Ray F. Kilcoyne

Relationships between mandibular and skeletal bone in an osteoporotic population

This study attempted to determine relationships between bone mass in the mandible and skeletal bone mass in a group of 85 postmenopausal women with osteoporosis. Mandibular bone mass was determined by microdensitometry, cortical thickness at the gonion, the height of the alveolar ridge in subjects who were edentulous, and periodontal probings. Skeletal measures were made up of total body calcium, bone mass at the radius, and the two newer bone mass measures of dual photon and computed tomography of the vertebrae. The height of the edentulous ridge correlated with total body calcium and mandibular mass. Most of the edentulous patients had ridges that were extremely resorbed. Mandibular mass correlated with all skeletal measures.

Relationships between mandibular and skeletal bone in a population of normal women.

In this study, we measured mandibular bone mass and density and cortical thickness at gonion in 50 normal women between the ages of 20 and 90. The subjects showed neither radiographic nor metabolic evidence of osteoporosis. Comparisons (by age) were made between mandibular measurements. Mandibular measurements were also compared with measurements of bone mass in the spine and the wrist. Mandibular bone mass was not significantly affected with age but mandibular bone mass was significantly correlated with skeletal bone mass. Cortical thickness at gonion decreased with age.

Femoral morphometry and anterior knee pain.

By computed tomography scan, morphology of the femur in 20 adult patients with anterior knee pain was compared with that of ten volunteers without knee pain to identify femoral characteristics associated with the painful patella. Anteversion, measured as the difference between the axis of the head-neck and the axis of the posterior condyles, was significantly greater in symptomatic adults (p < 0.01). Configuration of the distal femur and position of the patella relative to the femur were similar in each group. Adult anterior knee pain was, therefore, associated with increased anteversion without compensatory change in trochlear morphology or patellar orientation to the femur.

Knee version associated with anterior knee pain.

Version of the knee in the presence and absence of anterior knee pain was evaluated by computed tomography in this study. Version of the knee is defined as the static rotation of the tibia with respect to the femur in full knee extension. Fourteen patients in whom conservative management for anterior knee pain failed were compared with 14 volunteers with no symptoms. Computed tomography images of the femoral condyles and tibial plateau were obtained with the knee extended. The angle between the bicondylar and posterior tibial axes was measured. This angle, representing external rotation of the tibia relative to the femur, was increased significantly in patients with symptoms (7°) compared with volunteers with no symptoms(1°). This increased knee version identifies a unique morphologic characteristic of the knee with anterior pain.

Longitudinal changes in bone mass after one year as measured by different techniques in patients with osteoporosis

SummaryBone mass was measured in 49 post-menopausal women by the following techniques: single photon absorptiometry at the radius (SPA), dual photon absorptiometry at the lumbar spine (DPA), quantitative computed tomography at the lumbar spine with an area of interest of only trabecular bone (QCT) or of an integrated cross-section of the vertebral body (QCTi), and total body calcium by neutron activation analysis (TBCa). Each women had two measurements with a one-year interval. Half of them were treated with calcium supplementation only; the other half also received calcitriol (1,25 dihydroxycholecalciferol). The aim of this report was to compare the changes of bone mass as measured by the different techniques. The DPA and QCTi values were significantly lower at one year than at baseline (by paired t-tests). The mean percent changes (±SD) for the measurements were: TBC, −0.4 ±4.6%; SPA-1, 1.2±7.1%; SPA-2, 0.7±6.0%; DPA, −2.5±11%; QCT, 6.5±23%; and QCTi, −6.0±9%. The percent changes by one technique did not show significant correlation to the percent changes by the other methods. We conclude that the precision of the methods in this clinical setting is not sufficient to show correlations after only one year; in additon, there may have been different rates of changes at different sites of the skeleton.

Magnetic resonance imaging of soft tissue masses.

Twenty-nine soft tissue masses were studied with magnetic resonance imaging (MRI) which proved to be useful in the preoperative evaluation of these lesions. Other imaging modalities employed had significant limitations. Plain films were of little value because of the intrinsically low contrast of soft tissues. Angiography was not necessary unless MRI suggested a vascular lesion or proximity to major blood vessels. Computed tomography (CT) and MRI both readily identified fatty lesions and their relationship to adjacent structures. Some soft tissue tumors could not be delineated from normal muscle with CT, but were easily seen with MRI. MRI is ideally suited for the study of suspected soft tissue tumors because of its excellent soft tissue contrast and its ability to image directly in any plane. Optimum evaluation required imaging in at least two planes with spin echo sequences chosen to bring out both T1 and T2 features.

Ruvalcaba-Myhre-Smith syndrome: A new consideration in the differential diagnosis of intestinal polyposis

We present a case of Ruvalcaba-Myhre-Smith syndrome, which, to our knowledge, has not been reported in the radiologic literature. This rare entity is characterized by intestinal polyps, macrocephaly, and hyperpigmented genital macules. The differentiation of this syndrome from other polyposis syndromes is discussed.