Shoulder ultrasonography in the diagnosis of polymyalgia rheumatica: a case-control study.

OBJECTIVE: Magnetic resonance imaging (MRI) showed that subacromial/subdeltoid bursitis is the most frequent shoulder lesion in polymyalgia rheumatica (PMR). We evaluated whether shoulder ultrasonography (US) was as effective as MRI in the detection of this lesion and assessed the sensitivity and specificity of bilateral subacromial/subdeltoid bursitis in the diagnosis of PMR. METHODS: A case-control study of 57 consecutive case patients with untreated PMR and 114 controls seen over a 6 month period in 3 secondary referral rheumatology centers. Control patients consisted of the next 2 consecutive patients with bilateral shoulder aching and stiffness observed after the case patient. In all case and control patients the glenohumeral joint space, bursae, and long head biceps tendon were assessed by bilateral shoulder US. The first 24 case patients were also examined by bilateral shoulder MRI. RESULTS: US showed subacromial/subdeltoid bursitis in 55/57 (96%) patients with PMR and in 25/114 (22%) controls (p < 0.001). The lesion was bilateral in 53/55 (96%) case patients and in 1/25 (4%) controls (p < 0.001). The frequency of glenohumeral joint synovitis and biceps tenosynovitis did not differ significantly between case patients and controls. In 100% of case patients MRI showed subacromial/subdeltoid bursitis confirming US findings. The sonographic evidence of bilateral bursitis had a sensitivity of 92.9%, specificity of 99. 1%, and positive predictive value of 98. 1% for the diagnosis of PMR. CONCLUSION: US and MRI were equally effective in confirming bilateral subacromial and subdeltoid bursitis in PMR. This finding, in view of its high sensitivity and specificity, could be used as a new diagnostic criterion for PMR.

[Secondary liver lesions studied with double-helix spiral computed tomography: first experience]. / Studio delle lesioni secondarie epatiche mediante Tomografia Computerizzata volumetrica con doppia elica: prime esperienze.

The authors report their early personal experience with double-helix spiral CT (CT Twin Elscint) in the study of liver metastases. This work was aimed at optimizing the study technique and at assessing the diagnostic accuracy of this method. The high temperature developed by CT Twin and the presence of a double row of detectors permit to acquire proper length sequences (with 6.5 mm slice thickness) within a short scanning time which is easy for the patient to tolerate without breathing and moving. Two hundred and thirty patients were examined with US for focal hepatic lesions and then submitted to spiral CT: spatial and density resolution were higher with spiral CT than with US, and the former technique permitted the whole liver to be studied without any partial volume artifacts, which allowed us to confirm all the lesions depicted with US and to detect other lesions, missed at US, in 20% of patients. The choice of the proper time between contrast administration and sequence acquisition is sufficient to permit the detection of focal lesions, if the liver is studied in the portal phase. The authors stress the yield of spiral CT, especially with the double-helix technique, in studying liver metastases.

[Calcaneal fractures: CT aspects]. / Le fratture del calcagno: aspetti TC.

Calcaneal fractures account for 33.3% of foot fractures and 1.5% of all fractures. They were divided by Warrick and Brenner into two main groups according to whether they modify the astragalocalcaneal joint or not. Given the anatomical complexity of the foot, conventional X-rays are not always able to correctly visualize the articular facets and therefore provide insufficient information as to the characteristics of the fracture line, the position of bone fragments, and the involvement of capsulo-ligamentous structures. The authors report their personal experience with CT in the study of 12 patients with monolateral calcaneal fractures previously diagnosed on conventional X-rays. High-resolution CT (HRCT) was employed with 3-mm contiguous sections on the axial and the coronal planes. CT was used to study the normal anatomy of the foot and to evaluate 3 patients with calcaneal fracture without impaction of the posterior facet; 9 patients with impaction into the calcaneal body were also examined with CT. In the first 3 cases, an oblique fracture line was observed crossing from craniolateral to mediocaudal and thus dividing the calcaneus into 2 large fragments: sustentaculum tali and posterior facet of the talar joint. In the extant 9 cases the impaction of the posterior facet was indicated by an interruption in lateral and/or medial calcaneal walls. In 2/9 cases bone fragments were seen in the tarsal sinus, in 4/9 the sustentacular fragment was displaced, in 2 the cuboid bone was impacted into the anterior process of the calcaneus and, finally, in 7/9 cases a lateral/medial dislocation of the calcaneal tuberosity was observed. On the basis of these results, CT proved to be of greater value than conventional X-rays in the imaging of calcaneal fractures and to have a fundamental role every time an accurate evaluation of the region is needed to plan treatment.