Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma.

OBJECTIVE: To compare the diagnostic value of cone-beam computed tomography (CBCT) and conventional radiography (CR) after acute small bone or joint trauma. MATERIALS AND METHODS: Between March 2013 and January 2014, 231 patients with recent small bone or joint trauma underwent CR and subsequent CBCT. CR and CBCT examinations were independently assessed by two readers, blinded to the result of the other modality. The total number of fractures as well as the number of complex fractures were compared, and inter- and intraobserver agreement for CBCT was calculated. In addition, radiation doses and evaluation times for both modalities were noted and statistically compared. RESULTS: Fracture detection on CBCT increased by 35% and 37% for reader 1 and reader 2, respectively, and identification of complex fractures increased by 236% and 185%. Interobserver agreement for CBCT was almost perfect, as was intraobserver agreement for reader 1. The intraobserver agreement for reader 2 was substantial. Radiation doses and evaluation time were significantly higher for CBCT. CONCLUSION: CBCT detects significantly more small bone and joint fractures, in particular complex fractures, than CR. In the majority of cases, the clinical implication of the additionally detected fractures is limited, but in some patients (e.g., fracture-dislocations), the management is significantly influenced by these findings. As the radiation dose for CBCT substantially exceeds that of CR, we suggest adhering to CR as the first-line examination after small bone and joint trauma and keeping CBCT for patients with clinical-radiographic discordance or suspected complex fractures in need of further (preoperative) assessment.

Brodie's abscess revisited.

Radiology plays an important role in the diagnosis of a Brodie's abscess, as can be difficult for a clinician to identify the disease using clinical information alone. A Brodie's abscess is clinically difficult to diagnose because patients typically have mild local symptoms, few or no constitutional symptoms, and near normal laboratory values. Furthermore, a Brodie's abscess may mimic various benign and malignant conditions, resulting in delayed diagnosis and treatment. The most frequently made incorrect diagnosis is that of a primary bone tumor. The present pictorial review summarizes imaging clues to the diagnosis of a Brodie's abscess, such as the serpentine sign on conventional radiographs and the penumbra sign seen on Magnetic Resonance (MR) images. A Brodie's abscess is difficult to diagnose, however, once diagnosed, it is a curable disease with a 100% cure rate.

MR arthrography of the rotator cuff.

This article addresses the role of MR arthrography in the evaluation of the rotator cuff, including impingement, tendon degeneration and rotator cuff tears. Additionally, pathologic conditions of the long head of the biceps tendon, and mimickers of rotator cuff pathology are discussed as well. The drawbacks of conventional MR imaging and indirect MR arthrography, compared to the merit of direct MR arthrography are emphasized. The manuscript focusses on the potential clinical consequences of each finding and summarizes which relevant imaging findings should be reported by the radiologist.

Proceedings of the SRBR-KBVR Osteoarticular section meeting of October 18, 2003 in Antwerp--part two: imaging of foot anomalies.

Many conditions may produce pain in the foot region, including congenital or developmental anomalies, (micro-) traumatic or overuse syndromes, osteonecrosis, tumoral conditions, infectious and inflammatory disorders. The purpose of this review is twofold: to discuss the imaging features of a number of pathologic entities that elicit foot pain as a primary symptom and to comment which imaging technique should be used as the first modality.

Imaging of the normal pontine cisternal segment of the abducens nerve, using three-dimensional constructive interference in the steady state MRI.

Our objective was to determine the visibility of the cisternal segment of the normal abducens nerve using a three-dimensional Fourier-Transform constructive interference in the steady state (3DFT-CISS) sequence. Its visibility was rated in 150 patients without clinical evidence of abducens nerve disturbance. Axial 1-mm 3DFT-CISS images were obtained (TR/TE 17/7 ms, flip angle 50 degrees, field of view 160 mm, matrix 256 x 256). The cisternal segment was seen in 79% of cases, bilaterally in 73% and unilaterally in 11% of cases; neither cisternal segment was seen in 16% of cases. Identification of Dorello's canal was often of help in detecting the point lateral to the dorsum sellae at which the nerve pierces the dura mater. Flow artifacts and vascular loops in the pontine cistern sometimes caused problems in interpretation. 3DFT-CISS MRI with 1-mm-thick sections can however be considered a reasonably reliable technique for showing the cisternal segment of the abducens nerve.

Accuracy of single-sequence MRI for investigation of the fluid-filled spaces in the inner ear and cerebellopontine angle.

We prospectively studied 163 patients referred for MRI of the temporal bone. A presumed diagnosis was made using only one of three sequences: a single thick (12 mm) slice fast T2-sequence, 3D fourier transform constructive interference in steady state (3DFT-CISS) sequence and a gadolinium-enhanced T1-weighted sequence. The visibility of the cochlea, vestibule and superior, lateral and posterior semicircular canals of normal temporal bones was assessed on the T2-weighted images: they were almost always visible (98-100%), with exception of the superior semicircular canal, seen in only 35% of cases. The images were interpreted as abnormal in 34 patients (21%). Using only the fast T2-weighted, 3DFT-CISS and gadolinium-enhanced T1-weighted sequences a presumed false positive diagnosis was made in 5, 1 and 0 cases and a false negative diagnosis in 2, 2 and 4 cases respectively. The overall reliability of the thick-section fast T2-weighted images is limited. This study suggests that a combination of gadolinium-enhanced T1-weighted and 3DFT-CISS images can be considered the gold standard for temporal bone MRI and neither sequence performed separately is as accurate as both together.

Secondary superficial siderosis of the central nervous system in a patient presenting with sensorineural hearing loss.

We present a 50-year-old man who was investigated for sensorineural hearing loss. On MRI of the brain superficial siderosis of the central nervous system was seen, while MRI of the spine revealed an ependymoma of the cauda equina. This case illustrates the importance of performing T2-weighted imaging of the brain and posterior fossa when sensorineural hearing loss is present. Spine imaging is mandatory when superficial siderosis of the brain is diagnosed without identification of a bleeding source in the brain.

Pulmonary and mediastinal lesions in children with Langerhans cell histiocytosis.

Langerhans cell histiocytosis (LCH) is an uncommon group of disorders affecting mainly children and young adults. In children, pulmonary involvement occurs mostly in the disseminated forms; isolated pulmonary lesions are unusual. A retrospective study was undertaken on a group of 42 children diagnosed with LCH over a 19-year period. Eight children (19 %) had radiological evidence of pulmonary involvement. The lung lesions were either present at the time of diagnosis or, when appearing during the course of the disease, always coinciding with exacerbation or recurrence of the disease in other sites. Lung involvement did not appear to be an unfavourable prognostic factor. However, the toxic effects of treatment on the lungs might lead to important pulmonary sequelae.