J. Hodler

Unsuspected osteomyelitis is frequent in persistent diabetic foot ulcer and better diagnosed by MRI than by 18F-FDG PET or 99mTc-MOAB

Aim.  Prevalence, optimal diagnostic approach and consequences of clinically unsuspected osteomyelitis in diabetic foot ulcers are unclear. Early diagnosis of this infection may be crucial to ensure correct management.

Gadolinium-DOTA enhanced MR imaging of adnexal tumors.

We conducted a retrospective study to assess the potential of contrast enhanced magnetic resonance (MR) imaging in evaluating adnexal tumors. Sixty patients with a total of 77 pelvic lesions underwent MR imaging at 1.5 T and transabdominal ultrasound (US). Precontrast T1- and T2-weighted and Gd-DOTA enhanced T1-weighted MR images were obtained. Diagnoses were proved by surgery in 57 patients. Of the 77 lesions, 54 masses were of ovarian origin, including 12 malignant disorders. Ultrasound demonstrated the lesions in 92%, whereas the sensitivity of unenhanced T2-weighted and postcontrast MR images was 98 and 96%, respectively. Compared to the T2-weighted images, postcontrast MR imaging showed superior overall tumor delineation, assessment of intratumoral architecture, and definition of tumor origin. Contrast enhancement of tumors did not differ significantly between normal ovary and benign and malignant lesions. All modalities were unable to predict malignancy of complex lesions. Based on our study, US remains the screening modality of choice in the evaluation of adnexal tumors. Contrast enhanced MR imaging may be valuable for assessing complex lesions or when the origin of the mass cannot be determined by US. Using contrast enhanced T1-weighted images instead of T2-weighted images may lead to a significant reduction in acquisition time.

MRI and sonography of the shoulder

We prospectively evaluated the diagnostic value of sonography and magnetic resonance imaging (MRI) in 24 shoulders in 23 patients with suspected rotator cuff tears using arthrography as gold standard. Sonography demonstrated 14 of 15, MRI 10 of 15 rotator cuff tears, respectively. Sonography diagnosed seven of nine intact rotator cuffs correctly, MRI eight of nine. In a retrospective study we reviewed the diagnostic value of sonography and MRI in other pathologies of the shoulder including intra-articular pathology, humeral head and acromioclavicular joint pathology, and calcification. We conclude that with regard to cost and patient compliance, sonography should be the first radiologic examination in suspected rotator cuff tears if performed by an experienced sonographer. MRI is superior in depicting additional pathology and is less operator dependent. It may thus become the method of choice for the evaluation of the rotator cuff and related pathology in the future.

MR guidance of laser disc decompression: preliminary in vivo experience.

Abstract. The purpose of this study was to perform percutaneous laser disc decompression (PLDD) under MR guidance in an open configuration 0.5-T MR system. Following failed conservative treatment for 6 months, eight patients with contained disc herniations were enrolled in the study. Following MR guided introduction of the laser fiber into the targeted disc space, the laser-induced temperature distribution was visualized using a color-coded subtraction technique based on a T1-weighted GRE sequence. In seven patients PLDD could be performed. In all cases laser effects were depicted by MR. In this regard the color-coded technique was found to be superior to conventional magnitude images. Whereas no apparent decrease in the extent of herniation was discovered immediately following PLDD, T2-weighted FSE images showed signal intensity alterations in two of the seven patients. Clinical evaluation, obtained 3–4 months after PLDD, revealed a fair (n = 2) or good (n = 4) response to the treatment. One patient showed no change in symptoms. MR guidance and monitoring of PLDD is feasible within an open 0.5-T system and seems to render PLDD more safe and controllable.

Patient throughput times for orthopedic outpatients in a department of radiology: results of an interdisciplinary quality management program

Abstract. The purpose of this project was to employ quality management methods in order to decrease throughput times for orthopedic outpatients sent to the department of radiology. The following intervals were measured at the onset of the study and after 6 and 12 months: (a) between arrivals at outpatient clinic and radiology counter; (b) between arrival at radiology counter and time of last radiograph; and (c) between time of last radiograph and radiology report printing time. After the initial measurement, numerous changes were initiated both in radiology and in orthopedic surgery. The mean interval between arrival at the outpatient clinic and in radiology decreased by one third from 60 min during the first measurement to 40 (p < 0.001) and 41 min during the second and third measurement. The proportion of patients with total radiology times of more than 30 min decreased from 41 to 29 % between the first and third measurements (p < 0.001). The corresponding results for radiology times of more than 45 min were 17 and 11 % (p = 0.03). A standard type of quality management program can be employed successfully in order to reduce radiology throughput times for orthopedic outpatients.

Pitfalls in MR morphology of the sterno-costo-clavicular region using whole-body MRI.

AIM To analyse the imaging findings at the sterno-costo-clavicular (SCC) joint region using whole-body (WB) magnetic resonance imaging (MRI) in healthy individuals to minimize misinterpretation as changes due to spondyloarthritis (SpA). MATERIALS AND METHODS As part of a cross-sectional study of 122 SpA patients, 75 healthy individuals (42/33 males/females; median age 30.3 years; range 17.7-63.8 years) were scanned using sagittal and coronal WB short tau inversion recovery (STIR) and T1-weighted MRI sequences. The SCC region was analysed independently by seven readers for bone marrow oedema (BMO), erosions, subchondral fat signal intensity (FSI), and joint fluid accumulation. RESULTS SCC changes simulating inflammation were reported by four or more of the seven readers in 15 (20%) healthy individuals (12 male/three female; median age 32.1 years; range 20.2-48 years). Thirteen individuals (17%) had changes at the manubriosternal joint (MSJ); five had BMO, one BMO + erosion, four erosion, two erosion + FSI, and one FSI only. Changes at the sternoclavicular joint occurred in three individuals (4%) encompassing erosion, erosion + FSI + BMO, and joint fluid accumulation, respectively. One patient had both MSJ and sternoclavicular joint changes. CONCLUSIONS Findings mimicking inflammatory changes occurred in healthy individuals, particularly in the MSJ. Awareness of this is important in recognition of SCC inflammation in SpA.

Diseases of the Brain, Head & Neck, Spine 2012–2015

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Diseases of the Heart, Chest & Breast

Diseases of the heart, chest & breast : , Diseases of the heart, chest & breast : , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتی

Diseases of the Brain, Head and Neck, Spine

Brain Tumors.- Neuroimaging of Cerebral Vessel: Evidence-based Medicine in the Evaluation of Acute Stroke and Aneurysm Detection.- Evaluation of the Cerebral Vessels>.- Imaging and Management of Acute Stroke.- Brain Ischemia.- Haemorrhagic Cerebral Vas7331cular Disease.- Hemorrhagic Vascular Phatology.- Demyelinating Diseases.- Brain Degeneration and Aging.- Imaging the Effects of Systemic Metabolic Diseases on the Brain.- Neuroradiological Diagnosis of Craniocerebral and Spinal Trauma: Current Concepts.- Nontraumatic Neuroemergencies.- Imaging the Patient with Seizures.- Infectious Diseases of the Central Nervous System.- Cerebral Infections.- Diseases of the Sella.- Neuroimaging Diagnosis of Primary Brain Neoplasms in Childhood.- Central Nervous System Diseases in Children.- Orbit and Visual Pathways.- Temporal Bone and Auditory Pathways.- Imaging the Temporal Bone.- Imaging the Pharynx and Oral Cavity.- Imaging of the Larynx.- Imaging the Larynx and Hypopharynx.- Paranasal Sinuses and Nose: Normal Anatomy and Pathologic Processes.- Nose, Paranasal Sinuses and Adjacent Spaces.- Degenerative Diseases of the Spine.- Degenerative Diseases and Pain Syndromes.- Neoplastic Spinal Cord Disease.- Spinal Trauma and Spinal Cord Injury.- Spinal Inflammation and Demyelinating Diseases.- Spinal Inflammation and Demyelinating Disease.

Diseases of the Abdomen and Pelvis 2010–2013

diseases of the abdomen and pelvis 201