RESUMO
AIM: To quantify the wrist cartilage cross-sectional area in humans from a 3D magnetic resonance imaging (MRI) dataset and to assess the corresponding reproducibility. METHODS: The study was conducted in 14 healthy volunteers (6 females and 8 males) between 30 and 58 years old and devoid of articular pain. Subjects were asked to lie down in the supine position with the right hand positioned above the pelvic region on top of a home-built rigid platform attached to the scanner bed. The wrist was wrapped with a flexible surface coil. MRI investigations were performed at 3T (Verio-Siemens) using volume interpolated breath hold examination (VIBE) and dual echo steady state (DESS) MRI sequences. Cartilage cross sectional area (CSA) was measured on a slice of interest selected from a 3D dataset of the entire carpus and metacarpal-phalangeal areas on the basis of anatomical criteria using conventional image processing radiology software. Cartilage cross-sectional areas between opposite bones in the carpal region were manually selected and quantified using a thresholding method. RESULTS: Cartilage CSA measurements performed on a selected predefined slice were 292.4 ± 39 mm(2) using the VIBE sequence and slightly lower, 270.4 ± 50.6 mm(2), with the DESS sequence. The inter (14.1%) and intra (2.4%) subject variability was similar for both MRI methods. The coefficients of variation computed for the repeated measurements were also comparable for the VIBE (2.4%) and the DESS (4.8%) sequences. The carpus length averaged over the group was 37.5 ± 2.8 mm with a 7.45% between-subjects coefficient of variation. Of note, wrist cartilage CSA measured with either the VIBE or the DESS sequences was linearly related to the carpal bone length. The variability between subjects was significantly reduced to 8.4% when the CSA was normalized with respect to the carpal bone length. CONCLUSION: The ratio between wrist cartilage CSA and carpal bone length is a highly reproducible standardized measurement which normalizes the natural diversity between individuals.
Assuntos
Amiloidose/etiologia , Cabeça do Fêmur/lesões , Fraturas Espontâneas/etiologia , Fraturas do Quadril/etiologia , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Microglobulina beta-2/análise , Idoso , Amiloidose/diagnóstico , Amiloidose/metabolismo , Biomarcadores/análise , Biópsia , Cabeça do Fêmur/química , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/metabolismo , Fraturas Espontâneas/cirurgia , Hemiartroplastia , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/metabolismo , Fraturas do Quadril/cirurgia , Humanos , Imuno-Histoquímica , Falência Renal Crônica/complicações , Masculino , RadiografiaRESUMO
Despite great improvements in the management of metastatic clear cell renal carcinoma, complete responses with antiangiogenic therapies are infrequent and complete pathological responses remain anecdotal. We report the complete pathological response of a solitary bone metastasis from a clear cell renal carcinoma after sequential treatment with sunitinib and radiotherapy. In February 2009, a female patient was diagnosed with clear cell renal carcinoma of the left kidney, bearing only one metastatic site localized in the proximal extremity of the left tibia. Radical nephrectomy was performed at first. Thereafter, sunitinib was administered at standard dose level for four weeks followed by two weeks free at each cycle. The patient underwent palliative radiotherapy between the fifth and the sixth cycle. Due to stable status, a radical surgery of the left knee was then performed and pathological analysis concluded a complete response. This case highlights potential synergy between sunitinib and radiation therapy in clear cell renal carcinoma.
Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/terapia , Indóis/uso terapêutico , Neoplasias Renais/terapia , Pirróis/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/radioterapia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/radioterapia , Quimiorradioterapia , Feminino , Humanos , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/patologia , Neoplasias Renais/radioterapia , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , SunitinibeRESUMO
A traumatic fat effusion in a tendon sheath is an unreported entity. We report on the clinical and imaging features, including radiography and computed tomography (CT), of a fat-density effusion in the wrist joint and tendon sheaths of the extensor pollicis longus, extensor carpi radialis longus, and extensor carpi radialis brevis in a 28-year-old patient after a roller-skating accident. Radiographs showed a fracture of the distal radius and a wrist joint effusion. Preoperative CT examination exhibited two distinct layers resulting in a fat-fluid level pathognomonic of lipohemarthrosis in the radiocarpal joint. In addition, a fat-density effusion was noted in the sheaths of the second and third compartment extensor tendons. The lipohemarthrosis depicted on imaging classically results from the extrusion of fat from bone marrow into the joint space after an intraarticular fracture. Similarly, a traumatic fat effusion in a tendon sheath presents characteristic imaging features that may help to diagnose a potentially overlooked fracture.