Sajid Butt

Angioleiomyoma : magnetic resonance imaging features in ten cases

ObjectivesAngioleiomyoma is a rare, benign smooth muscle tumour arising from the tunica media of small veins and arteries and can occur anywhere in the body. The histological appearances are well documented, but there are relatively few descriptions of the magnetic resonance imaging (MRI) findings.Materials and methodsA retrospective study of the clinical presentation, MRI appearances and histological findings of ten angioleiomyomas presenting as extremity soft tissue masses.ResultsMRI typically demonstrated a well-defined, oval mass located superficial to the fascia with the commonest sites being the hand (three cases) and ankle/foot (five cases). The lesion was isointense to muscle on T1-weighted spin echo images with heterogeneous increased internal T2W/short tau inversion recovery (STIR) signal intensity, which commonly appeared as multiple linear or branching areas of hyperintensity. Enhancement after IV gadolinium ranged from diffuse to heterogeneous. In a single case, central fat signal intensity was seen, while a further case showed marked T2W/STIR hypointensity due to diffuse hyalinisation within the lesion.ConclusionsThis is the largest reported MRI series of extremity musculoskeletal angioleiomyoma. Angioleiomyoma should be considered in the differential diagnosis of a superficial mass in the hand or foot, particularly when characteristic linear or branching hyperintensity is seen on T2W or STIR images.

Advantages and Limitations of Imaging the Musculoskeletal System by Conventional Radiological, Radionuclide, and Hybrid Modalities

The endpoint of an efficient and accurate diagnosis of musculoskeletal pathology can take many different routes. Currently, conventional radiological techniques, such as plain radiography, ultrasonography, computed tomography, and magnetic resonance imaging are used in the assessment of patients with benign and malignant bone disease. An understanding of the advantages and limitations of the modalities available will help expedite diagnosis, and hence treatment. In this review, we discuss the advantages and limitations of the modalities available in investigating benign and malignant musculoskeletal pathology.

Basic Principles of MRI

Magnetic resonance imaging (MRI) is the imaging modality of choice for the evaluation of a variety of musculoskeletal pathologies. MRI has the advantage that it does not use ionising radiation and is non-invasive. In addition, it has a high soft tissue resolution and imaging capabilities in multiple planes.

MDCT of acute subaxial cervical spine trauma: a mechanism-based approach

AbstractInjuries to the spinal column are common and road traffic accidents are the commonest cause. Subaxial cervical spine (C3–C7) trauma encompasses a wide spectrum of osseous and ligamentous injuries, in addition to being frequently associated with neurological injury. Multidetector computed tomography (MDCT) is routinely performed to evaluate acute cervical spine trauma, very often as first-line imaging. MDCT provides an insight into the injury morphology, which in turn reflects the mechanics of injury. This article will review the fundamental biomechanical forces underlying the common subaxial spine injuries and resultant injury patterns or “fingerprints” on MDCT. This systematic and focused analysis enables a more accurate and rapid interpretation of cervical spine CT examinations. Mechanical considerations are important in most clinical and surgical decisions to adequately realign the spine, to prevent neurological deterioration and to facilitate appropriate stabilisation. This review will emphasise the variables on CT that affect the surgical management, as well as imaging “pearls” in differentiating “look-alike” lesions with different surgical implications. It will also enable the radiologist in writing clinically relevant CT reports of cervical spine trauma. Teaching Points • Vertebral bodies and disc bear the axial compression forces, while the ligaments bear the distraction forces.• Compressive forces result in fracture and distractive forces result in ligamentous disruption.• Bilateral facet dislocation is the most severe injury of the flexion-distraction spectrum.• Biomechanics-based CT reading will help to rapidly and accurately identify the entire spectrum of injury.• This approach also helps to differentiate look-alike injuries with different clinical implications.

Metastatic pulmonary intimal sarcoma presenting as cauda equina syndrome: first report of a case.

Study Design. Case report and clinical discussion. Objective. To describe a rare case of metastatic pulmonary intimal sarcoma presenting as cauda equine syndrome. Summary of Background Data. Pulmonary artery sarcoma is a rare tumor, frequently misdiagnosed as pulmonary embolism, and although it is highly aggressive, metastasis to bone is very rare. In our case, the tumor metastasised to the vertebral column, which lead the patient to present with cauda equine-type symptoms. Methods. We report the clinical and imaging features in a 38-year-old female presenting with back pain and weakness of the legs. Although initially misdiagnosed as a primary bone tumor of the vertebral column and a concurrent pulmonary embolism, the final diagnosis of pulmonary artery sarcoma with spinal metastasis, presenting as cauda equina syndrome was made. Results. At surgery, the mass was excised with the pulmonary valve and replaced with a homograft. The histology demonstrated an undifferentiated intimal sarcoma of the pulmonary artery. When stable enough the patient underwent a posterior L4-S1 decompression laminectomy after which she regained the power in the legs. The histology also showed a metastatic undifferentiated intimal sarcoma likely to have come from the pulmonary artery. The patient went on to receive a more formal vertebrectomy, front and back repair, and radiotherapy. Her 1-year follow-up computed tomography (CT) chest showed evidence of further metastases. Conclusion. To our knowledge, this is the first case of metastatic pulmonary intimal sarcoma presenting as cauda equine syndrome described in the literature.

Current concept in upright spinal MRI.

Magnetic resonance imaging (MRI) is the established technique for evaluating the spine. Unfortunately, the supine position of the patient during conventional MRI scanning does not truly reflect the physiological forces experienced by the discoligamentous structures during normal upright posture and ambulation. Upright MRI is a relatively new technique that allows the patient to be scanned in several different weight-bearing positions, which may potentially demonstrate occult pathology not visualised in the supine position. The imaging technique and current clinical indications of upright spinal MRI would be discussed.

Radiological Imaging of Primary Benign and Malignant Bone Tumours

Primary bone tumours are much less common than metastatic tumour deposits in bones and multiple myeloma/plasmacytoma. In this chapter, we shall describe the salient clinical features and radiological characteristics of primary benign and malignant bone tumours. Radiology of bone tumours relies heavily on assessment of patient’s age, bones affected and distribution of tumour in the bone. With the knowledge of only these three features, the differential diagnosis of bone tumours can be significantly narrowed down. Plain radiographs help characterise the tumours, and in most cases, a reasonably accurate diagnosis can be made on assessment of these clinico-radiological features. Although CT and MR help to characterise these features more, their main importance lies in local extent of bone involvement and distant staging of the tumour, assessment of treatment planning, to act as a guide to biopsy and for follow-up. Whole-body bone scan and lately FDG PET scans have important roles to play in staging of malignant tumours.