Andreas Neuhold

MAGNETIC RESONANCE IMAGING OF THE SPINE IN MULTIPLE MYELOMA

The lower thoracic and lumbar spine of patients with multiple myeloma was examined by magnetic resonance imaging (MRI), plain radiography, and bone scintigraphy. Three independent investigators evaluated the power of these diagnostic methods to detect bone lesions in 192 vertebrae from 18 patients and in 60 vertebrae from 7 controls. 41 foci with abnormal signal intensity were detected by MRI; X-ray films showed osteolytic lesions in 4 vertebral bodies; and bone scanning was positive in 2 cases. The superiority of MRI in detecting myeloma-associated focal bone lesions was statistically significant, and in one case the lesions were confirmed at necropsy. Deviations in shape and height of vertebral bodies were slightly more easily visible on radiographs. Early detection of imminent medullary compressions in 2 patients led to successful radiotherapy before symptoms appeared.

Magnetic resonance imaging of the lower vertebral column in patients with multiple myeloma.

Eighteen patients with multiple myeloma (clinical stages 1-3) and a control group of 21 persons underwent magnetic resonance imaging (MRI) studies of the lower thoracic and lumbar spine. This was done to determine the potential benefit of MRI in addition to conventional radiographs, tomograms, computed tomography and nuclear scans. In addition to focal fatty replacement of normal hematopoietic marrow, which presented as focal hyperintense lesions on T1-weighted images (T1-WI) and on T2-weighted images (T2-WI), two types of myelomatous lesions were found: (1) focal areas with reduced signal intensity when compared with normal bone marrow on T1-WI and enhanced signal intensity on T2-WI, mainly found in untreated myelomas; and (2) focal areas of decreased signal intensity on T1-WI and on T2-WI, which were predominantly detected after previous radiation therapy. MRI surpassed conventional radiography in detecting abnormal focal marrow infiltration in 41 of 247 vertebrae. Radiographs identified only 11 of the 41 as pathologic, based on shape and structure of the vertebral bodies; however, 15 other collapsed vertebrae showed no signal abnormalities of the marrow on MR images. Discrimination of normals and abnormals by statistical analysis of intensity measurements of the bone marrow was not possible.

Classifying calcaneal tendon injury according to MRI findings

Magnetic resonance imaging was performed on 28 patients with suspected calcaneal tendon injury prior to treatment. None of the patients were involved in competitive sports. All underwent clinical examination, some had had ultrasound or CT scans. We identified four types of lesions: type I, inflammatory reaction; type II, degenerative change; type III, incomplete rupture and type IV, complete rupture. Thirteen of the 28 patients underwent surgery and the diagnostic findings were verified. We recommend that type I, type II and type III lesions be managed conservatively, while type IV lesions should be operated in the young and active patient.

MRI evaluation of pigmented skin tumors. Preliminary study.

Magnetic resonance imaging (MRI) was performed in 16 patients with pigmented skin lesions, seven with nodular melanomas, two with superficial spreading melanomas, two with subcutaneous melanoma metastases, and five with different benign pigmented nodular skin lesions. The results of MRI were compared with the histologic diagnoses. Signal intensities of the lesions were compared with subcutaneous fat, revealing a lower signal intensity of all lesions on T1-weighted images. Intensity measurements showed a significant (P less than .01) difference between benign and malignant lesions on T2-weighted images.

MR arthrography in lesions of the labrum acetabulare.

SummaryMagnetic Resonance imaging with its excellent soft tissue contrast represents the method of choice for examination of intraarticular and periarticular structures of joints. However, conventional MR-imaging without intraarticular contrast application is not suitable for the diagnosis of labral lesions. MR-arthrography (MRA) of the hip clearly demonstrates labral pathology by distension of the joint space and entrance of the contrast medium into the lesion. Multiplanar 3-D-gradient echo sequences enable visualisation of the most important cranio-ventral portion of the labrum. With the MRA labral lesions can be subdivided into different, clinically relevant stages. Furthermore accompanying lesions (intra- and extraosseous ganglia, stress-bone marrow-edema) can be demonstrated. In our study including operatively verified cases, MRA showed excellent sensitivity (90 %) and accuracy (91 %) in detecting labral lesions. So far no complication occurred with more than 100 MRAs. Therefore this technique represents the method of choice for the radiological evaluation of labral lesions of the hip joint. In this review the technical details and results of our MRA method will be presented.ZusammenfassungDie Magnetresonanztomographie (MRT) mit ihrem hohen Weichteilkontrast ist die bildgebende Methode der Wahl zur Darstellung der intraartikulären Strukturen und der umgebenden Weichteile der Gelenke. Zur Diagnostik von Labrumläsionen des Hüftgelenks ist die Nativ-MRT jedoch nicht geeignet. Die MR-Arthrographie (MRA) des Hüftgelenks erlaubt durch die Distension des Gelenkraums und Markierung der Läsion die direkte Darstellung von Labrumläsionen. Multiplanare dreidimensionale (3D-)Sequenzen ermöglichen die Beurteilung in den entscheidenden kranioventralen Abschnitten. Die Labrumläsionen können mit der MRA in verschiedene, klinisch relevante Stadien eingeteilt werden. Zusätzlich ist auch die Darstellung von Begleitläsionen (intra- und extraossäre Ganglien, Streßödeme) möglich. In einer von uns durchgeführten Studie mit operativ verifizierten Fällen zeigte die MRA eine ausgezeichnete Sensitivität (90 %) und Treffsicherheit (91 %). Bei den inzwischen über 100 durchgeführten Arthrographien traten bisher keine Komplikationen auf. Aufgrund dieser Erfahrungen stellt die MRA die Methode der Wahl zur bildgebenden Diagnostik von Labrumläsionen dar. In dieser Übersichtsarbeit stellen wir die Technik und Ergebnisse der von uns verwendeten MRA-Methode vor.

Sonoanatomy of the Shoulder

With the aid of ultrasound we tried to visualize the muscles of the shoulder region, the collum scapulae, the axillary artery and vein and the brachial plexus. We were successful with exception of the vessels and the nerves. Knowledge of the anatomical landmarks is essential in ultrasound image reading.