Radiological findings in 31 patients with chondroblastoma in tubular and non-tubular bones.

INTRODUCTION: This study aimed to evaluate radiological findings in patients with chondroblastoma (CB) in tubular and non-tubular bones (NTBs). METHODS: We retrospectively reviewed the medical records of patients with CB. Data collected included patients' gender and age, type, size and location of bone involved, and imaging findings regarding border, lobulation, calcification, trabeculation, cortical expansion and destruction, periosteal reaction, soft tissue component and fractures. Magnetic resonance imaging and/or multidetector computed tomography were used to determine the presence of any internal cystic space or secondary aneurysmal bone cyst that may have affected the radiological appearance of CB. RESULTS: All 31 lesions (18 tubular bones, 13 NTBs) exhibited geographic bone destruction and did not involve the adjacent joints. Univariate analysis showed that NTB lesions were found in older patients and were associated with thin trabeculation (p < 0.01) and well-defined margins (p < 0.05), whereas tubular bone lesions correlated with thick trabeculation and partially ill-defined margins. On multivariate analysis, age and type of bone involvement were significantly correlated. An increase in age by one year reduced the risk of having tubular bone involvement by about 27% when compared with NTBs (p = 0.011). Thin trabeculation was also significantly correlated with NTB lesions. CONCLUSION: Age was the most significant parameter, as increased age was found to reduce the risk of tubular bone involvement. Patients with NTB lesions were significantly older than those with tubular bone lesions. Based on imaging alone, thin trabeculation showed significant correlation with CB occurring in NTBs on both univariate and multivariate analyses.

Emergency ultrasonography in patients with clinically suspected soft tissue infection of the legs.

INTRODUCTION: We aimed to retrospectively review the ultrasonography (US) findings of patients with clinically suspected soft tissue infection of the legs and to determine whether there is a correlation between US diagnosis and further clinical management. METHODS: We reviewed the US findings of consecutive patients with clinically suspected soft tissue infection of the legs who were referred for emergency US during a consecutive two-year period. The indications for US were recorded and the findings evaluated. The effect of the US findings on further clinical management (medication alone versus medication with surgical intervention [SI]) was reviewed. RESULTS: A total of 51 legs from 38 patients were enrolled in the study. The most common indication for US was to rule out necrotising fasciitis (35.3%). The most frequent US diagnosis was isolated cellulitis (21.6%). Both groups of patients (with and without abscess) were treated with medication with or without SI. There was no statistically significant correlation between the presence or absence of abscess and further clinical management (p = 0.216), between the size (length and thickness) of the abscess and the type of SI (p = 0.687 and 0.243, respectively) CONCLUSION: In our study, the most frequent US diagnosis was isolated cellulitis, and we found no significant correlation between US findings and clinical management (medication or SI). Our results should encourage sonologists to evaluate in detail patients with clinically suspected soft tissue infection of the legs and to provide information regarding each layer of tissue studied.

Dynamic contrasted MR imaging in differentiation of recurrent malignant soft tissue tumor from posttreatment changes.

OBJECTIVE: To investigate dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in term of differentiation recurrent malignant soft tissue tumor (MSTT) from post-treatment changes. MATERIAL AND METHOD: DCE-MRI was performed in consecutive patients in two-year periods to differentiate recurrent MSTT from post-treatment (surgery radiotherapy chemotherapy) changes. The steepest slope (SS) ratio between the artery and the lesion, sensitivity, and specificity were calculated. RESULTS: Thirty-five DCE-MRI studies were performed in 30 patients, which included 14 males and 16 females with an age range from 12 to 71 years (median 45.81 year). Thirteen were with recurrence and 22 were with post-treatment changes. The SS ratios were ranged from 0.66 to 29.15. The lesions with the SS ratio > 9.28 were all benign at follow up of at least two months, whereas those with SS ratio < 1.05 were all recurrent tumors proven by biopsy or surgery. Overlapping occurred when the SS ratios > 1.05 but < 9.28 in which the recurrence was 42.31%. The chance of having recurrence rather than post-treatment changes was approximately two andfive times in patients with the ratio of 5. 07 and 1.55, with the specificity of 54.55% and 90.91%, respectively CONCLUSION: The SS ratio between the artery and the lesion has limitations to differentiate recurrent MSTT from posttreatment changes. It is useful when the ratio is less than 1.05 (malignant) or more than 9.28 (benign). The chance of having recurrence rather than post-treatment changes was approximately two and five times in patients with the ratio of 5.07 and 1.55, respectively The less value the ratio is, the more possibility to be recurrent tumor.

The prevalence of carotid artery calcifications detected on panoramic radiographs in patients with metabolic syndrome.

OBJECTIVES: The purpose of this study was to determine the prevalence of carotid artery calcifications (CAC) detected on panoramic radiographs in patients with metabolic syndrome (MetS). STUDY DESIGN: Eighty-five Thai subjects (29 men, 56 women) who had MetS according to the International Diabetes Federation definition were evaluated for CAC detected on panoramic radiographs. The confirmation of findings was done by ultrasonography. RESULTS: Carotid artery calcifications were detected in 19 subjects (22.4%) with a mean age of 64 years, range 48-74 years. These subjects included 12 men and 7 women. The CAC were significantly more common in men than in women (P = .002). There were 8 subjects (9.4%) with bilateral calcifications and 11 subjects (12.9%) with unilateral calcification. No significant difference between the right and left sides was found (P = .44). CONCLUSION: Thai people with MetS have high prevalence of radiographically detectable carotid artery calcifications.

Three-Tesla MRI diagnosis of meniscal tears of the knee.

OBJECTIVE: To study and diagnose meniscal tear of the knee using 3-Tesla (3-T) magnetic resonance imaging (MRI) compared with arthroscopy. MATERIAL AND METHOD: One hundred twenty eight consecutive patients who underwent MRI of the knee using a 3-T magnet between April 2007 and Nov 2008 were included in this study. The inclusion criteria were the patients who had (i) subsequent knee arthroscopy, (ii) available medical records, and (iii) no history of meniscal surgery. Their MR images were retrospectively reviewed by two radiologists with consensus agreement. The diagnostic values for diagnosing meniscal tears were evaluated and compared to the arthroscopic results. RESULTS: Thirty-two patients (64 menisci) were included; 26 males and 6 females, mean age was 36.4 years (range 19-62). The mean interval between MRI and arthroscopy was 93 days. To diagnose tear of medial, lateral, and both menisci; the sensitivity was 100%, 90%, 100%; the specificity was 77%, 73%, 50%; the accuracy was 91%, 78%, 84%; the positive predictive value (PPV) was 86%, 60%, 81%; and the negative predictive value (NPV) was 100%, 94%, 100%, respectively. False positive MR findings were found predominantly at the posterior horn and at the peripheral third of the menisci. By dividing the patients into 2 groups according to the mean MRI-arthroscopy interval (< 93 and > 93 days): increased sensitivity and NPV of detecting lateral meniscal tear; increased specificity, accuracy, and PPV of both meniscal tear was observed in the longer duration group, but there was no statistical significance in the present study. CONCLUSION: The present results with 3-T MRI revealed high sensitivity and NP V comparable to the literature, thus supporting previous studies that if a meniscal tear is not seen on 3-T MRI, it is highly unlikely to be present. False positive MR findings found predominantly at the posterior horn and at the peripheral third of the menisci. The longer the MRI-arthroscopy interval yielded increased diagnosing values of meniscal tear but there is no statistical significance in the present study

Reappraisal of cervical spine subluxation in Thai patients with rheumatoid arthritis.

Subluxation of the cervical spine is one of a number of devastating complications of rheumatoid arthritis. In spite of this, the features of cervical spine subluxation in Thai patients with rheumatoid arthritis have never previously been studied. We enrolled 134 patients with rheumatoid arthritis who were being followed at the rheumatology clinic, Ramathibodi Hospital, during 1978-2001. Radiological examinations were made in lateral neck flexion, extension and open-mouth views. Symptoms of neck pain and the results of relevant neurological examinations were recorded at the time of imaging. Other data on clinical features and treatments since diagnosis were reviewed retrospectively. The overall prevalence of cervical spine subluxation was 68.7%, which can be categorised into anterior (26.9%), posterior (14.9%), lateral (17.2%), vertical (16.4%) atlantoaxial and subaxial subluxation (28.4%). The percentages of cervical subluxation in patients who had suffered from the disease for 1, 5, 10 or more than 10 years were 77.8%, 64.9%, 70% and 64.7%, respectively. None of the patients had neurological deficits. No correlation between neck pain and cervical spine subluxation was established. The number of patients treated with corticosteroids was significantly higher in the subluxation group than in the non-subluxation group ( p=0.04). However, no difference in duration of treatment and cumulative dosages of steroids was displayed between the two groups. It was concluded that the prevalence of cervical spine subluxation in Thai patients with rheumatoid arthritis is much higher than the average, even in the early phase of the disease. Hence, radiological examination of the cervical spine should be included in the initial evaluation of Thai RA patients. Corticosteroid use was associated with cervical subluxation, regardless of dose and duration of treatment. The possible explanations are that steroids may directly cause ligament laxity, osteoporosis and decreasing muscle mass, which leads to accelerated subluxation, or that steroid treatments are used in more severe cases which have a higher tendency towards cervical subluxation.