Russell W. Chapin

Imaging of scleroderma.

Systemic sclerosis is a rare autoimmune condition that affects a variety of organ systems. Knowledge of the imaging features in this patient population is essential in facilitating accurate diagnosis and guiding treatment. Common and rare imaging features of systemic sclerosis are reviewed in this article. Skin, musculoskeletal, pulmonary, cardiac, gastrointestinal, renal, and oral imaging are discussed. Conventional radiography, computed tomography of the chest, echocardiography, enterography, scintigraphy, and panorex dental imaging are reviewed. In addition, the evolving applications of ultrasonography and magnetic resonance imaging to evaluate the musculoskeletal and cardiac features of systemic sclerosis are discussed.

The impact of race on the development of severe heterotopic ossification following acetabular fracture surgery

OBJECTIVES To determine the association between race on severe heterotopic ossification (HO) following acetabular fracture surgery. DESIGN Retrospective case control study. SETTING Level I university trauma centre. METHODS Two hundred and fifty-three patients who were surgically treated for acetabular fractures were retrospectively evaluated. Postoperative radiographs were evaluated for HO by a blinded musculoskeletal radiologist, and classified based on a modified Brooker classification. RESULTS Of the 253 patients that met inclusion and exclusion criteria, 175 (69%) were male and 78 (31%) were female. One hundred and fifty-four (61%) patients were Caucasian, and 99 (39%) were African American (AA). Fifty-five (21%) patients developed severe HO. Of those who developed severe HO, 25 were Caucasian (45%), 30 were African American (55%). Forty-one patients (75%) with severe HO were male, and 14 (25%) were female. No statistical differences (p>0.05) were found between groups in terms of age, days to surgery, GCS at presentation, surgical approach, perioperative HO prophylaxis, or AO/OTA fracture classification. The patient population was then stratified by race, gender, and race/gender. AA were more likely than Caucasians to develop severe HO (odds ratio [OR], 2.24; confidence interval [CI], 1.22-4.11). When gender was considered independent of race, no statistical differences (p>0.05) were observed (OR, 1.40; CI, 0.71-2.75). AA males were much more likely to develop severe HO when compared to Caucasian females (OR, 4.4; CI, 1.38-14.06). CONCLUSION Race is associated with different rates of severe HO formation following acetabular fracture surgery. AA patients are significantly more likely to develop severe HO following acetabular fracture surgery when compared to Caucasian patients.

Radiology Resident Education in France from Medical School Through Board Certification

INTRODUCTION French radiologists-in-training begin medical school directly after high school, but similar to their U.S. counterparts, would typically complete radiology fellowship approximately 14 years after high school graduation. During radiology residency, French residents rotate in 6 month blocks over 5 years, do not have to rotate through every radiology specialty and have more autonomy. It is interesting that while the number of radiologists per capita is greater in France than in the U.S., the number of radiology residency positions offered in France is increasing at a much higher rate than in the U.S. Although France is only the 22nd most populous country (66 million inhabitants versus 319 million in the United States [1]), it has the sixth highest gross domestic product (GDP) in the world (

Insufficiency Fracture Associated With Oncogenic Osteomalaciar

2.8 trillion versus

Measuring lupus arthritis activity using contrasted high-field MRI. Associations with clinical measures of disease activity and novel patterns of disease

16.7 trillion in the United States [2]). Annual health care spending as a percentage of GDP is 11.6% in France, the third highest among OECD (Organization for Economic Co-operation and Development) countries, but significantly less than the 16.9% rate in theUnited States (OECD 2014 data) [3]. In 2012, a total of 27,986 radiologists were practicing in the United States, according to the Association of American Medical Colleges (AAMC) physician specialty data book [4], and

Predicted quadriceps vs. quadrupled hamstring tendon graft size using 3-dimensional MRI

Oncogenic osteomalacia is a rare paraneoplastic syndrome of systemic bone demineralization secondary to a tumor-induced dysregulation of phosphorus metabolism. The tumors low prevalence, small size, and variable location often result in years of muscular weakness and bone pain before diagnosis. With complete treatment, patients symptoms swiftly dissipate. We report the case of a 63-year-old previously healthy man with a 20-month course of musculoskeletal symptoms before diagnosis and resection of a posterior tibial tumor. Postoperatively, the patient had returned to his previous lifestyle when an insufficiency fracture required prophylactic stabilization.

Myxofibrosarcoma: First report of myxofibrosarcoma of bone arising at a bone infarct

Objective Arthritis in SLE is poorly described, and there is no objective measure for quantification of arthritis. In this pilot study, we aim to assess the utility of the Rheumatoid Arthritis MRI Scoring System (RAMRIS) for the quantification of lupus arthritis. Methods Patients were eligible for entry into the study if they were evaluated at the Medical University of South Carolina Lupus Center and determined by their treating rheumatologist to have active hand arthritis due to SLE. Standard of care lupus activity measures were collected, along with a detailed physical exam. MRIs were obtained using standard musculoskeletal sequences with gadolinium contrast. Semiquantitative scoring of the images used the Outcome Measures in Rheumatology Clinical Trials RAMRIS system. Results RAMRIS demonstrates large amounts of synovitis, tenosynovitis, bone marrow oedema and erosive disease in only a minority of patients. Some patients were not scored as having any synovitis or tenosynovitis. We describe potential features of lupus arthritis that are not captured in the RAMRIS scores and may be contributing to symptoms. Conclusion Lupus arthritis is an entity separate from rheumatoid arthritis and requires the development of new quantitative methods to describe and quantitate it. MRI findings suggest the inadequacy of a typical lupus musculoskeletal measure including swollen/tender joint counts to assess the level of disease activity.

Metachronous Aneurysmal Bone Cysts in a Fourteen-Year-Old Girl

BACKGROUND The objective of this study is to (1) compare the predicted cross-sectional area and diameter between quadriceps tendon and quadrupled hamstring autografts, and (2) assess the predicted size of the quadriceps tendon graft in patients with hamstrings that are insufficient for use in ACL reconstruction. METHODS A retrospective review of 54 knee 3D MRIs was conducted. Quadriceps tendon graft area was defined as a one-centimeter wide area of quadriceps tendon, measured three centimeters above the patella perpendicular to tendon axis. Quadrupled hamstring graft area was defined as double the combined areas of the gracilis and semitendinosus tendon, measured three centimeters above the joint line perpendicular to tendon axis. Pearson correlation was used to compare the quadriceps tendon and quadrupled hamstring grafts. RESULTS Mean cross-sectional area of quadrupled hamstring and quadriceps tendon grafts were 47.2 mm2 and 84.4 mm2 respectively. A statistically significant positive correlation exists between quadrupled hamstring graft and quadriceps tendon graft cross-sectional area (r = 0.41; p = 0.002). Nine of the 54 patients had predicted quadrupled hamstring grafts deemed insufficient for use in ACL reconstruction (<8 mm diameter). All of these patients had predicted quadriceps tendon graft diameters >8 mm. CONCLUSION There is a positive correlation between predicted quadriceps tendon and quadrupled hamstring grafts. While 17% of patients in this series had predicted insufficient quadrupled hamstring grafts, all of the patients had predicted quadriceps tendon grafts of sufficient size for ACL reconstruction. Quadriceps tendon grafts are a viable alternative in patients at-risk for insufficient quadrupled hamstring grafts. LEVEL OF EVIDENCE IV.

Case report: imaging features in a renal transplant patient with calcineurin inhibitor-induced pain syndrome (CIPS)

Approximately 3300 new primary bone tumors will present to American physicians this year. This small but important group of malignancies has become more defined with developments in pathologic morphology, immunohistochemistry, and molecular studies. As tumor types are better partitioned, their specific characteristics are more readily observed. In this article we present the first reported case of a myxofibrosarcoma of bone developing within a bone infarct. With improved delineation of rarer tumor types, it is expected that additional cases of myxofibrosarcoma of bone will be recognized, potentially arising from a bone infarct. By framing the context, describing the case, and sharing pertinent figures, we hope to facilitate this recognition.

Heterotopic Ossification Formation Following a Simple Concussion: A Case Report

Aneurysmal bone cysts (ABCs) were first described by Jaffe and Lichtenstein in 19421. Eighty percent of these lesions occur during the first two decades of life2; the most common location is the metaphysis of long bones. To the best of our knowledge, only four cases of individuals with multiple ABCs occurring over a period of time (metachronous ABCs) have been described to date3-6 (Table I). The cases all have been similar in presentation, imaging, and pathology to solitary ABCs; the only difference has been regarding the sex of the patient. While solitary ABCs have been shown to be predominant in females (62%)7, the reported cases of metachronous ABCs have all occurred in males. We report the case of an adolescent girl with multiple ABCs presenting separately in the proximal part of the femur and the distal part of the humerus over a five-month period. The patient and her parents were informed that data concerning the case would be submitted for publication, and they provided consent. View this table: TABLE I Reported Cases of Metachronous Aneurysmal Bone Cysts A healthy and active fourteen-year-old girl presented to the sports medicine clinic with unilateral hip pain. She had no history of trauma or an activity-related injury. Radiographs demonstrated a well-defined (5.4 × 2.8 cm) oval lucent geographic lesion in the proximal part of the femur, which initially was thought to be consistent with a unicameral bone cyst. At the short interval follow-up, the pain had worsened, and a new palpable mass was noted. Additional radiographs revealed substantial interval progression of the lesion with extension into the adjacent soft tissues with expansion of the bone (Fig. 1). Fig. 1 Anteroposterior radiograph demonstrates a lucent geographic lesion with a well-defined border (black arrow) in the right hip. However, there is focal extension …