Stephen F. Quinn

Imaging foreign glass and wooden bodies of the extremities with CT and MR.

This paper reviews our recent experience imaging glass and wooden foreign bodies of the extremities with magnetic resonance (MR) and CT. In all five cases the foreign bodies were detected by CT or MR or both. Only two of the foreign bodies were detected by plain radiography. Computed tomography and MR provided additional information regarding the adjacent tendons, neurovascular bundles, and muscle groups. The surrounding inflammatory reactions were accurately compartmentalized, and the extent of the disease along anatomic pathways of potential spread was demarcated. Magnetic resonance was superior to CT in soft tissue contrast resolution. Magnetic resonance and CT are not necessary for a case of acute foreign body injuries, but in complicated cases CT and MR may not only diagnose a foreign body but also serve to guide the surgical approach and extent of exploration.

Magnetic resonance images of chronic patellar tendinitis.

Chronic patellar tendinitis can be a frustrating diagnostic and therapeutic problem. This report evaluates seven tendons in five patients with chronic patellar tendinitis. The etiologies included “jumpers knee” and Osgood-Schlatter disease. In all cases magnetic resonance images (MRI) showed thickening of the tendon. Some of the tendons had focal areas of thickening which helped establish the etiology. All cases had intratendinous areas of increased signal which, in four cases, proved to be chronic tendon tears. MRI is useful in evaluating chronic patellar tendinitis because it establishes the diagnosis, detects associated chronic tears, and may help determine appropriate rehabilitation.

MR imaging of chronic osteomyelitis.

Magnetic resonance (MR) at 1.5 T was used preoperatively and prior to aspiration to determine extent and location of infection in eight patients with chronic osteomyelitis. There was excellent correlation between MR and surgical findings in all cases. Infected areas, both Intraosseous and extraosseous, displayed increased signal intensity on T2-weighed images. Sequestra, sinus tracts, and soft tissue abscesses were seen. By directly imaging foci of infection MR may have certain advantages over CT and scintigraphy in the evaluation of chronic osteomyelitis.

Percutaneous Placement of a Low-profile Stent-Graft Device for Aortic Dissections

PURPOSE The use of stent-grafts has proved to be safe and effective treatment for complicated aortic dissections but usually requires surgical cutdown to accommodate large-profile devices. Preliminary results of the use of a low-profile design that allows percutaneous access are presented. MATERIALS AND METHODS Fifteen patients with aortic dissection were treated with use of a low-profile stent-graft. Dissection types included Stanford type A (n = 6) and type B (n = 9). The procedures were performed with use of Perclose devices to achieve hemostasis. The stent-graft device was composed of Gianturco stents connected with longitudinal wire struts covered with radially expanded polytetrafluoroethylene. The delivery sheath sizes were 14-20 F. RESULTS In 87% of patients (13 of 15), the entry tear was excluded completely. Successful femoral closures were achieved in 93% of patients (14 of 15) with use of the suture-mediated devices. In 7% of patients (one of 15), surgical closure of the femoral arteries was required. The rate of pseudoaneurysm occurrence was 7% (one of 15). Hospitalization ranged from 1 to 30 days with a mean duration of 6.5 days. The 30-day mortality rate was 27% (four of 15). In the remaining 11 patients, entry tear sites were excluded and, on follow-up CT examinations, there was thrombosis and retraction of the false lumen and enlargement of the true lumen. CONCLUSION Preliminary results of the use of a low-profile stent-graft device to treat aortic dissections show that, in most patients, it can be used with a suture-mediated device without surgical exposure of the common femoral artery.

Work in progress postarthrography computed tomography of the wrist evaluation of the triangular fibrocartilage complex

This report reviews a work in progress evaluating the use of postarthrography computed tomography (CT) of the wrist in assessing triangular fibrocartilage complex abnormalities. Twenty-two triangular fibrocartilage complex perforations in 119 patients were identified with both multiple compartment arthrography and postarthrography CT. To obtain a double contrast image of the triangular fibrocartilage complex, the postarthrography CT examinations were performed after multiple compartment arthrography and the injection of air into the radiocarpal compartment. The site of triangular fibrocartilage complex perforation could be identified (radial versus peripheral) as could degenerative changes and internal derangements such as chondrocalcinosis. We did not, however, find any information not provided by arthrography that would have changed the course of management. At this time there is no clinical role for postarthrography CT in the evaluation of triangular fibrocartilage complex derangements.

MRI appearance of disseminated osseous tuberculosis

Disseminated osseous tuberculosis is a rare disease. This is a report of two cases of disseminated osseous tuberculosis imaged with MRI at 1.5-T, CT, plain radiography and bone scintigraphy. CT and plain radiography demonstrated either highly destructive or cystic lesions with sclerotic margins. Bone scintigraphy and plain radiography were quite insensitive in detecting areas of involvement compared to MRI. On MRI the abnormal areas had short T-1 relaxation values, which is an atypical appearance for bony infections, and prolonged T-2 relaxation values. The reason for the T-1 relaxation behavior is uncertain. MRI also provided delineation of epidural extent.

Digital subtraction wrist arthrography: use of double contrast technique as a supplement to single contrast arthrography

A new technique using double contrast after digital subtraction wrist arthrography is presented. Results of the double contrast wrist arthrograms were essential to the diagnosis, confirmed the diagnosis, or salvaged an otherwise poor or nondiagnostic examination. It was found that intra-articular injection of air augments the information obtained during postarthrogram active motion studies under fluoroscopy. Double contrast wrist arthrography has proved valuable when the standard contrast arthrogram fails to yield diagnostic information.

Treatment of advanced gynecologic malignancies with intraarterial chemotherapy and accelerated fractionation radiation therapy: A preliminary report

The results of a pilot study employing the administration of intraarterial chemotherapy and accelerated fractionation radiotherapy for advanced gynecologic malignancies are reported. The protocol consisted of three treatment sessions every 3 to 4 weeks. Each session consisted of bilateral or unilateral catheterization of the hypogastric artery with the infusion of cisplatin 100 mg/m2 on Day 1 and 2-deoxy-5-fluorouridine (FUDR) 300 mg/m2 on Day 2. An accelerated fractionation schedule of external-beam radiation was begun on Day 1 consisting of 200 rads twice daily for 4 days (1600 rads per session). Eight patients entered the protocol, and seven completed external-beam radiotherapy. Five completed three intraarterial sessions, and three, two sessions. Five of seven evaluable patients had a complete local response. Local control was sustained fom 6 to 24 months in four patients. Complications included three sensorimotor neuropathies, one clinically insignificant catheter-related thrombosis, and three clinically significant radiation injuries. This multimodality treatment for locally advanced gynecologic tumors appears feasible with modification, and continued work exploring this approach is encouraged.

Reactive perineurial fibroblastic proliferation of the median nerve: MR characteristics.

We report a case of fibroblastic proliferation of the median nerve presenting as a focal mass. This report discusses the pathological and magnetic resonance correlations and reviews the differential diagnosis for median nerve masses.

Case report 298

Fig. 1. A An anteroposterior roentgenogram centered over the area of the left upper hemithorax to include the left clavicle shows a diffusely sclerotic process involving most of the clavicle and particularly its medial two-thirds. Interspersed lytic areas are present in the medial 2/3 of the clavicle. B A plain film laminagram obtained over the area of the left clavicle again shows the diffusely sclerotic pattern in the clavicle, noted in A, interspersed with lyric areas. An erosive defect affecting the inferior surface of the clavicle near its medial third is delineated clearly