis of a large compressive pericardial effusion combined with moderate hypoplasia of the aortic isthmus. Emergency pericardial drainage removed 80ml of chylous liquid. Following prolonged parenteral nutrition, the pericardial effusion stabilised. A mechanism of diffuse vascular disease affecting the aorta and the lymphatic system is suggested.
Assuntos
Aorta Abdominal/anormalidades , Aorta Abdominal/patologia , Aorta Torácica/anormalidades , Aorta Torácica/patologia , Derrame Pericárdico/patologia , Drenagem , Ecocardiografia , Humanos , Recém-Nascido , Nutrição Parenteral , Resultado do TratamentoRESUMO
Glucagonoma is a rare neuroendocrine neoplasm. Characteristics are clinical (necrolytic migratory erythema, weight loss), biological (diabetes) and radiological (pancreatic tumor). The Authors report a case of glucagonoma that also secreted insulin.