Early rheumatoid arthritis and its differentiation from other joint abnormalities

The introduction of disease-modifying antirheumatic drugs has created new demands on imaging to early identify patients with rheumatoid arthritis and opened new prospects in therapeutic management of patients with aggressive disease. Therefore, new imaging modalities such as magnetic resonance imaging and ultrasound have developed during the past few years in this field. In some cases, both magnetic resonance imaging and ultrasound may be also useful in making the distinction between early rheumatoid arthritis and other joints abnormalities, including early psoriatic arthritis. This article will review key aspects of important advances in imaging in rheumatoid arthritis, particularly focusing on magnetic resonance imaging and ultrasound.

Sonographic assessment of the lateral femoral cutaneous nerve

PURPOSE

To evaluate the ability of high-frequency sonography to evaluate the lateral femoral cutaneous nerve (LFCN).

METHODS

A cadaveric study was performed on 5 cadavers to outline the normal course of the LFCN. Next, 37 LFCNs in 21 volunteers were evaluated via sonography with a 5-13-MHz linear-array transducer.

RESULTS

The LFCN was easily identified in our dissections. It always entered the thigh under the inguinal ligament and coursed superficially to the sartorius muscle. In 2/10 (20%) cases, anatomical variants were observed. Sonography revealed the LFCN in 26/37 (70%) cases. The relationships of the nerve with the deep circumflex iliac artery, the anterior superior iliac spine, and the sartorius were visualized. Neuromas were observed bilaterally in 1 volunteer.

CONCLUSION

The LFCN can be seen in the groin with the aid of sonography.

[Plain radiographs of the wrist and hand]

The purpose of this review is to describe the value of the different radiographic projections of the wrist and hand, provide criteria for quality control and key interpretation points. Plain radiographs of the hand and wrist are still, in this era of cross-sectional imaging, of great importance in the assessment and understanding of bone and joint disorders, particularly in the setting of trauma. Indeed postero-anterior and lateral views have to be completed with additional projections depending on the suspected lesion and clinical presentation.

In vivo MR tractography of thigh muscles using diffusion imaging: initial results

The aims of this preliminary study were (1) to demonstrate the feasibility of providing in vivo 3D architecture of human thigh muscles using tractography on a 1.5T magnet, and (2) to assess the value of tractography images to obtain averaged microstructural parameters, i.e., the fractional anisotropy (FA) and the mean apparent diffusion coefficient (ADC), over the whole thigh. Five healthy volunteers were included in this study. Their right thighs were imaged using diffusion tensor imaging and gradient-echo T2* sequences. Muscular tractography was performed on each muscle. MR tractography provided a good approach of the muscle shape and of the orientation of the muscle fibers. There was no aberration in the color-encoding scheme nor in the luminosity assigned to each fiber. In contrast, tendons were not drawn in any of the muscles studied. FA values ranged from 0.27 to 0.38. Mean ADC values ranged from 0.76 to 0.96 x 10(-3) mm2/s. Our study demonstrated the feasibility of providing in vivo 3D architecture of human thigh muscles using tractography on a 1.5T magnet, and of determining muscular microstructural parameters (FA and ADC). Musculoskeletal radiologists should be aware of these new developments that may provide complementary information on muscles to the usual sequences.

Imaging of the hip in patients with rheumatic disorders

Hip joint abnormalities are commonly encountered in patients with rheumatic disorders. Although conventional radiography remains the mainstay for diagnosis of joint damage and subsequent follow-up, magnetic resonance imaging and, to a lesser extent, ultrasound have afforded the ability to detect early signs of articular involvement (i.e., synovitis and bone erosions), and to assess disease activity in treated patients. In more advanced stages of rheumatic disorders, magnetic resonance imaging and ultrasound are both useful in assessing paraarticular involvement (i.e., bursitis and synovial cysts).

SAPHO Syndrome: MR Appearance of Vertebral Involvement

PURPOSE

To retrospectively evaluate the magnetic resonance (MR) imaging findings of vertebral involvement in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome.

MATERIALS AND METHODS

Ethics committee approval and informed patient consent were not required for this retrospective study. MR images obtained in 12 patients (seven female, five male; mean age, 42 years; range, 16-65 years) with SAPHO syndrome involving the spine were reviewed. One vertebral lesion separated by one or more normal vertebrae was analyzed as a distinct lesion. For each lesion, the number of associated vertebrae with abnormal signal intensity (SI) (ie, single vertebra, two adjacent vertebrae, or more than two adjacent vertebrae) was noted. The following MR imaging findings were evaluated: cortical bone erosion, abnormal vertebral body SI compared with normal vertebral body SI, increased anteroposterior diameter of the vertebral body, soft-tissue involvement, vertebral body height loss of more than 30%, and abnormal SI of the adjacent intervertebral disk compared with the SI of the other disks.

RESULTS

Of 24 vertebral lesions found, 17 involved a single vertebra, four involved two adjacent vertebrae, and three involved three or four adjacent vertebrae. Vertebral corner cortical erosion was present in all lesions, and 23 (96%) lesions had anterior vertebral corner involvement. The erosion was confined to a vertebral corner in five (21%) lesions and included the adjacent endplate and/or the anterior cortex of the vertebral body in the remaining 19 (79%) lesions. In four (17%) lesions, involvement of two adjacent vertebral corners on either side of an intervertebral disk mimicked to some extent early disk space infection. An adjacent disk space was narrowed in six (25%) lesions and exhibited abnormal SI in two (8%). Prevertebral tissue thickening was observed in eight (33%) lesions.

CONCLUSION

Erosion of a vertebral body corner is consistently seen on MR images of SAPHO vertebral lesions and may support the diagnosis of SAPHO syndrome in the appropriate clinical context.

Influence of labral tears on the outcome of acetabular augmentation procedures in adult dysplastic hips. Prospective assessment with a minimum follow-up of 12 years

Lesions of the acetabular labrum have been suspected to be one factor responsible for failures of Chiari osteotomy. We undertook a prospective investigation to adress this question. Twenty-six adult patients (mean age 34.5 years) with 26 dysplastic hips were enrolled consecutively. All the hips studied showed arthritic changes. The labrum was inspected by arthroscopy during surgery (19 shelf acetabuloplasties and 7 Chiari procedures). All hips were followed for a minimum of 12 years (12-14 years). Sixteen dysplastic hips (62%) were found to have labrum tears. Computed tomography (CT)-arthrography findings were similar to arthroscopic observations in 13 hips. Coxomety results showed that the acetabular roof angle (HTE), cervico-diaphyseal angle (CDA) and lateralisation were higher in cases with acetabular labral tears. On the other hand, the ventral center-edge angle (VCEA) was lower in hips with labral tears. During the follow-up period, eight hips which had undergone a Chiari osteotomy were converted to total hip replacement. Adult dysplastic hips are at risk for presenting labral tears. Clinical signs appear to have limited diagnostic value. Coxa valga, a small lateral center edge angle and a high acetabular roof angle were found in this study to be associated with a higher incidence of labral tears. Contrary to previous data reported in retrospective studies, the results of the present prospective investigation suggest that labral tears do not compromise the outcome of acetabulum enlargement procedures.

Imaging assessment of thoracic outlet syndrome

The thoracic outlet includes three compartments (the interscalene triangle, costoclavicular space, and retropectoralis minor space), which extend from the cervical spine and mediastinum to the lower border of the pectoralis minor muscle. Dynamically induced compression of the neural, arterial, or venous structures crossing these compartments leads to thoracic outlet syndrome (TOS). The diagnosis is based on the results of clinical evaluation, particularly if symptoms can be reproduced when various dynamic maneuvers, including elevation of the arm, are undertaken. However, clinical diagnosis is often difficult; thus, the use of imaging is required to demonstrate neurovascular compression and to determine the nature and location of the structure undergoing compression and the structure producing the compression. Cervical plain radiography should be performed first to assess for bone abnormalities and to narrow the differential diagnosis. Computed tomographic (CT) angiography or magnetic resonance (MR) imaging performed in association with postural maneuvers is helpful in analyzing the dynamically induced compression. B-mode and color duplex ultrasonography (US) are good supplementary tools for assessment of vessel compression in association with postural maneuvers, especially in cases with positive clinical features of TOS but negative features of TOS at CT and MR imaging. US may also allow analysis of the brachial plexus. However, MR imaging remains the method of choice when searching for neurologic compression.

A specific clinical pattern of camptocormia in Parkinson's disease

BACKGROUND

Camptocormia, characterised by extreme forward flexion of the thoracolumbar spine and severe stooping in the supine position, seems to be prevalent in Parkinson's disease.

OBJECTIVE

The aim of this study was to identify features of parkinsonian camptocormia and to describe the main clinical characteristics of patients with Parkinson's disease who develop the condition.

METHODS

An extensive range of clinical, biochemical and imaging data were gathered for 23 patients with Parkinson's disease with camptocormia, notably including magnetic resonance imaging (MRI) of the brain and spine, electromyographic recordings of the paravertebral muscles and muscle biopsies.

RESULTS

Camptocormia occurred in severe Parkinson's disease with axial predominance, motor fluctuations and dysautonomic symptoms. The condition was often associated with spondyloarthritic changes and pain. MRI showed paraspinal muscle signal abnormalities in five patients and fatty involution in seven patients. The seven patients had motor unit reductions on the spinal erector electromyogram. The MRI results for the girdle muscles were normal. Cranial MRI showed signal abnormalities for the basal ganglia in three patients.

DISCUSSION

Various mechanisms may contribute to the development of parkinsonian camptocormia: dopaminergic depletion in Parkinson's disease induces functional changes in the organisation of the corticospinal and reticulospinal tracts, where dysfunction could contribute to axial rigidity. Furthermore, rigidity of the spinal flexion muscles could lead to under-use of the spinal extension muscles, which become progressively atrophic. Rigidity may also induce spinal deformations, leading to a neurogenic syndrome via compression of the spinal nerves.

CONCLUSION

The screening and early management of camptocormia in Parkinson's disease is likely to be important for preventing axial disorders and spinal deformations.

Imaging features of musculoskeletal involvement in systemic sclerosis

This article describes the radiographic, sonographic and magnetic resonance (MR) features of musculoskeletal involvement in patients with systemic sclerosis (SSc). Conventional radiography is the traditional method of detecting digital calcifications, but ultrasonography (US) is also able to detect such calcifications before they appear on radiographs. MR imaging can be used to diagnose overlapping conditions (i.e., SSc and myositis or SSc and rheumatoid arthritis), and less frequently, to reveal neurologic complications of SSc. In patients with vascular ulcers, MR angiography is able to depict decreased flow within collateral digital arteries.

Multimodal visualization interface for data management, self-learning and data presentation

A multimodal visualization software, called the Data Manager (DM), has been developed to increase interdisciplinary communication around the topic of visualization and modeling of various aspects of the human anatomy. Numerous tools used in Radiology are integrated in the interface that runs on standard personal computers. The available tools, combined to hierarchical data management and custom layouts, allow analyzing of medical imaging data using advanced features outside radiological premises (for example, for patient review, conference presentation or tutorial preparation). The system is free, and based on an open-source software development architecture, and therefore updates of the system for custom applications are possible.

Mature neuroblastic tumors with spinal cord compression: report of five pediatric cases

BACKGROUND

Neuroblastic tumors cause spinal cord compression when they arise primarily in the spinal canal or invade it through the radicular foramen. Whereas neuroblastomas (NB) are relatively common and are generally treated with chemotherapy, mature neuroblastic tumors (MNT), which include intermixed ganglioneuroblastomas (iGNB) and ganglioneuromas (GN), are less common and the role of surgery is more prominent. Because MNT are rare and have been separated only recently from NB, their clinical and radiological features as well as the role of surgery are poorly defined.

MATERIALS AND METHODS

In order to increase our knowledge on MNT, we reviewed our database for cases operated for spinal cord compression in our department since the introduction of magnetic resonance imaging (MRI). We treated four cases of NB and one case of iGNB presenting primarily with spinal cord compression.

REPORT OF CASES

MNT represented 10% of spinal tumors and 1.6% of all tumors of the nervous system in our pediatric neurosurgical practice. The neurological and oncological outcomes were generally favorable after surgical resection, followed by orthotic treatment. In one case with neurofibromatosis type 1, the tumor was inoperable and the child died of tumor progression several years later.

CONCLUSION

GN, and some iGNB, are chemo-insensitive and can only be cured by surgical removal. Surgery is an emergency in case of rapidly progressing paraplegia and can be challenging because the tumor is often hard and hemorrhagic. In case of subtotal removal, tumor remnants can stay stable without oncological treatment.

Imaging of rock climbing injuries

Competition climbing has grown increasingly in popularity, and many people are being drawn to this sport with a parallel increase in the occurrence of sport-related injuries. One of the most common and unique lesions occurring in the rock climbing population is the closed rupture of the flexor pulley system of the fingers. This lesion is strictly related to some climbing techniques in which the entire body weight is placed on fingerholds, which causes bowstringing of the flexor tendons with subsequent loss of strength across the full range of motion of the finger. This article summarizes the current literature regarding the application of imaging modalities in the diagnosis of rock climbing injuries with a specific focus on ultrasound and magnetic resonance imaging. Biomechanics of the sporting activity and resultant pathophysiologic and clinical considerations concerning flexor pulley system injuries are also discussed.