Craig W. Walker

MR imaging of hepatocellular carcinoma: Relationship between lesion size and imaging findings, including signal intensity and dynamic enhancement patterns

To assess the relationship between lesion size and MR imaging findings of pathologically‐proven hepatocellular carcinoma (HCC).

THE INFLUENCE OF CLINICAL HISTORY ON VISUAL SEARCH WITH SINGLE AND MULTIPLE ABNORMALITIES

RATIONALE AND OBJECTIVESFacilitation of detection by clinical history generally has been found with a single abnormality per image but not with multiple abnormalities. Multiple abnormalities per image can occasion a “satisfaction-of-search” effect in which detection of one lesion is reduced in the presence of other distant lesions. Our experiment studied the combined effect of multiple abnormalities and clinical history on accuracy. METHODSDetection of native lesions was measured 1) with histories suggestive of the native abnormality; 2) with these histories and added simulated pulmonary nodules; and 3) with the same added nodules and histories suggestive of metastatic disease. These conditions also were compared with those of a previous experiment that were similar but included no history. RESULTSDetection was substantially improved for appropriately prompted abnormalities even in the presence of a pulmonary nodule. In fact, satisfaction of search vas not found in the presence of an appropriate history. Detection of unprompted abnormalities was unchanged when prompts indicated other abnormalities actually present. Prompted abnormalities were detected earlier in search. CONCLUSIONSHistory appears to direct perceptual resources to the prompted abnormalities, thereby alleviating satisfaction of search. The presence of nodules yielded a small but consistent reduction in total search time for searches involving false responses, suggesting that satisfaction of search may depend more on reduction in search time than had been indicated by previous research.

Bone presence between the central peg's radial fins of a partially cemented pegged all poly glenoid component suggest few radiolucencies.

BACKGROUND Cement penetration problems and/or cement-induced bone necrosis may contribute to glenoid component failures. An all polyethylene component was developed that promotes biologic fixation between radial fins of its central peg and utilizes minimal cement fixation for its peripheral pegs, but it has little published data. We hypothesized better bone presence between the radial fins would be associated with less overall radiolucencies. This studys purpose was to utilize computed tomography (CT) and plain films to assess for bone between the central pegs radial fins and to assess overall component radiolucencies. MATERIALS AND METHODS Thirty-five of 48 consecutively performed total shoulder arthroplasties (TSA) for primary glenohumeral osteoarthritis were in patients able to participate a minimum 2 years after surgery. All had reamed humeral head bone packed between radial fins of the central peg and minimal cement for the peripheral pegs. Thin cut (0.625 mm) CT scans, standardized plain films, Simple Shoulder Tests (SST), and Constant scores were obtained. A musculoskeletal radiologist calculated Yian CT scores, bone presence between fins on CT, and Lazarus radiolucency scores. RESULTS At a mean of 43 months, by CT: 1) better Yian scores correlated with more bone between fins, and 2) bone was present in 6/6 inter-fin compartments in 23/35 shoulders, averaging 4.5/6 overall. Mean Lazarus radiolucency score was 0.45. Mean SST and Constant scores were 10.3 and 81.3, respectively. CONCLUSION TSA utilizing autologous bone in inter-fin compartments of the central peg and minimal peripheral peg cement maintained bone presence a minimum 2 years post-op. More bone imparted fewer overall component radiolucencies.

Patellar fatigue fractures

Abstract Three cases of patellar fatigue fracture are reviewed. Two fractures presented with acute displacement and were initially thought to represent pathological fractures. Histological appearances in one case, and the clinical course in another, subsequently indicated that these were fatigue fractures. A third patient developed a chronic undisplaced fracture and followed the typical clinical course of fatigue fractures at other sites. The importance of recognizing patellar fatigue fractures and of differentiating spontaneously displaced fatigue fractures from pathological fractures is emphasized.

The use of intravenous gadopentetate dimeglumine in magnetic resonance imaging of synovial lesions

Spin echo T1- and T2-weighted images and intravenously administered gadopentetate dimeglumineenhanced T1-weighted images were obtained in 4 normal volunteers and 11 patients (11 joints) with painful, intermittent, or persistent joint swelling of unknown etiology. These studies were retrospectively reviewed to assess the benefits of contrast-enhanced magnetic resonance imaging (MRI) in evaluating the synovium. Normal synovium and joint fluid showed no visually apparent enhancement on images obtained immediately after intravenous injection of gadopentetate dimeglumine. Abnormal synovium enhanced significantly, allowing the precise identification of equivocal or unsuspected synovial disease processes. These results suggest that, in selected cases, enhanced MRI can be a useful adjunct in the evaluation of suspected synovial disease processes.

The third head of gastrocnemius in CT images

A 17 year old male patient was undergoing a CT scan for pain and swelling of the left knee. The CT images of both legs, taken simultaneously, revealed an asymmetry of the musculature in the popliteal fossa of the right leg. Serial images indicated the presence of a third head joining the medial head of gastrocnemius.

Pericytoma with t(7;12) and ACTB-GLI1 fusion arising in bone

Cytogenetic analysis of a primary bone neoplasm with pericytic features in a 67-year-old man revealed a t(7;12)(p22;q13) among other karyotypic abnormalities. Subsequent molecular studies confirmed the presence of an associated ACTB-GLI1 fusion transcript. An identical 7;12 translocation is known to characterize a discrete group of soft tissue tumors belonging to the myopericytic category termed pericytoma with t(7;12). To the best of our knowledge, this is the first case of pericytoma with t(7;12) arising in bone. Cytogenetic and molecular analyses were useful, if not essential, in classifying this rare diagnostic entity.

Multifocal, metachronous, giant cell tumor of the lower limb.

A case of multifocal giant cell tumor in a skeletally immature male with documented metachronous disease of the lower limb is described followed by a review of the literature including treatment options and their outcomes.

Heel ultrasonography is not a good screening tool for bone loss after kidney and pancreas transplantation

Abstract:  Background:  Solid organ transplant recipients, particularly simultaneous pancreas kidney recipients, are at high fracture risk. We tested whether quantitative ultrasonography (QUS) of the heel predicts bone mineral density (BMD) by dual energy X‐ray absorptiometry (DXA) in solid organ transplant recipients.

The association of incomplete glenoid component seating and periprosthetic glenoid radiolucencies after total shoulder arthroplasty

BACKGROUND Radiolucent lines surrounding prosthetic glenoid components are commonly seen after unconstrained total shoulder arthroplasty and can be a harbinger of subsequent glenoid component failure. Whether less than 100% glenoid seating is associated with the development of radiolucent lines around glenoid prostheses is unknown. This study investigated the association between incomplete glenoid component seating and periprosthetic glenoid radiolucencies. METHODS Thirty-six unconstrained total shoulder arthroplasties were performed in 29 patients for primary glenohumeral osteoarthritis with a minimum 2-year follow-up. All were implanted with a partially cemented all-polyethylene glenoid prosthesis. Patients were evaluated with standardized plain films preoperatively and postoperatively and with thin-cut computed tomography (CT) scans at the latest follow-up. The Lazarus and Yian classifications were used to assess radiolucency and seating on radiographs and CT scans. Ratings were calculated for intraobserver and interobserver reliability and given κ, the Kendall coefficient, and interclass correlation coefficient values. RESULTS At a mean of 43 months (range 24-26 months) after surgery, neither Lazarus plain film radiolucency scores (P = .78) nor Yian CT radiolucency scores (P = .68) were associated with Lazarus plain film seating scores. Neither Lazarus plain film radiolucency scores (P = .25) nor Yian CT radiolucency scores (P = .91) were associated with modified Lazarus CT scan seating scores. CT allowed for better intraobserver and interobserver reliability in all categories. CONCLUSION Radiolucencies around a partially cemented glenoid component were not associated with the degree of component seating. Complete seating of the glenoid component is not necessary to achieve radiographic implant stability at a mean follow-up of 43 months.